I. What is stroke
Stroke is any damage to brain tissue caused by abnormal blood supply. This disease is called “stroke” in Chinese medicine and “acute cerebrovascular disease” in Western medicine, because it occurs when the cerebrovascular accident is wrong, the onset is sudden and unpredictable, so it is also called “cerebrovascular accident The onset of the disease is sudden and unpredictable, so it is also called “cerebrovascular accident. Generally this disease is divided into two cases: one case is cerebrovascular failure, called ischemic stroke or cerebral infarction; the other case is cerebrovascular rupture and bleeding, called hemorrhagic stroke.
Case 1, an elderly patient, usually smokes, drinks, and is lucky to have a mahjong game, and has high blood pressure that he did not pay attention to. Last Monday morning, he found that one side of his arms and legs were not flexible, half of his body could not move, and he could not speak. Carried to the hospital by the family, a test is a brain infarction. Fortunately, the treatment was timely, and his life was saved, but he will be confined to a wheelchair.
Case 2, a middle-aged male, was the head of a unit department, usually busy with work, socializing more, and irregular life. During a meeting, he suddenly had a severe headache and vomited. He was sent to the hospital by a colleague and was found to have a brain hemorrhage caused by a ruptured cerebral aneurysm, which was treated by emergency surgery. Now he is back to health and back to life and work.
China is the hardest hit by stroke. A survey shows that cerebrovascular disease has become the first cause of death of our nationals. In recent years, the incidence of stroke in China is increasing at a rate of 8.7% per year. There are 7 million stroke patients, 4.5 million of whom are in various degrees of labor loss and unable to take care of themselves. The disability rate is as high as 75%. The direct cost of treating this disease in China is about 20 billion yuan per year. This disease seriously affects the quality of life of patients and imposes a huge burden on families and society. Although most stroke patients are over 60 years old, there is a “younger trend” of stroke. The root cause of the problem is the unhealthy lifestyle. There are many misconceptions about the lifestyle of our population, such as diet, exercise, and hobbies. These unhealthy lifestyles also lead to a variety of other chronic diseases, such as hypertension, diabetes, etc., and hypertension, dyslipidemia, and hyperglycemia can lead to strokes.
Stroke is so dangerous, can it be prevented. The answer is yes. Most strokes can be prevented. We should correct unhealthy lifestyle and consciously avoid the risk factors of stroke; we should pay attention to the lesions already formed, such as carotid artery or cerebral artery stenosis caused by arterial plaque, and conduct regular screening for stroke risk factors to detect the problem in time, so that early prevention, early diagnosis and early treatment can effectively prevent the occurrence of stroke.
Second, a thousand miles of dike, collapse in the anthill – to see what factors cause stroke
1, high blood pressure.
Hypertension is the most important risk factor for stroke, both high systolic and diastolic blood pressure will lead to higher risk of stroke, and the higher the blood pressure, the greater the possibility of stroke. The risk of stroke in hypertensive patients is 3-4 times higher than in normotensive people. The Chinese Guidelines for the Prevention and Treatment of Hypertension state that for every 10 mmHg increase in systolic blood pressure, the relative risk of stroke increases by 49%, and for every 5 mmHg increase in diastolic blood pressure, the relative risk of stroke increases by 46%. Effective long-term control of blood pressure can significantly reduce the occurrence of cardiovascular and cerebrovascular complications. We recommend that blood pressure levels should be lower than 140/90mmHg in the general population and lower than 130/80mmHg in diabetic patients.
2.Smoking
So far, more than half of the men in China smoke, smoking is not only harmful to themselves, but also to the people around them who smoke secondhand, such as family, relatives and friends, especially infants and children, many studies have shown that smoking is a major risk factor for many cardiovascular and cerebrovascular diseases, the incidence of coronary heart disease, hypertension, stroke and peripheral vascular disease are significantly higher in smokers. It has been reported that the risk of stroke in smokers is 2-2.5 times that of nonsmokers, and if smoking and hypertension are present at the same time, the risk of stroke will rise 20 times.
