文档介绍：从复发性卒中 %发病人数500-600万存活者中约1/4不同程度丧失劳动能力重度致残约40%2WHO-MONICA:复发性脑卒中比例的国际间比较(2003)男性女性(%)27%27%3北京地区急性脑卒中事件复发率中国MONICA研究结果(年)10%22%41%4人群中可改变的脑卒中的危险因素------------------------------------------------------------------危险因素患病率相对危险------------------------------------------------------------------高血压25-40%3-5胆固醇升高6-40%-%%%--8%2饮酒2-5%(非瓣膜性)1%5房颤(瓣膜性)17-------------------------------------------------------------------SharonEStrausJAMA2002,288:13885脑卒中二级预防策略的效果总结--------------------------------------------------------------------------------预防策略RR减少(%)NNT一年中预防1例需要治疗的人数---------------------------------------------------------------------------------降压治疗2851()他汀治疗2557()Warfarin(非瓣膜性房颤)6213()戒烟3343()抗血小板治疗Aspirin2877()Thienopyridines(vsAspirin)1364()颈动脉内膜切除术4426()(有症状)----------------------------------------------------------------------------------SharonEStrausJAMA2002,288:13886非风湿性房颤的分层治疗策略的效果总结--------------------------------------------------------------------------------P建议NNT预防1例需要治疗的人数--------------------------------------------------------------------------------低危(2%)Aspirin227低中危(3%)AspirinorWarfarin152(54)高中危(5%)Warfarin32高危(12%)Warfarin14极高危(20%)Warfarin8----------------------------------------------------------------------------------NewEvidenceforStrokePrevention--ScientificReveiwSharonEStrausJAMA2002,288:13887SolutionsforStrokeinChinaInitialstrokeRecurrentstrokeHypertensioncontrolSmokingcessationAtrialFibrillationtreatmentLipidcontrolDietA:Aspirin,AFtreatmentsB:BloodpressurecontrolC:CholesterolD:Diet,DiabetesE:ExercisesStrokeUnit8卒中二级预防的ABCDE策略A:Antiplatelet(抗血小板)Anticoagulation(抗凝)ACEI/ARB(血管紧张素转换酶抑制剂/肾素血管紧张素受体阻滞剂)B:Bloodpressurecontrol(控制血压)β-blocker(β-受体阻滞剂)BMI(体重指数)C:Cholesterollowing(降低胆固醇)Cigarettequit(戒烟)CAS(颈动脉血管成形和支架术)CEA(症状性颈动脉内膜剥脱术)D:Diabetescontrol(治疗糖尿病)Dietadjust(调整饮食)E:Education(健康教育)Exercise(锻炼身体)Examination(定期查体)9脑卒中二级预防指南AHA关于卒中二