What is cerebral infarction?
Cerebral infarction is a cerebrovascular disease in which brain tissue becomes necrotic and soft due to ischemia and hypoxia caused by impaired blood supply to the brain, forming infarction. The most common types clinically are cerebral thrombosis and cerebral embolism, of which the cerebral artery wall is narrowed or even occluded due to atherosclerosis or other factors causing lumen narrowing and resulting in focal cerebral infarction, called cerebral thrombosis. Secondly, the embolism from other parts of the body, such as the thrombus fragment shed by the atherosclerotic plaque of the extracranial artery wall or the fragment shed by the attached wall thrombus of the heart or the flabby heart valve, enters the cerebral circulation and leads to the blockage of a cerebral blood vessel and the formation of focal cerebral death plug is called cerebral embolism.
According to the data, there were 1090 cases of first stroke in 7 urban communities in China during 5 years (1986-1990), of which 502 cases were diagnosed by CT examination, 38.6% of which were hemorrhagic type, 60.4% were ischemic infarction, and 1% were unclassified.
Cerebral infarction is called stroke in Chinese medicine, and since the onset of stroke is generally conscious, it is mostly a stroke in the meridian. Regarding the etiology of stroke, before the Tang and Song dynasties, most of them were based on the doctrine of external wind, and were based on the theory of internal deficiency and evil in the middle, such as “The Essentials of the Golden Needle”, which holds that: the meridians and veins are empty, and wind evil takes advantage of the deficiency to enter the middle. After the Tang and Song dynasties, especially during the Jin and Yuan dynasties, the theory of internal wind was highlighted, which can be considered a major shift in the doctrine of the etiology of stroke. For example, Liu Heshan advocated that the heart fire is strong; Li Dongyuan believed that the righteousness is deficient, and Zhu Danxi advocated that the dampness and phlegm generate heat; Wang Cui proposed the true middle class from the etiological point of view, in which those who are triggered by the attack of external evil are called true middle, and those who develop without the attack of external evil are called class middle. Zhang Jingyue also advocates the theory of non-wind and puts forward the argument of internal injury and accumulation of loss.
Causes of cerebral infarction Cerebral infarction mainly has two types of thrombosis and embolism.
(a) The etiology of non-embolic cerebral infarction are.
1, atherosclerosis in the arterial blood vessel wall, the formation of thrombus on the basis of atherosclerotic plaque.
2, arteritis inflammatory changes in cerebral arteries can mostly cause changes in the vessel wall, narrowing of the lumen and the formation of thrombus.
3, hypertension can cause transparent degeneration of the arterial wall, arterial intima rupture, so that platelets can easily attach and collect and form thrombus.
4, blood diseases such as erythrocytosis are prone to thrombosis.
5, mechanical compression of the outside of the cerebral vessels by nearby tumors and other factors, can appear the change of vascular occlusion.
(B) The cause of embolic cerebral infarction is often a solid, liquid, or gas embolus brought into the cranium by blood flow to block a cerebral vessel. There are many causes, mainly of cardiogenic and non-cardiogenic origin.
1. Acute or subacute endocarditis of cardiac origin, which generally occurs on the basis of heart disease. The lesion of the endocardium due to inflammation knotted into superfluous, after shedding with the blood circulation into the cranium occurs cerebral embolism. Such as wind heart disease, myocardial infarction, congenital heart disease, heart tumor, heart surgery, etc. are prone to dislodge emboli. Especially these heart diseases, when atrial fibrillation occurs, it is more likely to dislodge the embolus, which can cause cerebral embolism.
2, non-cardiogenic gas embolism, fat embolism when long bone fracture, pulmonary vein embolism, cerebral vein embolism are the causes of non-cardiogenic cerebral embolism. Some of them cannot be traced to the source of embolism called cerebral infarction of unknown source.
Symptoms of cerebral infarction.
(1) Those with thrombosis are mostly seen in middle-aged and elderly patients with atherosclerotic hypertensive disease, diabetes mellitus and other diseases; while those due to emboli often have signs of diseases of embolic origin, such as heart diseases, especially atrial fibrillation and heart valve diseases.
(2) In thrombosis, there are often previous transient ischemic attacks, such as dizziness, vertigo, and weakness of one limb, which start slowly and often occur during sleep or quiet time; while in those caused by emboli, there are mostly no prodromal symptoms, rapid onset, and development to peak within minutes.