3. Diabetes
Diabetes is a series of metabolic disorders such as sugar, protein, fat, water and electrolytes due to congenital and acquired causes such as hypoglycemia and insulin resistance. In typical cases, there may be symptoms of polyuria, polydipsia, polyphagia and emaciation. Although it is called diabetes, it is actually an increase in glucose in the blood. There are two kinds of blood glucose measurement requirements, one is called random blood glucose, which refers to the blood glucose at any time of the day without considering the time of the last meal, and if it is ≥11.1mmol/L, diabetes can be diagnosed; there is another measurement method called fasting blood glucose, which refers to the blood glucose that has not been eaten for at least 8 hours. There is another measurement method called fasting blood glucose, which means no food for at least 8 hours, and if it is ≥7.0mmol/L, diabetes can also be diagnosed. There are currently 92.4 million people with diabetes in China, the highest number in the world. Diabetes can increase the risk of ischemic stroke by 2-5 times.
4. Dyslipidemia
There is a significant correlation between dyslipidemia and the incidence of ischemic stroke. There are many types of lipids, including total cholesterol, triglycerides, HDL, LDL, etc. Some indicators are good if they are high and some are good if they are low. Studies have shown that for every 1 mmol/L increase in total cholesterol, the incidence of stroke increases by 25%, while the opposite is true for HDL, where every 1 mmol/L increase in HDL reduces the incidence of ischemic stroke by 47%. Lifestyle changes are the first step in the treatment of dyslipidemia. These include: eating less animal oil, choosing foods that lower lipids (such as vegetable oils, especially corn oil, oatmeal, and beans), quitting smoking, losing weight, and increasing regular physical activity. Drug selection should be decided according to the patient’s blood lipid level and dyslipidemia typing, commonly used drugs are statins.
5.Seldom do physical exercise
There is a standard for the amount of exercise, and it is only when the standard is reached that there is an effect. The standard for physical exercise is to exercise ≥ 3 times a week, ≥ 30 minutes each time, and for a duration of more than 1 year. Life is about exercise, and people who exercise regularly are significantly less likely to have a stroke. According to statistics, men who exercise after the age of 40 have a 30% lower risk of stroke than those who are inactive. Exercise enhances heart function, improves blood vessel elasticity, and increases blood flow to the brain. Exercise dilates blood vessels, accelerates blood flow, and reduces blood viscosity, thereby reducing thrombosis. Exercise can promote lipid metabolism and prevent atherosclerosis. There are many ways to increase physical activity, such as bicycling, jogging, mountain climbing, tai chi, etc. Each person can choose the right exercise according to his or her physical condition and hobby. Each activity time in 30-60 minutes is appropriate, long-term adherence.
6.Obesity
To know what is obese first of all to understand the standard weight. Calculate the standard weight has a simple formula, standard weight = height (cm) – 105. such as a person’s height 165 cm, which his standard weight: 165 – 105 = 60 kg. A person’s weight exceeds the standard weight by 20% is called obese. Some data show that the incidence of stroke in obese people is 40% higher than the average person, and sudden death may be 1.86 times higher than the average person. Why is obesity prone to stroke? The main reason is that obese people have endocrine disorders, dyslipidemia and atherosclerosis, in addition to obesity and diabetes, coronary heart disease and hypertension, which are all risk factors for stroke.
7, atrial fibrillation and heart valve disease
Both atrial fibrillation and heart valve disease can form emboli in the heart, and the emboli can be dislodged to form a stroke. Foreign studies have shown that atrial fibrillation can increase the risk of stroke by 3-4 times.
8, have a family history of stroke
Patients with stroke in their close relatives have an increased risk of stroke by about 30%. The reason for this may be a genetic decision on the one hand, and a similar lifestyle in the family on the other hand, with some bad habits.
The above 8 points are indicators to assess whether you are at high risk of stroke. If you have more than 3 risk factors or a previous history of stroke, you are considered to be at medium to high risk. This is the time to pay attention and go to the local hospital for consultation and stroke screening. The screening includes a neurological physical examination and various laboratory and instrument tests. If there is any problem, treat it early.
3. Health tips
Prevention is the key to prevent stroke. The “four cornerstones of health” are “reasonable diet, moderate exercise, smoking and alcohol cessation, and psychological balance”. Also note the following four points.
1, hypertension patients should pay attention to control hypertension, adhere to take antihypertensive drugs.
2, hypercholesterolemia patients should pay attention to cholesterol control, adhere to take lipid-lowering drugs.
3, diabetic patients should actively control blood sugar.
