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Akuttherapie des ischämischen Schlaganfalls

Acute therapy of ischaemic stroke

  • Themenschwerpunkt „Schlaganfall“
  • Published:
Wiener Medizinische Wochenschrift Aims and scope Submit manuscript

Zusammenfassung

Die thrombolytlsche Therapie des ischämischen Schlaganfalls wurde an den neurologischen Abteilungen in Wien im Mittel bei 3,7% der Patientinnen und Patienten eingesetzt. Die hochdosierte Gabe von Heparin ist ein unabhängiger Risikofaktor für eine symptomatische Einblutung (OR 10,3; 95% CI 2,4–43,2) und sollte daher nur in begründeten Einzelfällen eingesetzt werden. Patientinnen und Patienten nach TLA oder einem ischämischen Schlaganfall mit geringer Ausfallssymptomatik haben aber kein Einblutungsrisiko unter hochdosierter Gabe von Heparin. Ein Absinken des diastolischen Blutdrucks um mehr als 20 mmHg in der Akutsituation geht mit einem 3fach erhöhten Risiko für ein ungünstiges funktionelles Ergebnis einher. Komplikationen nach Schlaganfall sind häufig und treten zu 55 % innerhalb der ersten 5 Tage nach dem Ereignis auf. Die (Aspirations-Pneumonie ist ein unabhängiger Risikofaktor für ein ungünstiges funktionelles Ergebnis nach 3 Monaten. Eine wesentliche Aufgabe der akuten Stroke Unit liegt in der Verhinderung bzw. im frühzeitigen Erkennen und Behandeln von Komplikationen.

Summary

Thrombolysis was used in 3.7% of stroke patients who were admitted to the Neurological Departments of Vienna. High doses of heparin were associated with an increased risk of secondary symptomatic hemorrhage (OR 10,3; 95% CI 2,4–43,2). But none of the patients with TIA or minor stroke who received high dosages of heparin suffered from secondary symptomatic hemorrhage. Spontaneous or therapeutically induced decrease of the diastolic blood pressure by more than 20 mmHg was associated with a three-fold risk of an unfortunate functional outcome. Complications following stroke are frequent and most likely to occur within the first 5 days. Pneumonia was found to be an independent risk factor for an unfortunate functional outcome after three months. A main field of activity of stroke units should be to prevent or to early recognize and treat complications.

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Authors and Affiliations

  1. Neurologische Abteilung, Krankenhaus der Barmherzigen Brüder Wien, Große Mohrengasse 9, A-1021, Wien

    Wilfried Lang

  2. Neurologischen Abteilung des Krankenhauses der Barmherzigen Brüder, Wien

    Wolfgang Lalouschek

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  1. Wilfried Lang
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  2. Wolfgang Lalouschek
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Correspondence to Wilfried Lang.

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stellvertretend für die Wiener Schlaganfallarbeitsgruppe (eine Liste der teilnehmenden Zentren befindet sich im Anhang)

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Lang, W., Lalouschek, W. Akuttherapie des ischämischen Schlaganfalls. WMW 153, 21–24 (2003). https://doi.org/10.1046/j.1563-258X.2003.02109.x

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  • DOI: https://doi.org/10.1046/j.1563-258X.2003.02109.x

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