부천재활병원 뇌졸중 진단과 치료 •뇌졸중 예방이 최선입니다

<div class="blog2_post_function"> <input title="URL 복사" class="copyTargetUrl" style="display: none;" type="text" alt="url" value="https://blog.naver.com/bch1588/221416944014"> </div>   <div class="se_doc_title_bottom" id="SEDOC-1544509724011--517189716_se_doc_title_bottom"></div><div class="location_component"><div class="location"></div></div>  <div class="se_doc_header_end" id="SEDOC-1544509724011--517189716_se_doc_header_end"></div><div class="se_doc_contents_start" id="SEDOC-1544509724011--517189716_se_doc_contents_start"></div> <div class="se_component_wrap sect_dsc __se_component_area"><div class="se_component se_paragraph default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_ff_nanumgothic se_fs_T3 se_align-left"><div class="se_editView"><div class="se_textView">뇌줄중에서 가장 중요한 것은 진단과 치료입니다. 빠르고 정확한 진단이 있어야 신속하고 후유증이 없는 상태로 회복될 수 있기 때문에 아무리 강조해도 지나치지 않습니다. </div></div></div></div></div></div><div class="se_component se_quotation default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_fs_T1"><div class="se_editView"><div class="se_textView"><blockquote class="se_textarea"> 뇌졸중 진단</blockquote></div></div></div></div></div></div><div class="se_component se_paragraph default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_ff_nanumgothic se_fs_T3 se_align-left"><div class="se_editView"><div class="se_textView"> 신경학적 검사, 혈액검사, CT, MRI, 혈관 조영술, 경동맥 초음파 등으로  진단할 수 있습니다. </div></div></div></div></div></div><div class="se_component se_image default"><div class="se_sectionArea se_align-extend"><div class="se_editArea"><div class="se_viewArea"><a class="se_mediaArea __se_image_link __se_link" href="https://blog.naver.com/PostView.nhn?blogId=bch1588&logNo=221416944014&categoryNo=10&parentCategoryNo=0&viewDate=&currentPage=1&postListTopCurrentPage=1&from=postList&userTopListOpen=true&userTopListCount=30&userTopListManageOpen=false&userTopListCurrentPage=1#" data-linktype="img" data-linkdata='{"imgId" : "SEDOC-1544509724011--517189716_image_0_img", "src" : "https://postfiles.pstatic.net/MjAxODEyMTFfMzUg/MDAxNTQ0NTA0NDUxMzk1.aVVV8RdfkD-7b3jmRB4LNCdh9IS0Jy0zJLAQ_iQhGPIg.LOIwd-zciCYg27Reor0ygp3LYWp05ocxR7bGE6B4eNMg.PNG.bch1588/image.png", "linkUse" : "false", "link" : ""}'><img width="1217" height="750" class="se_mediaImage __se_img_el" id="SEDOC-1544509724011--517189716_image_0_img" alt="" src="https://img1.daumcdn.net/relay/cafe/original/?fname=https%3A%2F%2Fpostfiles.pstatic.net%2FMjAxODEyMTFfMzUg%2FMDAxNTQ0NTA0NDUxMzk1.aVVV8RdfkD-7b3jmRB4LNCdh9IS0Jy0zJLAQ_iQhGPIg.LOIwd-zciCYg27Reor0ygp3LYWp05ocxR7bGE6B4eNMg.PNG.bch1588%2Fimage.png%3Ftype%3Dw773" data-attachment-id="IVlg1xZAU4Z7hvY1PNGBC9_0H2XM" data-lazy-src="" data-width="1217" data-height="750"> </a></div></div></div></div><div class="se_component se_paragraph default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_ff_nanumgothic se_fs_T3 