A. Precursors of cerebral infarction
1, the recent appearance of unexplained numbness or weakness of the hands and feet, and the objects held in the hands sometimes suddenly fall to the ground.
2.Sudden appearance of transient double vision or diplopia or blurred vision.
3. sudden loss of speech or slurred or difficult speech, but “clear in the mind” (clear consciousness), and quickly return to normal without leaving any trace.
4. Dizziness from time to time, sometimes even fainting suddenly, but waking up quickly.
5. recent memory impairment, especially recent memory.
6. unexplained mental retardation, lack of concentration, reduced work efficiency, and often “errors” for no apparent reason.
All of the above manifestations occur unconsciously without any causative factors, and last for a short period of time, only a few seconds or even minutes.
Second, the sequelae of cerebral infarction
There are mainly hemiplegia (hemiplegia), hemiplegia, limb numbness, hemianopia, aphasia. Or crossed paresis, crossed sensory disorder, external eye muscle paralysis, nystagmus, difficulty in constructing speech, language disorder, memory loss, distorted mouth and eyes, difficulty in swallowing, choking and choking, ataxia, dizziness, etc.
III. Pathology
The root cause of cerebral vascular disease is the presence of blood lesions such as high blood viscosity, high blood lipids, high blood pressure, high blood sugar, and platelet aggregation, which eventually lead to the formation of atherosclerotic plaques blocking the cerebral arteries, resulting in the interruption of local blood flow to the brain and ischemic and hypoxic necrosis of brain tissue. If it affects the motor nervous system controlled by the brain nerve, corresponding sequelae such as hemiplegia and limb movement disorder will occur; if it affects the central nerve of language controlled by the brain nerve, it will lead to language disorder or even aphasia and other corresponding neurological symptoms, and can also cause dementia.
IV. General treatment
The effective methods to improve the symptoms of cerebral infarction sequelae and reduce the high recurrence rate should be based on low-salt, low-fat and high-protein diet and active and passive disability exercise, as well as effective treatment of the underlying lesions such as atherosclerotic plaque formation and high blood viscosity, which are the causative factors of cerebral infarction, through reliable drug treatment, to prevent the re-formation of atherosclerotic thrombus; improve the blood and oxygen supply to brain tissues, create a good internal It also improves the blood and oxygen supply to the brain tissue, creates a good internal environment for the brain tissue, restores the brain nervous system, and improves the signs of the motor and language nervous system controlled by it. Fundamentally, it improves the symptoms of cerebral infarction such as unfavorable language and limb disorders, and effectively prevents the progress of disease recurrence.
Drugs are mainly divided into the following categories: 1. drugs for the treatment of underlying diseases, such as anti-hypertensive drugs, hypoglycemic drugs, lipid-lowering drugs, etc.; 2. anti-platelet drugs: aspirin, clopidogrel, etc.; 3. statins, such as Rosuvastatin, atorvastatin, etc.; 4. blood-vitalizing Chinese medicine can also be tried, but international and domestic experts agree that the effect has yet to be verified, the effect is not certain, available or It can be used or not.
V. Rehabilitation treatment
Recovery of sensory dysfunction after cerebral infarction
Whether the physical motor function of cerebral infarction patients can be restored and whether various treatment methods can receive satisfactory results depends largely on whether the sensory function can be normalized. Sensory impairment hinders the normal performance of motor function, especially the impairment of tactile sensation and motor position sense. Due to the lack of normal sensory feedback, it is difficult for patients to regulate and control their movements normally, resulting in the loss of coordinated movements of the hands. Therefore, sensory training and motor training cannot be separated in the training process, and the concept of integration of sensory-motor training must be established.
