A week ago, 65-year-old Mr. He woke up in the morning and found that his hands and feet were weak and unable to speak. The family rushed him to our hospital. Mr. He’s head DWI (magnetic resonance diffusion weighted imaging) showed that he had acute cerebral infarction in the left side of the coronary-basal ganglia and left frontal and parietal lobe. After symptomatic treatment, Mr. He is now able to walk independently on crutches, and after a period of rehabilitation, he can be discharged. My colleague learned that Mr. He has a history of severe smoking and years of hypertension. Last year, he was admitted to the hospital for cerebral infarction. Although he quit smoking after being discharged from the hospital, he often forgets to take antihypertensive drugs because of his old age and bad memory.
The cold winter season is a period of high incidence of cardiovascular and cerebrovascular diseases. Recently, the Department of Neurology in our hospital has admitted many patients with cerebral infarction, and most of them are like Mr. He, with a history of hypertension. Middle-aged and elderly people with a history of hypertension, when the outside temperature drops, their blood vessels suddenly contract, which increases blood pressure and is prone to cerebral infarction.
Cerebral infarction, also known as ischemic stroke, refers to the ischemic necrosis or softening of the local brain tissue caused by the blood supply of the brain, ischemia, and hypoxia. Cerebral infarction has the characteristics of high disability, high fatality and high recurrence, which is extremely harmful to life and health, so once it occurs, early treatment is directly related to the prognosis. So, how to treat after cerebral infarction?
1. Deal with brain edema
After the onset of the disease, some patients will have symptoms such as disturbance of consciousness, vomiting, and increased blood pressure. At this time, it is necessary to consider the situation of cerebral edema, implement timely treatment of lowering intracranial pressure, give mannitol dehydration, or use glycerin intravenous drip, 1 to 2 times a day.
2. Thrombolytic therapy
Cerebral thrombosis can be easily dissolved by the drug within a few hours after its formation, thereby dredging blood vessels and solving the most fundamental blood vessel blockage problem. However, this treatment has a time window limit and it is only used in the acute phase of the onset. The guidelines recommend that it be applied within 6 hours after the onset. As time goes on, the thrombus will harden and it is difficult to dissolve even with thrombolytic drugs, so the earlier The better the treatment. If it exceeds 6 hours, the thrombosis of large blood vessels can be treated with interventional thrombus removal, and the thrombus removal time does not exceed 16 hours.
It should be noted that thrombolysis only dissolves the blocked part and does not fundamentally remove the cause of the thrombosis. For example, if atherosclerosis is not followed by medication, or cardiogenic embolism does not deal with the heart problem, then There will be a second cerebral infarction. Therefore, the clinical improvement of vasolysis does not mean that the disease is cured. To avoid the recurrence of cerebral infarction, it is necessary to actively treat the primary diseases that cause thrombosis (such as high blood pressure, dyslipidemia), and avoid undesirable triggers, such as smoking, Drinking, tired, etc.
3. Anticoagulant therapy
The purpose of this treatment is to avoid the further development of blood clots, or the appearance of new blood clots. After confirming that the patient does not have intracranial hemorrhage or infection, some antiplatelet drugs, such as heparin, warfarin, etc., can be given appropriately. During this period, the dose of the drug should be adjusted reasonably according to the actual time of clotting.
4. Interventional therapy
The above treatment methods are ideal for mild cerebral infarction, and if the patient has severe vascular stenosis and the cerebral infarction is in the acute phase, interventional treatment will be “immediate”. This kind of treatment has low risk, is not easy to relapse, and suffers less pain. Interventional therapy is like a pipe repairer. It can use balloons to expand narrow blood vessels and remove lumen obstacles. It can also place metal stents in the lumen to create “artificial channels” to restore normal physiological functions of the human body.
5. Rehabilitation training
After a period of treatment, the patient will gradually enter the recovery period, symptoms such as aphasia and hemiplegia will also be well improved, and neurological function will gradually recover. Patients at this stage should pay attention to the rehabilitation training of limb function. Under the guidance of professionals, they can choose the appropriate exercise method, intensity, and exercise time according to their specific conditions. Rehabilitation needs to be done step by step, and you can’t rush for success. For example, some patients are eager to recover and increase the amount of training on their own. As a result, the contracture of the affected limb becomes more serious; there are patients who practice walking on their own, resulting in “leg throwing”. Wrong walking actions such as “circle”. Firm confidence and correct rehabilitation training are the real “good medicine” for restoring function.