se_align-left"><div class="se_editView"><div class="se_textView"></div></div></div></div></div></div><div class="se_component se_image default"><div class="se_sectionArea se_align-extend"><div class="se_editArea"><div class="se_viewArea"><a class="se_mediaArea __se_image_link __se_link" href="https://blog.naver.com/PostView.nhn?blogId=bch1588&logNo=221416944014&categoryNo=10&parentCategoryNo=0&viewDate=&currentPage=1&postListTopCurrentPage=1&from=postList&userTopListOpen=true&userTopListCount=30&userTopListManageOpen=false&userTopListCurrentPage=1#" data-linktype="img" data-linkdata='{"imgId" : "SEDOC-1544509724011--517189716_image_1_img", "src" : "https://postfiles.pstatic.net/MjAxODEyMTFfMTA0/MDAxNTQ0NTA2MTc0MTcx.wmkNmPks1EUqI-dafNYMRbpaOLMVR_UIZ5D6ZUKVguQg.LI_tLrwu0jo2-4OYwJbq2gI-kSJ3enjKrj0BgBrpO3gg.PNG.bch1588/image.png", "linkUse" : "false", "link" : ""}'><img width="1437" height="760" class="se_mediaImage __se_img_el" id="SEDOC-1544509724011--517189716_image_1_img" alt="" src="https://img1.daumcdn.net/relay/cafe/original/?fname=https%3A%2F%2Fpostfiles.pstatic.net%2FMjAxODEyMTFfMTA0%2FMDAxNTQ0NTA2MTc0MTcx.wmkNmPks1EUqI-dafNYMRbpaOLMVR_UIZ5D6ZUKVguQg.LI_tLrwu0jo2-4OYwJbq2gI-kSJ3enjKrj0BgBrpO3gg.PNG.bch1588%2Fimage.png%3Ftype%3Dw773" data-attachment-id="IZdV2HFcB9-cpUR0S8G2aTSxHMAY" data-lazy-src="" data-width="1437" data-height="760"> </a></div></div></div></div><div class="se_component se_quotation quotation_underline"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_fs_T1"><div class="se_editView"><div class="se_textView"><blockquote class="se_textarea">뇌졸중 치료</blockquote></div></div></div></div></div></div><div class="se_component se_paragraph default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_ff_nanumgothic se_fs_T3 se_align-left"><div class="se_editView"><div class="se_textView"> 뇌졸중 치료는 급성기 치료와 만성기 치료 그리고 후유증 재활 치료가 있습니다. 각각의 치료는 특성이 다르기 때문에 환자에게 적절하고 상태에 맞는 치료가 필요합니다. </div></div></div></div></div></div><div class="se_component se_quotation default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_fs_T1"><div class="se_editView"><div class="se_textView"><blockquote class="se_textarea"> 급성기 치료</blockquote></div></div></div></div></div></div><div class="se_component se_paragraph default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_ff_nanumgothic se_fs_T3 se_align-left"><div class="se_editView"><div class="se_textView"> 급성기는 뇌졸중이 발생하고 신경학적으로 안정이 된 시점, 즉 뇌졸중 발생 후 약 48시간에서 72시간 내를 말합니다. 대부분의 시간을 입원치료로 보내게 되는 기간입니다. 이 기간의 치료는 전문적이고 약리 작용을 정확히 알아야 하기 때문에 간단한 언급으로 대신합니다. 급성기 치료약물 1.혈전용해제 2.항응고제 3.뇌압강하제 4.안정제 5.혈압약 6.당뇨약 1.혈전용해제 발병3-4.5시간에 투여하여야 효과가 높은 약물입니다.왜냐하면 뇌졸중이 3시간이 넘으면 뇌신경이 죽기 시작하기 때문에 대부분의 경우 혈전용해제로 치료할 수 없기 때문입니다. 1)유로키나아제(urokinase:UK): 혈전을 용해시키는 작용을 합니다. 신장에서 만들어지는 효소인 유로키나아제(urokinase; UK)는 아시아에서 가장 널리 임상적으로 사용하고 있습니다. 2)스트렙토키나아제(streptokinase): 구미에서는 연쇄상구균으로부터 추출한 효소 UK보다 값이 싼 스트렙토키나아제(streptokinase; SK)를 널리 쓰고 있습니다. 3)조직 플라스미노겐 활성화인자(tissue plasminogen activator, TPA): 혈전을 만드는 피브린(fibrin)에 대한 친화성이 있고 투여하면 혈전부분에서 농축되어서 전신투여하여도 출혈 등의 부작용을 경감할 수 있습니다. 