Recovery of hand function after cerebral infarction
The restoration of hand function in post-infarction patients can be carried out by training finger grasping and fine motor activities. There are many clinical activities to train finger grasping ability, and almost all movements in daily life are related to hand manipulation. Choosing various sizes of wooden pegs or pencils, etc., holding them in your hands and turning them up and down or back and forth is conducive to improving hand dexterity. In addition, the children’s sets of toys sold in the market, all contain the hand pinching, inserting, pulling, twisting, turning and other aspects of the function, has a certain therapeutic significance. Activities such as chess, poker and mahjong are both entertaining and a good opportunity to train the fingers to grasp objects of different sizes and shapes, such as thick, thin, large, small, square and round. If necessary, the shape of the pieces can be adjusted according to the patient’s grip level, and some small hooks or pouches can be fixed on the pieces.
Recovery of limb function after cerebral infarction
Pay attention to keeping the limbs in the functional position, and do passive activities on the limbs regularly every day, as well as massage, massage, acupuncture, electrotherapy and hot compress to promote blood circulation of the limbs, maintain the range of motion and function of the joints and ligaments, and prevent muscle atrophy and spasm. To prevent decubitus ulcers in hemiplegic patients, make sure the bed is flat, dry and wrinkle-free, turn over and pat the back regularly, and massage the bony prominence regularly. Try to encourage the patient to eat by himself, don’t be afraid of dirty clothes and trouble, so as to exercise the function of upper limbs, and gradually train the patient to learn to take care of himself or partially take care of himself. In the early recovery period, the patient should get out of bed and sit on a chair every day, with both feet on the ground and both knees and hips flexed, and assist the patient to stand for several times, gradually increasing in time, and then the patient can practice walking when he has certain muscle strength in both feet. Take the patient to outdoor activities to make the patient feel confident about life, and also exercise walking with a cane, and gradually move on to stair training.
Recovery of language after cerebral infarction
For patients with aphasia or language disorders, language training starts with simple words and sentences, such as “eat”, “drink”, “sleep”, “urinate”, etc. and addressing people. “eat”, “drink”, “sleep”, “urinate”, etc. and address people. Make patients gradually express their requirements, encourage patients to say live, avoid patients lazy words or simple gestures, to repeatedly train patients to gradually improve to be able to the language, so that part of the aphasic patients can completely restore language function. Regular activities to exercise the tongue muscles also help the recovery of aphasia, aphasia improvement and then training speech, reading aloud, etc.. Auditory, visual images and words can be combined to enhance stimulation and strengthen language training.
Health education of cerebral infarction
Patients with cerebral infarction generally go through three stages: the acute phase, the recovery phase and the sequelae phase. Most patients’ comprehensive prevention and treatment in the recovery phase and the sequelae phase are carried out at home, and if they can adhere to effective medication, adhere to dietary regulation, adhere to rehabilitation training such as limb function, and control risk factors such as blood pressure and blood lipids, it is possible to achieve the rehabilitation treatment purpose of effectively improving symptoms and not recurring. Effective rehabilitation health care treatment for patients with cerebral infarction should include the following points.
1. Diet.
Eat more fiber-rich foods, such as various vegetables, fruits, brown rice, whole grains and legumes, which can help defecate, prevent constipation, stabilize blood sugar and lower blood cholesterol. Choose vegetable fats and oils, and cook them in boiled, steamed, cold, roasted, baked, brined, stewed, etc.; forbid fatty meat, offal, fish eggs, cream and other foods with high cholesterol; choose more fish and skinless chicken with less fat content; eat 1-2 whole eggs per week. Milk and its products, grains and roots, meat, fish, beans and eggs, vegetables, fruits and fats and oils and other six categories of food, it is appropriate to take a variety of intake, in order to fully obtain a variety of nutrients.
2, exercise.
Should be appropriate amount of physical exercise and physical activity, should not do strenuous exercise, running, climbing are not desirable, can be walking, soft gymnastics, playing tai chi and other aerobic exercise. But should be selected according to the individual’s physical condition, not too much to not overly fatigue as the degree. Proper physical exercise can increase fat consumption, reduce cholesterol deposition in the body, improve insulin sensitivity, which is beneficial to the prevention of obesity, weight control, increase circulatory function, adjust blood lipids and lower blood pressure, reduce blood clots, and is a positive measure to prevent and treat cerebral infarction, cerebral embolism and cerebral infarction.
