Stroke, also known as stroke, accounts for about 1.5-2 million new cases of stroke in China each year, with an age-corrected annual stroke incidence rate of about 116-219 per 100,000 population and an annual stroke mortality rate of about 58-142 per 100,000 population. There are currently more than 7 million existing cerebrovascular disease patients in China, and about half of the survivors of stroke are left with significant functional disability, and many need to spend the rest of their lives in hospitals, nursing homes, and other medical institutions. These cold numbers seem a bit distant, but cerebrovascular disease is already the number one cause of death in China, surpassing the dreaded cancer and heart attack, which shows its prevalence. Many people are scared of cancer, and when they hear words related to tumor, cancer, occupying lesion, mass, swelling, XX swelling, or even the English abbreviation CA, they are scared and restless, and they must find out whether it is benign or malignant. But the necessary vigilance is lacking for the great threat of stroke. The general population has a great deal of room for improvement in stroke prevention, timely recognition and delivery in the acute phase, and understanding of the condition and treatment in China. Stroke is divided into ischemic and hemorrhagic, with the former accounting for about 60-80% of the total and the rest being hemorrhagic strokes. The former is often referred to as cerebral infarction, cerebral infarction, cerebral thrombosis, cerebral embolism, “blocked cerebral vessels”, etc., while the latter is often referred to as cerebral hemorrhage, cerebral hemorrhage, etc. With current technology, the treatment and prevention of ischemic strokes, which are the most common, are relatively more effective. We will start with the recognition and treatment of acute ischemic stroke in its acute phase. Why do I want to use this topic as the first article in my series? Because I am often in the front line of emergency medicine and have seen a large number of patients with acute ischemic stroke who, for various reasons, arrived at the hospital far beyond the time window for the most effective treatment, which simply means that they came too late and could have had a better prognosis, but were just a few hours late and lost a chance to change their fate. Why is the difference of a few hours so regrettable? Because our brain tissue is so delicate that cellular necrosis occurs within minutes after complete disruption of the blood supply. But acute ischemic stroke is not so simple, because the human brain is supplied with blood by a complex system of reticulated tubes, which communicate with each other but have their own spheres of influence. When a major blood vessel is thrombosed or embolized (there is a difference caused by these two words, but both vessels are blocked, the difference will be discussed later, for today’s topic, it has little impact), the brain tissue it supplies will immediately be in a starved state. However, due to the existence of this complex network, supported by some other blood vessels, the brain tissue it supplies will not be completely necrotic all at once, and as these cells starve for longer, they will die in batches. Therefore, our main task is to rush to open the occluded blood vessels before the large number of brain cells die, so that they can be supplied with blood again. Foreigners are always emphasizing the phrase: time is brain, time is brain. This is definitely a race against time. It is possible to arrive at the hospital 2 hours after the onset of the disease and rush to use medicine, can save 80% of the cells, this stroke does not leave any sequelae at all, but 5 hours later to the hospital, no matter how to use high technology, at most can save 20% of the brain cells will be good, will leave obvious sequelae, and this time to open the blood vessels, because the blood vessels inside the brain tissue has also been broken, even if there is blood flow to restore, it will be like the Yangtze River dike Bad gap like, gushing to the outside of the blood vessel, causing secondary brain hemorrhage, the end is more terrible. Through the above introduction, the first cerebrovascular disease, especially acute ischemic stroke is very common and scary. Secondly, the possibility of taking effective treatment is closely related to the time of arrival at the hospital, and it must be the earlier the better. So should we all be at risk? Of course not. With so many years of medical development, there are many ways to know who is prone to cerebrovascular disease, and they are the ones we need to focus on. Knowing who is prone to cerebrovascular disease is the only way to be on guard. Popularize this knowledge. On the one hand, the people at risk can learn the relevant knowledge themselves, so that they can take the correct measures in a timely and decisive manner in case of the onset of the disease. On the other hand, the family members, friends and colleagues of the people at risk also have the relevant knowledge, so that on the one hand, they can supervise the prevention, and on the other hand, they can take the correct measures in a timely manner when people around them develop the disease, so that the patients can have the best prognosis. Studies have shown that most patients with cerebrovascular disease are brought to the hospital by family members, friends and colleagues, so it is important to spread knowledge about the disease to those at risk and to those around them. First, we need to understand some important risk factors, which means that people with these factors are at high risk of developing cerebrovascular disease. The first one is age. The older you are, the higher the risk of stroke, and after the age of 55, the risk of stroke increases by a factor of 10. Some of the others are already familiar: hypertension, diabetes, hyperlipidemia, and here we need to emphasize smoking, atrial fibrillation, coronary artery disease, heart failure, carotid and peripheral artery lesions, lack of physical activity, obesity, and lack of vegetables and fruits in the diet. Simply put, the more of these conditions you have, the higher the risk of getting cerebrovascular disease. Who is not surrounded by older people? Considering that with the development of China’s economy and the improvement of the population’s lifestyle, the above risk factors are very widespread. Therefore, for almost every one of us, it is necessary to know something about stroke. First of all, it is important to recognize stroke in time, and only when stroke is recognized in time, it is possible to proceed to the later steps. Here we recommend the FAST established by the University of Cincinnati, the most simple and easy to remember. face, see if the patient has facial asymmetry, commonly known as crooked mouth, crooked mouth, crooked eyes, crooked mouth 。。。。 