1., What is cerebral hemorrhage?
Brain hemorrhage is a hemorrhage in the brain parenchyma, which is also called hypertensive brain hemorrhage or cerebral hemorrhage because it is directly related to hypertensive disease. It is a common acute cerebrovascular disease in middle-aged and elderly people, with high mortality and disability rates. Cerebral hemorrhage accounts for 10%-20% of all stroke patients, and according to epidemiological surveys, about 24 out of l0 million people have cerebral hemorrhage for the first time each year. The occurrence of this disease is most closely related to hypertension, which has about 1/3 chance of occurring in patients with hypertension, and about 95% of patients with cerebral hemorrhage have hypertension. In addition, a small number of cerebral hemorrhages, which are caused by causes other than hypertension, are also known as non-hypertensive cerebral hemorrhages. Cerebral hemorrhage caused by hypertension is called primary cerebral hemorrhage, while cerebral hemorrhage caused by other causes (such as trauma, blood disorders, etc.) is called secondary cerebral hemorrhage.
2. What are the causes of cerebral hemorrhage?
The causes of cerebral hemorrhage can be broadly divided into two categories, namely, cerebral hemorrhage related to hypertension and cerebral hemorrhage caused by non-hypertension. Hypertension is the most common and important cause of cerebral hemorrhage, and about 95% of patients with cerebral hemorrhage have hypertension. How does hypertension cause cerebral hemorrhage? A lot of research has been done around this issue and there are many arguments, the more recognized one is the microaneurysm theory.
The mechanism of formation is as follows: due to long-term hypertension, blood vessels are subjected to large shocks, blood flow shear stress acts on the intima surface of cerebral arteries for a long time, which can cause damage, shedding or increased permeability of endothelial cells, and passive blood pressure causes turbulence and eddy currents in the arterial division and the dilated part after stenosis, resulting in intima damage and atherosclerosis, and microaneurysms can be formed in the penetrating arteries in the brain.
According to research, microaneurysms are more common over the age of 50 and are mainly found in the arteries supplying the basal ganglia, the striate arteries and the arteries supplying the cerebral bridge, the white matter of the brain and the cerebellum (with a diameter of 100 to 300 microns). Miniature aneurysms are caused by the continuous action of high blood pressure, which leads to structural changes in the arterial wall itself, reducing the strength and elasticity of the arterial wall and causing the weak parts of the vessel wall to bulge outward, resulting in the formation of sac-like miniature aneurysms.
When the blood pressure suddenly rises, it can cause the rupture of the miniature aneurysm and result in cerebral hemorrhage. Non-hypertensive cerebral hemorrhage can be caused by cerebrovascular malformation, cerebral artery amyloidosis, cerebral aneurysm stroke, blood being disease, traumatic brain injury, and many other causes. Cerebrovascular malformation is the more common cause and one of the main causes of cerebral hemorrhage in young people, accounting for about 1/4 of non-hypertensive cerebral hemorrhage.
Vascular malformations are mostly arteriovenous malformations, and these vessels are extremely irregular in their morphology, often with segmental dilatation, discontinuous elastic fibers, poorly developed smooth muscle, or even completely replaced by fibrous tissue, so they are prone to break-type hemorrhage. Cerebral artery amyloidosis, a common cause of spontaneous cerebral lobe hemorrhage, accounts for about 5%-10% of cerebral hemorrhage, and is caused by amyloidosis of the interstitial matrix of the vessel wall, which is fragile G Other such as cerebral tumor stroke, coagulation disorders, aplastic anemia, thrombocytopenic purpura, hemophilia, fungal cerebral arteritis, leptospirosis cerebral arteritis, and traumatic brain injury can cause cerebral hemorrhage, accounting for about l0%.
3.What factors are related to the development of cerebral hemorrhage?
There are many factors that cause cerebral hemorrhage, mainly in the following aspects.
(1) Hypertension is an important cause of cerebral hemorrhage, of which systolic blood pressure is particularly important. As the systolic blood pressure increases, the incidence of cerebral hemorrhage also gradually increases. When physical and mental words are tense, blood pressure rises further, and when the pressure exceeds the ability of the blood vessels to withstand it, cerebral hemorrhage occurs when the blood vessels rupture. It is reported that about 70-80% of brain hemorrhage is caused by high blood pressure.
(2) Type A personality, is said to be manic temper. People with this personality are prone to cerebral hemorrhage, and the incidence of anti-hemorrhage is four times higher than that of people with other personalities. People with this personality have a strong desire for success, quick success, high goals, keen competition, a sense of time urgency, too competitive, fast-paced speech and action, all day in a state of tension, impatient temper. Due to mental tension, sympathetic excitability increases, catecholamine secretion increases, pulse, heartbeat accelerates, vasoconstriction reaction is strong, resulting in increased blood pressure, cerebrovascular rupture is easy to occur hypertensive cerebral hemorrhage.