최근에 많이 사용하는 약물입니다.  2.항응고제 혈액이 응고되는 것을 방지하기 위해 사용하는 것으로 처음 시작할때 헤파린(혈액응고방지물질)으로 시작하고(병원에서). 퇴원하기 며칠 전부터. 조금씩 와파린으로 전환을 합니다. 1)비타민K 길항제 비타민 K 길항제는 간에서 생성되는 혈액응고인자의 생산을 방해함으로써 혈액이 응고되는 것을 막는 항응고제의 일종입니다. 종류: 4-하이드록시쿠마린과 디쿠마롤, 와파린 2)비(非)-비타민K 길항제(Non-vitamin K Antagonist Oral Anticoagulants:NOAC) 비(非)-비타민K 길항제는 비타민 K 길항제의 단점인 비타민K 저하를 막기위해 나온 약물입니다. 종류: 다비가트란·아픽사반·리바록사반. 최근에는 치매 예방에 효과적이어서 관심이 증가하고 있습니다. 3)헤파린 고등 동물의 각종 조직에 넓게 분포하여 근육, 간장, 흉선, 폐, 비장, 혈액 등에  혈액응고방지·혈전방지에 사용됩니다. 3.뇌압강하제 급성기에 뇌의 압력이 급격히 증가하기 때문에 뇌압을 낮추어 주어야 합니다. 1)만니톨(mannitol): 뇌조직의 수분(뇌의 간질액) 감소 시켜서 뇌압을 떨어지게 합니다. 2)이뇨제:이뇨작용을 이용하여 뇌척수액 생산감소, 뇌부종 감소를 유도합니다. 3)스테로이드:뇌부종과 뇌울혈을 감소시킵니다. 4.안정제:뇌신진대사를 줄일 목적으로 사용합니다. 종류:코데인, 페노바르비탈, 펜토바르비탈 5.혈압약·당뇨약 혈압과 혈당을 조절하여야만 뇌나 신체 손상을 줄일 수 있기 때문에 적극적으로 치료하여야 합니다. </div></div></div></div></div></div><div class="se_component se_quotation default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_fs_T1"><div class="se_editView"><div class="se_textView"><blockquote class="se_textarea">만성기 치료와 예방약물</blockquote></div></div></div></div></div></div><div class="se_component se_paragraph default"><div class="se_sectionArea"><div class="se_editArea"><div class="se_viewArea se_ff_nanumgothic se_fs_T3 se_align-left"><div class="se_editView"><div class="se_textView"> 뇌졸중 급성기(발생 후 약 48시간에서 72시간)가 지나면  재활치료와 약물치료를 같이 지속적으로 해야만 합니다. 이때 사용하게 되는 약물들에 대해서 알아보겠습니다. 환자분들의 일상생활로의 복귀에 작은 도움이 되기를 바랍니다. 만성기 치료약물 1.혈압약 ·당뇨약 ·고지혈증약 2.항혈소판제 3.항응고제 4.혈관확장제 5.혈류개선제 1.혈압약· 당뇨약·고지혈증약 너무나도 당연한 이야기지만 뇌졸중을 일으키는 원인이 되는 혈압,당뇨,고지혈증을 계속 조절하고 식생활개선, 재활치료 등을 병행해야 합니다. 2.항혈소판제 뇌졸중의 재발을 예방하기 위해 사용합니다. 종류:아스피린 ,트리플루잘(Triflusal),티클로피딘(Ticlopidine),클로피도그렐(Clopidogrel) 실로스타졸(Cilostazol),디피리다몰(Dypyridamole)등 3.항응고제 1)비타민K 길항제 종류: 4-하이드록시쿠마린과 디쿠마롤, 와파린 2)비(非)-비타민K 길항제 종류: 다비가트란·아픽사반·리바록사반 4.혈관확장제 혈관을 확장시켜 피가 쉽게 흐르도록 해줍니다. 혈관확장제는 고혈압, 심부전증, 협심증을 치료하기 위해 사용되는 약물입니다. 종류:니트로글리세린(nitroglycerin), 이질산이소소르비드(isosorbide dinitrate) 등 5.혈류개선제 일반적으로 혈액순환장애(피가 걸죽해지는 것)에 처방하는데 실제적으로는 치매, 이명, 어지럼증, 난청등의 보조적 치료제 사용하는 경우가 많습니다. 꼭 필요한 분들만 전문의와 상의해서 복용하는 것이 현명합니다. </div></div></div></div></div></div><div class="se_component se_image default"><div class="se_sectionArea se_align-extend"><div class="se_editArea"><div class="se_viewArea"><a class="se_mediaArea __se_image_link __se_link" href="https://blog.naver.com/PostView.nhn?blogId=bch1588&logNo=221416944014&categoryNo=10&parentCategoryNo=0&viewDate=&currentPage=1&postListTopCurrentPage=1&from=postList&userTopListOpen=true&userTopListCount=30&userTopListManageOpen=false&userTopListCurrentPage=1#" data-linktype="img" data-linkdata='{"imgId" : "SEDOC-1544509724011--517189716_image_2_img", "src" : 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-khtml-user-select: none; -webkit-user-drag: none; -khtml-user-drag: none; -moz-user-drag: