2026年急性缺血性卒中患者早期管理指南：美国心脏协会/美国卒中协会的指南

摘要(中文译文)

“2026年AIS患者早期管理指南”取代了“2018年AIS患者早期管理指南”及其2019年更新版，以反映近期证据进展。本更新指南旨在提供一套全面、最新、基于证据的建议，涵盖从院前评估到急性治疗、院内早期并发症管理及早期二级预防措施启动的管理。目标读者包括院前急救专业人员、医师、相关健康专业人员和医院管理人员。文献检索于2024年9月至12月期间进行，检索范围为主要涉及人类受试者的研究、自2018年AIS指南及2019年更新版以来以英文发表、并被MEDLINE、PubMed、Cochrane Library及其他与本指南相关的精选数据库收录的文献。随后酌情补充了截至2025年3月发表的其他高影响力研究和文章。本指南代表了AIS诊疗领域中当前最新、最全面的可用证据。关键更新包括：纳入有关溶栓药物选择及适用资格的新证据、血管内取栓术适用资格的判定、高血糖和吞咽困难的管理；对儿科人群的专门考量；以及溶栓禁忌证处理方法的修改。尽管本指南反映了重大进展，但也凸显了知识空白，并强调了持续研究以进一步优化和改善治疗策略的迫切需求。

Abstract

The "2026 Guideline for the Early Management of Patients With AIS" replaces the "2018 Guidelines for the Early Management of Patients With AIS" and the 2019 update to reflect recent advances in evidence. This updated guideline is intended to provide a comprehensive, up-to-date, evidence-based set of recommendations, advising management from prehospital evaluation through acute treatment and early in-hospital management of complications and initiation of early secondary prevention measures. The intended audience includes prehospital care professionals, physicians, allied health professionals, and hospital administrators. A search for literature derived from research principally involving human subjects, published in English since the last AIS guideline in 2018 and the 2019 update, and indexed in MEDLINE, PubMed, Cochrane Library, and other selected databases relevant to this guideline, was conducted between September and December 2024. Additional high impact studies and articles published through March 2025 were added later, where appropriate. This guideline represents the most current and comprehensive evidence available in AIS care. Key updates include the incorporation of new evidence related to thrombolytic choice and eligibility, determination of eligibility for endovascular thrombectomy, and management of hyperglycemia and dysphagia; a focused consideration of the pediatric population; and modification of the approach to thrombolysis contraindications. Although this guideline reflects significant advances, it also highlights gaps in knowledge and underscores the urgent need for continued research to further refine and improve treatment strategies.

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