3.Medication.
The pathological basis of cerebral infarction is cerebral atherosclerosis, and cerebral atherosclerosis does not subside after the thrombus subsides, and cerebral infarction may still re-form, so anti-thrombotic drugs such as aspirin and statins cannot be interrupted. Aspirin worship: mainly antiplatelet agglutination and release, improve the balance of prostaglandin and thromboxane A2, and prevent thrombus formation. The disadvantage is that 47% of patients develop resistance to the drug. A good doctor or hospital will test the anti-platelet aggregation rate of aspirin for you to help patients choose the most effective drug. If you are not sensitive to aspirin you can switch to clopidogrel. Disadvantage: it is expensive and also has resistance characteristics, so the combination of two drugs is also a strategy. Or switch to a new generation of anti-platelet aggregation drugs.
Why not choose Chinese medicine? Let me explain: because so far there is no scientific discovery that any Chinese medicine has anti-platelet aggregation effect, and for thrombosis, blood activation does not play a major role.
4.Risk factors control.
Hypertension: It can accelerate the speed and degree of development of atherosclerosis, and the higher the blood pressure, the greater the chance of cerebral infarction or recurrence of cerebral infarction. High blood lipid: On the one hand, it makes the blood sticky, the blood flow is slow, and the amount of blood supplied to the brain is reduced; on the other hand, it damages the vascular endothelium and forms atherosclerotic plaque in the vascular wall, which directly leads to the occurrence and development of cardiovascular and cerebrovascular diseases. Diabetes: more than 80% of diabetes leads to abnormal lipid metabolism, often accompanied by atherosclerosis and hyperlipidemia complicating cardiovascular and cerebrovascular disease; and increased glucose content in the blood also increases blood viscosity and coagulability, which is conducive to the formation of cerebral infarction. Heart disease: the blood of the brain comes from the heart. When myocardial infarction and heart failure occur, the blood supply to the brain is insufficient, which can cause cerebral infarction; when rheumatic heart disease is combined with atrial fibrillation and other arrhythmia attacks, the emboli in the atria will be dislodged and enter the cerebral vessels, which can cause cerebral embolism.
5. Regularly come to the hospital to review blood pressure, blood routine, lipid analysis, blood biochemistry, cranial CT, limb and speech recovery, etc. At the beginning, it will be once a month, and further treatment and nursing guidance will be provided according to the condition, and the condition can be checked once every three months to six months if there is no obvious change.
6.Take medication regularly according to medical advice
Medication is essential to promote the condition, therefore, patients should be told to adhere to regular medication. Since most of the drugs taken by patients are vasodilators and blood-stasis activators, it is important to observe whether there is a tendency of bleeding from the skin mucous membrane and the gastrointestinal tract, such as unexplained skin spots, easy bleeding from the gums or black stools, etc., you should immediately consult a doctor. Other side effects of various drugs should also be known, and once they appear, they should be treated symptomatically in time. Blood pressure can be monitored at least once a week, and medication can be taken according to the blood pressure to keep the blood pressure in the normal range. The current treatment for cerebral infarction is the best method scientifically proven in the western developed countries to precisely determine the cause and treat the cause. The efficacy of Chinese medicine in the clinic is still uncertain and can be used as an auxiliary medicine, so we seldom go to the Chinese hospital for treatment after the disease, which is one of the reasons behind.
7.Regularly go to the hospital for review
The examination items include blood pressure, blood routine, blood lipid, blood sugar, brain CT, head and neck CTA, neck vascular ultrasound, TCD and cerebral angiography, and the condition without obvious changes can be examined every 6 months to 1 year.