短暂性脑缺血发作危险等级分层策略(2)
判断TIA患者是否需要住院是急诊医生面临的问题。2006年，美国国家卒中协会提出了TIA患者住院治疗的指导方案[19]。该方案建议对过去24～48 h内首次发生的TIA，明确提出需考虑住院治疗。对近期内的(1周)TIA，如存在以下状况也推荐住院，包括：渐强的TIA、症状持续超过1 h、有症状的颈动脉狭窄(>50%)、存在已知的心源性栓子、存在已知的高凝状态以及临床评分的高风险状态。
总之，过去的十几年里人们通过大量的回顾性、前瞻性的研究，充分认识到了TIA发展为卒中等意外的风险，从而更加注重其临床的诊断与处理策略。从某种程度上讲，TIA应当象“不稳定性心绞痛”一样得到及时的医疗处理。
参考文献
[1]Albers GW, Caplan LR, Easton JD, et al. Transient ischemic attack-proposal for a new definition [J]. N Engl J Med, 2002, 347(21):1713-1716.
, 百拇医药
[2] Johnston SC, Gress DR, Browner WS, et al. Short-term prognosis after emergency department diagnosis of TIA [J]. JAMA, 2000, 284(22):2901-2906.
[3] Rothwell PM, Giles MF, Flossmann E, et al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack [J]. Lancet, 2005, 366(9479):29-36.
[4] Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack [J]. Lancet, 2007, 369(9558):283-392.
, 百拇医药
[5] Tsivgoulis G, Vassilopoulou S, Spengos K. Potential applicability of ABCD score in triaging TIA patients [J]. Lancet, 2007, 369(9567):1082-1083.
[6] 张振, 张东君, 徐宁,等. ABCD2评分法预测短暂性脑缺血发作患者脑梗死的风险[J]. 山东大学学报：医学版, 2009, 47(9):89-92.
[7] Cucchiara BL, Messe SR, Taylor RA, et al. Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack [J]. Stroke, 2006, 37(7):1710-1714.
, http://www.100md.com
[8] Johnston SC. Clinical practice. transient ischemic attack [J]. N Engl J Med, 2002, 347(21):1687-1692.
[9] Kidwell CS, Alger JR, Di Salle F, et al. Diffusion MRI in patients with transient ischemic attacks [J]. Stroke, 1999, 30(6):1174-1180.
[10]Purroy F, Montaner J, Rovira A, et al. Higher risk of further vascular events among transient ischemic attack patients with diffusion-weighted imaging acute ischemic lesions[J]. Stroke, 2004, 35(10):2313-2319.
, 百拇医药
[11] Redgrave JN, Schulz UG, Briley D, et al. Presence of acute ischaemic lesions on diffusion-weighted imaging is associated with clinical predictors of early risk of stroke after transient ischaemic attack [J]. Cerebrovasc Dis, 2007, 24(1):86-90.
[12] Engelter ST, Wetzel SG, Bonati LH, et al. The clinical significance of diffusion-weighted MR imaging in stroke and TIA patients [J]. Swiss Med Wkly, 2008, 138(49/50):729-740.
[13] Purroy F, Begué R, Quílez A, et al. The California, ABCD, and unified ABCD2 risk scores and the presence of acute ischemic lesions on diffusion-weighted imaging in TIA patients [J]. Stroke, 2009, 40(6):2229-2232., http://www.100md.com(程文伟 李金龙)
总之，过去的十几年里人们通过大量的回顾性、前瞻性的研究，充分认识到了TIA发展为卒中等意外的风险，从而更加注重其临床的诊断与处理策略。从某种程度上讲，TIA应当象“不稳定性心绞痛”一样得到及时的医疗处理。
参考文献
[1]Albers GW, Caplan LR, Easton JD, et al. Transient ischemic attack-proposal for a new definition [J]. N Engl J Med, 2002, 347(21):1713-1716.
, 百拇医药
[2] Johnston SC, Gress DR, Browner WS, et al. Short-term prognosis after emergency department diagnosis of TIA [J]. JAMA, 2000, 284(22):2901-2906.
[3] Rothwell PM, Giles MF, Flossmann E, et al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack [J]. Lancet, 2005, 366(9479):29-36.
[4] Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack [J]. Lancet, 2007, 369(9558):283-392.
, 百拇医药
[5] Tsivgoulis G, Vassilopoulou S, Spengos K. Potential applicability of ABCD score in triaging TIA patients [J]. Lancet, 2007, 369(9567):1082-1083.
[6] 张振, 张东君, 徐宁,等. ABCD2评分法预测短暂性脑缺血发作患者脑梗死的风险[J]. 山东大学学报：医学版, 2009, 47(9):89-92.
[7] Cucchiara BL, Messe SR, Taylor RA, et al. Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack [J]. Stroke, 2006, 37(7):1710-1714.
, http://www.100md.com
[8] Johnston SC. Clinical practice. transient ischemic attack [J]. N Engl J Med, 2002, 347(21):1687-1692.
[9] Kidwell CS, Alger JR, Di Salle F, et al. Diffusion MRI in patients with transient ischemic attacks [J]. Stroke, 1999, 30(6):1174-1180.
[10]Purroy F, Montaner J, Rovira A, et al. Higher risk of further vascular events among transient ischemic attack patients with diffusion-weighted imaging acute ischemic lesions[J]. Stroke, 2004, 35(10):2313-2319.
, 百拇医药
[11] Redgrave JN, Schulz UG, Briley D, et al. Presence of acute ischaemic lesions on diffusion-weighted imaging is associated with clinical predictors of early risk of stroke after transient ischaemic attack [J]. Cerebrovasc Dis, 2007, 24(1):86-90.
[12] Engelter ST, Wetzel SG, Bonati LH, et al. The clinical significance of diffusion-weighted MR imaging in stroke and TIA patients [J]. Swiss Med Wkly, 2008, 138(49/50):729-740.
[13] Purroy F, Begué R, Quílez A, et al. The California, ABCD, and unified ABCD2 risk scores and the presence of acute ischemic lesions on diffusion-weighted imaging in TIA patients [J]. Stroke, 2009, 40(6):2229-2232., http://www.100md.com(程文伟 李金龙)