4.Patients with atrial fibrillation or other heart diseases should actively treat related diseases.
Daily life behavior should pay attention to the following 10 points.
1, a light diet.
2, moderate increase in physical activity.
3.Overcome bad habits such as smoking, alcoholism, and sedentary lifestyle.
4.Prevent overexertion.
5, the elderly should prevent too rapid change of position, constipation.
6, pay attention to climate change.
7, drink enough water every day.
8.Don’t watch TV and surf the Internet for too long.
9, maintain emotional stability.
10.Regular health checkups to find problems for early prevention and treatment.
Fourth, the command of the crisis – what to do with a stroke
First look at what are the symptoms of stroke
1. Suddenly, the mouth and eyes are distorted, the corners of the mouth salivate, speech is unclear, spitting is difficult, words do not reach the point, swallowing is difficult, one side of the limb is weak or inflexible, walking is unstable or suddenly fall down. This is due to the blockage or rupture of cerebral blood vessels that damage the nerve function.
2. Sudden onset of severe headache, dizziness, or even nausea and vomiting, or the form and feeling of headache and dizziness are different from those of the previous days, and the degree is aggravated or changed from intermittent to continuous. These signs indicate fluctuations in blood pressure, or brain dysfunction, and are precursors of cerebral hemorrhage or subarachnoid hemorrhage.
3. Numbness of the face, tongue, lips or limbs, or haziness in front of the eyes or momentary difficulty in seeing, tinnitus or hearing changes. This is due to insufficient blood supply to the cerebral vessels and affects the sensory function of the brain.
4. Disorders of consciousness, performance of mental depression, always want to sleep, the whole day drowsy. Or the personality is uncharacteristic, suddenly become silent, indifferent expression, slow action or talkative and irritable, or even a brief loss of consciousness.
5, the province fatigue, weakness, sweating, low fever, chest tightness, panic or sudden appearance of erratic, vomiting, etc., which is the performance of plant nerve dysfunction.
The above symptoms may not be present in every patient, but as long as there are symptoms, it is an alarm of stroke and should not be taken lightly. In this case, the following procedures should be followed.
1. Stay quiet, rest in bed, notify people around you or your family, and have a family member who understands the condition accompany you to the hospital so that you can give your doctor a detailed medical history.
2. Call the emergency number and choose a specialized hospital that can treat the stroke as soon as possible. The best time to treat a stroke is within 4.5 hours of onset. You should not wait for your self to get better so that you do not miss the best treatment time. It is best to move on a stretcher and avoid bumps on the way.
3. Emergency treatment at home. If there is a blood pressure monitor at home, measure and record the blood pressure. Be careful not to give the patient drugs that cannot be identified to avoid aggravation or adverse drug reactions; if the stroke patient already has difficulty swallowing, the feeding process is likely to result in choking, mis-aspiration and asphyxiation, leading to aggravation or even life-threatening conditions. In this case, the patient should be placed on his or her back and the head tilted to one side to prevent choking and coughing caused by sputum or vomit, or suffocation caused by aspiration. If the patient’s mouth and nose are obstructed by vomit, try to pick it out to keep the airway open. If the patient is not awake, do not blindly feed water and drinks to the patient.
V. Mend the sheep – see what the doctor can do.
1.Acute cerebral infarction
It is an acute blockage of cerebral blood vessels. If the onset time is within 4.5 hours, the patient’s symptoms can be improved by opening the blood vessels to save the brain tissue that is not completely necrotic. The specific methods are: intravenous thrombolysis, in which thrombolytic drugs are given intravenously; arterial thrombolysis, in which microcatheters are sent into the cerebral vessels under X-ray fluoroscopy and thrombolytic drugs are given locally; intra-arterial pulling, in which microcatheters are sent into the cerebral vessels under X-ray fluoroscopy and the thrombus is removed with special instruments to make the vessels pass again.
If the time exceeds 4.5 hours, the time for thrombolysis is basically lost, and the main treatment at this time is medication and systematic rehabilitation. If the area of cerebral infarction is very large and the intracranial pressure is increased, surgical treatment is needed if necessary.