(3) Less often, there are whole-brain symptoms such as severe consciousness impairment and intracranial hypertension, but mainly signs of focal cerebral deficits, which vary according to the involved blood bone sites: for example, ipsilateral unilateral blindness or/and Horner’s syndrome and contralateral hemiparesis in internal carotid artery occlusion; contralateral complete hemiparesis, sensory impairment, and ipsilateral hemianopia in middle cerebral artery occlusion; vertigo, nausea and vomiting, hoarseness, and dysphagia in posterior inferior cerebellar artery occlusion. The occlusion of the posterior inferior cerebellar artery is associated with vertigo, nausea and vomiting, hoarseness, dysphagia, ipsilateral Horner’s syndrome, ataxia, ipsilateral facial hyperalgesia and ipsilateral limb hyperalgesia or mild hemiparesis.
(4) If it is caused by emboli, in addition to brain signs, embolic signs such as skin, mucous membrane, retina, spleen, kidney and heart can also be seen.
Diagnosis of cerebral infarction.
(1) Electrocardiogram, echocardiogram, chest X-ray and monitoring of blood pressure can provide signs of primary diseases, such as hypertensive disease and different types of heart diseases, etc.
(2) Head X-ray radiographs can sometimes reveal calcified shadows in the siphon of the internal carotid artery; those with more extensive infarction may show midline wave shift after 2—3 days of onset, which lasts for about 2 weeks.
(3) Cerebral angiography can reveal the site of arterial occlusion or stenosis, vascular compression due to cerebral edema, displacement and collateral circulation, etc.
(4) Brain CT and MRI can show the site of cerebral infarction, its size, its surrounding cerebral edema and the presence of hemorrhagic signs, etc. They are the most reliable non-invasive diagnostic tools.
Lacunar cerebral infarction is a kind of small infarct foci with a diameter of no more than 1.5 cm. This kind of infarction mostly occurs in the deep basal ganglia region of the brain and the brainstem, etc. Blockage of deep penetrating arteries in these areas results in small focal brain tissue ischemia and necrosis called lacunar cerebral infarction. The most common cause of lacunar cerebral infarction is hypertensive atherosclerosis, in which long-term hypertension causes degeneration of the walls and narrowing of the lumen of small arteries in the brain, and occlusion of small arteries occurs under certain hemodynamic factors or triggers of blood changes. CT scan is the most effective test to diagnose lacunar cerebral infarction.
Treatment of cerebral infarction 1. Western medical treatment of cerebral infarction 2. Chinese medical evidence-based treatment of cerebral infarction The treatment principles of cerebral infarction are: for large infarcts, dehydrating agents should be applied promptly to remove cerebral edema. For general infarct foci, it is appropriate to apply anti-platelet aggregation drugs, calcium antagonists, and vasodilators to prevent re-formation of new infarcts as well as to strengthen collateral circulation to facilitate the repair of lesions. The exercise of neurological function should be started as early as possible after the acute phase to reduce the disability rate.
Dietary considerations for patients with cerebral infarction Cerebral infarction patients can first get timely treatment, on the basis of which, together with dietary therapy, there will be great results, and their diet should pay attention to giving an easily digestible, high vitamin diet. Some fresh vegetables can be given finely chopped, and fruit pressed juice is taken frequently. If a patient with cerebral infarction cannot eat for more than 24 hours, nasal feeding can be given to maintain nutrition. Daily diet should pay attention to.
(1) Limit fat intake. Reduce the total amount of fat in the daily diet, reduce animal fat, cook without animal oil, but use vegetable oil, such as soybean oil, peanut oil, corn oil, etc. To limit the cholesterol in the diet, it should be within 300 mg per day, equivalent to 3 egg yolks per week
(2) Control total calories. If the total fat intake in the diet is controlled, blood lipid is going to drop.
(3) Increase protein in moderation. As the amount of fat in the diet decreases, protein should be increased appropriately. Can be provided by lean meat, skinless poultry, can eat more fish, especially sea fish, daily to eat a certain amount of soy products, such as tofu, dried beans, is beneficial to reduce blood cholesterol and blood sticking.
(4) Limit the intake of refined sugar and sweet foods containing sugar, including snacks, candy and drinks.