none; -o-user-drag: none; user-drag: none;" draggable="false" alt="" src="https://img1.daumcdn.net/relay/cafe/original/?fname=https%3A%2F%2Fssl.pstatic.net%2Fstatic%2Fmaps%2Fv3%2Fpin_default.png" unselectable="on"></div></div><div style="margin: 0px; padding: 0px; border: 0px currentColor; border-image: none; left: 0px; top: 0px; width: 100%; height: 0px; overflow: visible; display: block; position: absolute; z-index: 106;"></div></div></div><div style="margin: 0px; padding: 0px; border: 0px currentColor; border-image: none; left: 0px; top: 0px; width: 100%; height: 100%; overflow: visible; display: none; position: absolute; z-index: 10000; opacity: 0.5; background-color: rgb(255, 255, 255); -webkit-tap-highlight-color: rgba(0, 0, 0, 0);"></div></div></div><div style="margin: 0px; padding: 0px; right: 0px; bottom: 0px; position: absolute; z-index: 100; pointer-events: none;"><div style="margin: 0px; padding: 0px; border: 0px currentColor; border-image: none; height: 21px; float: right; pointer-events: none;"><div style="margin: 0px 12px 7px 2px; width: 52px; height: 14px; overflow: hidden; position: relative; pointer-events: auto;"><span style='margin: 0px; padding: 0px 4px; text-align: center; line-height: 11px; font-family: Helvetica,AppleSDGothicNeo-Light,nanumgothic,NanumGothic,"나눔고딕",Dotum,"돋움",sans-serif; font-size: 10px; font-weight: bold; display: block; text-shadow: -1px 0px rgba(255,255,255,0.3), 0px 1px rgba(255,255,255,0.3), 1px 0px rgba(255,255,255,0.3), 0px -1px rgba(255,255,255,0.3);'>50m<img width="44" height="4" style="margin: 0px; padding: 0px; border: 0px currentColor; border-image: none; left: 4px; width: 44px; height: 4px; bottom: 0px; overflow: hidden; display: block; position: absolute; z-index: 2; min-height: 0px !important; max-height: none !important; min-width: 0px !important; max-width: none !important;" alt="" src="https://img1.daumcdn.net/relay/cafe/original/?fname=https%3A%2F%2Fssl.pstatic.net%2Fstatic%2Fmaps%2Fmantle%2F1x%2Fscale-normal-b.png"><img width="4" height="10" style="margin: 0px; padding: 0px; border: 0px currentColor; border-image: none; left: 0px; width: 4px; height: 10px; bottom: 0px; overflow: hidden; display: block; position: absolute; z-index: 2; min-height: 0px !important; max-height: none !important; min-width: 0px !important; max-width: none !important;" alt="" src="https://img1.daumcdn.net/relay/cafe/original/?fname=https%3A%2F%2Fssl.pstatic.net%2Fstatic%2Fmaps%2Fmantle%2F1x%2Fscale-normal-l.png"><img width="4" height="10" style="margin: 0px; padding: 0px; border: 0px currentColor; border-image: none; width: 4px; height: 10px; right: 0px; bottom: 0px; overflow: hidden; display: block; position: absolute; z-index: 2; min-height: 0px !important; max-height: none !important; min-width: 0px !important; max-width: none !important;" alt="" 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