(3) obesity can indirectly affect the occurrence of cerebrovascular disease through blood pressure factors. Studies have confirmed that weight increase blood pressure also increased. Reduce body weight can reduce the risk of hypertension, each reduce body weight 1 kg * to reduce systolic blood pressure 0.3 kPa (2.25 mm Hg), diastolic blood pressure decreased by 0.2 kPa (1.5 mm Hg). More than 20% of the standard weight of obese people, the prevalence of hypertension, than normal weight people 2.9 times higher.
(4) Excess salt is a contributing factor to hypertension, thus increasing the chance of cerebral hemorrhage. Salt is an indispensable substance for the human body, but long-term consumption is harmful. Some people love to eat salty food, which is a bad habit. Studies have confirmed that salt has a direct damaging effect on the blood vessel wall, can increase the sensitivity of blood vessels, so that the blood volume increases, blood pressure increases, easy to occur brain hemorrhage.
(5) Other, such as smoking, alcoholism, emotional excitement, excessive fatigue, sexual intercourse, constipation, and brain tension activities, are all contributing factors to cerebral hemorrhage.
4.What are the principles of treatment in the acute stage of cerebral hemorrhage?
The purpose of treatment in the acute phase of cerebral hemorrhage is to save the patient’s life, prevent various complications and enable the patient to pass the acute phase smoothly. The treatment principles are as follows.
Surgical treatment: If the amount of cerebral hemorrhage is more than 30ml, or if there is hemiplegia or coma, surgical treatment should be performed at an early stage to remove the hematoma in order to save the patient’s life and reduce the appearance of complications and sequelae. The following points should be noted in the postoperative period and in patients who do not require surgery.
(1) Keep quiet and bed rest: Minimize unnecessary moving and preferably treat in close proximity. Regularly observe changes in blood pressure, pulse, respiration and consciousness.
(2) Keep the airway unobstructed: loosen the collar and remove the denture. Lateral position is better to facilitate the flow of oral secretions and prevent backward tongue drop. For those with excessive respiratory secretions and sputum, tracheotomy should be performed if necessary.
(3) Maintain nutrition and water and electrolyte balance: for those who are awake and do not vomit, try comb food; for those who are unconscious, nasal feeding can be done after 3-5 days of stable condition; patients with vomiting should be fasted; maintain water and electrolyte balance through intravenous supplemental nutrition to prevent the disease from worsening.
(4) treatment of cerebral edema, reduce intracranial pressure: commonly used drugs are 20% mannitol, 25% sorbitol or glycerol preparations. The acute phase advocates intravenous administration of drugs to avoid vomiting or gastrointestinal bleeding, and even cause complications such as aspiration pneumonia. Specific usage, by the doctor depending on the condition.
(5) Adjustment of blood pressure: In principle, the blood pressure should not be lowered too low or too fast, and it is generally appropriate to keep the blood pressure around 20/12 kPa (150/90 mm Hg injection).
(6) Prevention and control of complications; fainting patients often occur lung infection, do not turn easy to occur] sores and joint strong appropriate. For seriously ill patients, give antibiotics early to prevent pulmonary infections. If infection occurs, give sufficient amount of effective antibiotic treatment. Pay attention to the patient’s oral cleanliness, aspirate oral secretions and vomit at any time, change the position regularly, maintain the functional position of the limbs, etc.
(7) Use hemostatic drugs: commonly used hemostatic minerals, 6-amino acid, peptidase, cyclamate, etc.
5.How to prevent recurrence of cerebral hemorrhage?
Hypertension and atherosclerosis are important risk factors for cerebral hemorrhage, while excessive excitement, agitation, constipation and alcoholism are common triggers for cerebral hemorrhage. Therefore, in view of the above risk factors and triggers, taking corresponding measures to actively prevent and treat hypertension and arteriosclerosis is of great significance to prevent the recurrence of cerebral hemorrhage and to reduce the incidence and mortality of cerebral hemorrhage, which can be reduced by about 50% for those who receive treatment. Specific measures are.
(1) Insist on taking blood pressure lowering drugs to stabilize blood pressure at a safe and ideal level, with systolic blood pressure below 20 kPa (150 mmHg).
(2) eat less food containing high cholesterol, moderate food, can drink a small amount of alcohol, avoid smoking, to prevent overweight.
(3) Regularize your life, be broad-minded, prevent emotional excitement, and eat more fresh vegetables and fruits.
(4) When there is elevated blood pressure, hypertensive encephalopathy or a tendency to bleeding, all should be treated actively in time to avoid brain hemorrhage.
(5) Severe cough, constipation and sexual intercourse activities can cause cerebral hemorrhage to recur and should not be ignored.
(6) Exercise of paralyzed limbs should not be done too quickly and too early, and not too vigorously and roughly.