(5) Patients with cerebral infarction have a small amount of salt, and should adopt a low-salt diet with 3 grams of salt daily, which can be added after cooking and mixed with salt.
Pay attention to the cooking ingredients. In order to increase appetite, you can add some vinegar, tomato sauce and sesame sauce when stir-frying vegetables. Vinegar can season outside, but also accelerate the dissolution of fat, promote digestion and absorption, sesame paste contains high calcium, regular consumption can supplement calcium, which is beneficial to prevent cerebral hemorrhage.
(6) Patients with cerebral infarction should drink water frequently, especially in the early morning and in the evening. This can dilute the blood and prevent the formation of blood clots.
Care of cerebral infarction Cerebral infarction refers to the brain blood supply disorder, ischemia and hypoxia causing necrosis and softening of brain tissue. The main common clinical ones are cerebral thrombosis and cerebral embolism. Common nursing problems include.
① Defective self-care of life.
(ii) Ineffective airway clearance.
③impaired physical activity.
④ activity intolerance.
⑤ verbal communication impairment.
⑥anxiety.
⑦ the possibility of decubitus ulcers
⑧ risk of trauma.
⑨ risk of aspiration by mistake.
⑩potential complications – pulmonary infection; 11 potential complications – urinary tract infection.
Goals of care for cerebral infarction.
1.Patients feel clean and comfortable during bed rest, and their living needs are met.
2.Patients can perform self-care activities, such as combing hair, washing face, going to the toilet, dressing, etc.
3.Patients return to the original level of self-care of daily life.
4.Nursing measures for cerebral infarction 5.Assist the patient to complete self-care activities and encourage the patient to seek help.
6.Place the items frequently used by the patient in an easy-to-reach place so that the patient can easily access them at any time.
7.Signal lights are placed at the patient’s hand and answered immediately when the bell is heard.
8.Encourage the patient to complete self-care activities independently during the recovery period to enhance the patient’s ability and confidence in self-care, so as to adapt to the needs of returning to the family and society and improve the quality of survival.
9.Assist the patient to complete life care during bed rest.
Dressing/fixing self-care defects.
①Guide the patient to dress on the affected side first, then on the healthy side, and to undress on the healthy side first, then on the affected side.
② Encourage the patient to wear looser and softer clothes to make dressing and undressing easy and comfortable.
③ Wear shoes without laces.
④When changing the patient’s clothes and pants, pay attention to cover with a screen, and shake the head of the bed appropriately to help the patient when needed.
Hygiene/bathing self-care deficiencies.
①Help the patient to complete morning and evening care, assist the patient to wash face, brush teeth, rinse mouth, comb hair and cut finger (toe) nails.
②A family member or chaperone needs to be present during bathing to give appropriate assistance.
③Give a bed bath if necessary, close the doors and windows, and adjust the room temperature.
④When sweating a lot, scrub in time and change clean clothes and pants.
Self-care defects in toileting.
①Someone should accompany the patient when going to the toilet and give the necessary help.
②Place toilet paper within the patient’s reach and help the patient to dress and undress when necessary.
③ Pay attention to safety when going to the toilet to prevent falls.
④Encourage the patient to develop the habit of regular bowel movement as much as possible to keep the bowels open.
⑤ Give a commode if necessary and assist the patient to defecate in bed.
Self-care deficits in eating.
①Keep the eating place quiet and clean, and avoid nursing activities such as changing bed sheets and cleaning bed sheets while eating.
②Give the patient sufficient time to eat, and the speed of eating should be slow.
③Patients with swallowing difficulties should be fed semi-liquid diet or liquid diet.
④For patients who cannot eat by mouth, give nasal feeding of fluid if necessary, and provide oral care twice a day.
⑤ Encourage the patient to eat with the healthy hand as much as possible.
First aid for cerebral infarction Home emergency treatment for cerebral infarction.
(1) Patients should rest flat on their backs and be given a diet rich in nutrients, multivitamins and easily digestible food.
(2) When vomiting, the contents of the mouth should be removed in time.
(3) Protect the paralyzed limbs to avoid abrasions.
(4) Turn the limb more often and make passive movements early to prevent muscle contracture and restore muscle strength.
(5) Send to hospital for treatment as soon as possible.