每日一题_2023.02.10

A 51-year-old man presents to the emergency department (ED) 30 minutes after experiencing difficulty speaking and moving the left side of his body. The patient is alert and oriented to person and place. His wife states that he has a history of benign prostatic hypertrophy and high blood pressure. According to the wife, the patient has never experienced symptoms like this before and has never had surgery of any type. The ED physicians determine that the patient is hemodynamically stable and an initial CT scan is normal. Which of the following is the best next step in management?

一名51岁男性在出现说话困难和左侧身体移动困难30分钟后到急诊科(ED)就诊。病人保持警觉，对人和地点有方向感。他的妻子说他有良性前列腺肥大和高血压的病史。据患者妻子说，患者以前从未出现过这样的症状，也从未做过任何类型的手术。急诊科医师判定患者血流动力学稳定，初始CT扫描正常。下面哪一个是管理的下一个最好的步骤?

(A) Echocardiogram 超声心动图

(B) Hemicraniectomy 偏侧颅骨切除术

(C) Heparin 肝素

(D) Insulin 胰岛素

(E) Tissue plasminogen activator 组织型纤溶酶原激活物

答案解析：

病史和体格检查提示可能是脑血管意外。在进行任何治疗干预之前，必须进行紧急CT扫描以排除出血。在此例中，我们被告知CT检查正常，这意味着未见出血。鉴于临床高度怀疑卒中，你的注意力应该集中在缺血性病因的可能性上。然而，重要的是要记住，10度的缺血性梗死在初次扫描时是不可见的，尤其是在症状出现后几小时内进行扫描时。组织型纤溶酶原激活剂(tPA)是一种溶栓药物，鉴于患者没有任何明显的血栓溶解治疗禁忌证，是下一步治疗的最佳选择。tPA治疗已被证明在急性缺血性卒中的治疗中非常有效，尤其是在症状发生后3小时内给药。然而，这种治疗方式有出血的风险。

正确答案：E