2.Cerebral vascular stenosis
There are extracranial vascular stenosis and intracranial vascular stenosis. The main symptoms caused by this are the manifestations of insufficient blood supply to the brain, such as dizziness, headache, tinnitus, etc. Extracranial vascular stenosis such as carotid stenosis and vertebral artery opening stenosis. Intracranial vascular stenosis such as middle cerebral artery stenosis. Treatment is divided into two main categories: the first is drug therapy, which is also the commonly used method at present. Antiplatelet drugs such as aspirin and clopidogrel can be taken orally. At the same time, oral statins are used to lower blood lipids and combat atherosclerosis. However, such methods can only relieve and alleviate the symptoms caused by cerebral artery stenosis, and cannot cure the narrowed arteries that have already formed, and the cause of cerebral artery stenosis needs to be found and treated for the cause. Currently, the most common causes are chronic diseases such as hypervascularity, diabetes and hyperlipidemia. If the patient has these underlying diseases, they should be strictly treated and controlled. The second method is to perform neurovascular intervention for the stenotic vessels based on the aforementioned methods, which is to place special intravascular alloy stents to prop up the stenotic vessels under X-ray fluoroscopy. In the case of carotid stenosis, surgical removal of the stenotic plaque and sewing up of the vessel may also be considered. The advantage of this method is that it is a direct treatment for the stenosis, and the effect of improving symptoms is more obvious than that of drug treatment alone.
3.Brain hemorrhage
Also called cerebral hemorrhage, it is a spontaneous bleeding in the brain. If the amount of blood is small, it can be treated by medication. If the amount of blood is large, surgery is needed to remove the hematoma, lower the intracranial pressure and save lives.
4.Subarachnoid hemorrhage
They are often caused by intracranial aneurysms, which are abnormal blood blisters in the cerebral arteries, and localized thinning of the arteries that can easily rupture. The aneurysm must be treated, otherwise the chances of rebleeding are high. Specific treatment includes cranial aneurysm clamping, which uses a small metal clip to clamp the blood bubble from the outside to provide local reinforcement, or endovascular intervention, which fills the blood bubble with metal wire from inside the blood vessel to reinforce the local blood vessel from the inside.
5.Smoke disease
It can cause cerebral hemorrhage as well as cerebral infarction. Treatment is mainly surgical vascular tower bridge.
VI. Rehabilitation of stroke patients in snow
Stroke patients often have various sequelae and dysfunction, such as unfavorable limb movement, sensory numbness, slurred speech, swallowing difficulties, incontinence, etc., resulting in patients unable to take care of themselves or even bedridden for a long time. Clinical emergency treatment mainly focuses on saving patients’ lives and reducing complications, while the management of these sequelae requires timely rehabilitation treatment. Rehabilitation treatment methods include rehabilitation medical disposition, physical therapy, occupational therapy, speech therapy, psychotherapy, orthotic therapy, Chinese traditional therapy and rehabilitation nursing. Among them, rehabilitation medical treatment mainly deals with various clinical complications of stroke patients. Physiotherapy emphasizes on improving the patient’s mobility through repetitive movement training to enable the patient to turn over, sit up, stand and walk independently, and also includes electrotherapy, phototherapy, magnetotherapy and hydrotherapy. Occupational therapy focuses on training patients to perform daily activities such as dressing, eating and washing independently to improve their self-care ability. Psychotherapy is the psychological guidance and medication for patients with depression or anxiety secondary to stroke. Orthotic treatment is to assist in the rehabilitation of limb function by adding orthotics according to the specific deformity of the limb when it is difficult for the patient to correct foot drop and inversion by himself. The rehabilitation team consists of rehabilitation physicians, rehabilitation therapists and rehabilitation nurses, who analyze and evaluate all aspects of the stroke patient’s problems, develop individualized rehabilitation treatment plans and carry out integrated, comprehensive and systematic rehabilitation treatment. Prolonged bed rest for stroke patients can lead to muscle atrophy, joint contracture and deformation, osteoporosis, and skin breakdown. Therefore, stroke rehabilitation must be carried out as early as possible, and patients can be rehabilitated as soon as their vital signs are stable. Early rehabilitation such as passive joint movement, early bedside sitting training, etc. The best time for rehabilitation is within 3 months after the onset of stroke. If rehabilitation is carried out more than 1 year later, the efficiency of recovery of various functions will be reduced.
The above is a general introduction to the risk factors, performance, treatment, and rehabilitation of stroke. We hope that our readers can start from themselves and develop healthy habits to stay away from stroke.