In the case of prehospital emergencies, the patient should be able to speak fluently and clearly, with or without language dysfunction. In the case of pre-hospital emergency, a new occurrence of one of the above conditions has a 72% chance of being an acute ischemic stroke, and if all three conditions occur together, there is an 85% chance of being an acute ischemic stroke. Since stroke is an emergency, on the one hand, the delay in coming to the clinic can miss the valuable opportunity to get better treatment. On the other hand, about 1/3 of patients will experience an exacerbation within the first few days of onset, and although not all of these exacerbations will improve effectively with treatment, at least they will have an increased chance of getting better in the hospital than at home. Therefore, we need to pay attention to the high-risk group and send them to the appropriate hospital for treatment as soon as possible when they develop stroke-related symptoms. After all the talk about timely detection and coming to the hospital, what happens when you get to the hospital? First, the doctor will determine if the stroke is a new acute ischemic stroke based on the patient’s course, past medical history (assessing risk factors and some related medical history, allergy history, etc.), examination of the patient’s neurological and cardiac functions (through their own five senses and tools such as stethoscope and percussion hammer), and their knowledge and experience. If suspected, immediately go for blood tests for some necessary items, such as coagulation function, condition of several types of blood cells, heart condition, etc. Immediately go for head CT and possibly MRI (magnetic resonance imaging) if conditions are good, to visually determine what is going on in the patient’s brain through imaging. Through the above process, if the diagnosis is acute ischemic stroke, thrombolytic therapy can be given within 4.5 to 6 hours (mostly through the vein, but there are also hospitals with transarterial conditions, the former is similar to infusion, the latter needs to go into the catheterization room, under X-ray, through the catheter into the body, and directly open the occluded blood vessels with drugs or even instruments) to restore the blood supply to the ischemic brain tissue as soon as possible. Of course, these methods of restoring blood perfusion are not 100% effective, and are accompanied by certain risks. For thrombolytic drugs, recombinant tissue-type fibrinogen activator (Aitongli, rtPA) is generally used in Europe and the United States, while urokinase (several hundred RMB) is also available in China, in addition to rtPA (costing about 5,000 to 10,000 RMB per person). From the perspective of the population, about 30 out of 100 patients without thrombolysis may recover completely, and about 40 out of 100 patients with thrombolysis may recover completely. In other words, it increases the chance of complete recovery for patients by 1/3. However, it is possible to increase the risk of cerebral hemorrhage, which is very rare, but it can happen. Still, the risk of cerebral hemorrhage is more significant than the possible benefit of thrombolytic therapy. Therefore, industry guidelines in all countries recommend thrombolysis as the best treatment in the acute phase. However, due to the fragility of brain tissue and the bleeding complications of thrombolysis, to ensure the efficacy and safety of treatment, experts have specified many contraindications to thrombolysis that must be carefully checked before treatment. Thrombolysis only increases the chance of patients getting better, therefore, even thrombolysis may cause 1/6 to 5/1 of patients to die soon after stroke, and still more than 1/3 of patients will be left with significant functional disability, therefore, when patients receive treatment, if the efficacy is not good, or even deterioration and death, do not just blame the doctor, after all, birth, old age, illness and death are natural laws, our medical Even if the country’s best drugs and equipment are used, people will still be disabled and die when they get sick. Nowadays, some hospitals in China do not dare to apply thrombolysis for acute ischemic stroke, which is related to the medical environment in China. Imagine, in the current environment of medical disturbances, if the patient’s condition worsens or even dies after thrombolysis, especially when there are complications of cerebral hemorrhage, the family will blame the doctor for the worsening condition and death, how much pressure the doctor has to face, and even personal safety may be threatened. In this case, it becomes a common mentality to seek stability, preferring to do less of this slightly higher risk treatment and not to have accidents due to the treatment. The result is that many patients with acute ischemic stroke do not receive the most effective treatment in a timely manner, miss the opportunity, and are left with functional disability or even death. Medical staff and patients and families have the same goal, and patients will be better treated if we all understand each other and cooperate actively.