Cerebral infarction is a chronic disease with “high morbidity, high mortality, high disability, high recurrence rate and many complications”. At present, the recurrence rate of cerebral infarction in China is as high as 40%, and many patients have frequent infarction and find it difficult to get rid of the entanglement of cerebral infarction. Patients with cerebral infarction often have a recurrence and their condition is aggravated once, which is even life-threatening. For patients with cerebral infarction, insisting on scientific and reasonable secondary prevention is the most effective measure to improve patients’ quality of life and reduce the high recurrence rate.
I. Common causes of cerebral infarction recurrence.
1.Interruption of reliable drug treatment: the pathological basis of cerebral infarction is atherosclerosis. Cerebral atherosclerosis does not subside after thrombosis subsides, and cerebral infarction may still re-form. Therefore, the effective treatment of the cause of cerebral infarction by anti-atherosclerotic and anti-thrombotic drugs cannot be interrupted. In particular, anti-platelet drugs such as BAY aspirin and Polivy can effectively antiplatelet aggregation, which can reduce the risk of recurrence.
2, excessive blood pressure lowering: excessive blood pressure lowering is an important cause of cerebral infarction. Therefore, it is necessary to correctly apply antihypertensive drugs. The process of medication should adhere to regular blood pressure measurement, adjust the dose, do not just increase the dose.
3, overworked or poor rest: overworked or poor rest is likely to cause blood pressure fluctuations or hemodynamic changes, which can easily cause the formation of cerebral infarction.
4, irregular life: the same reason as overwork, is one of the causes of recurrence of cerebral infarction.
5, tobacco addiction: tobacco poisoning can damage the intima, and can cause small blood vessel constriction, narrowing of the lumen, and therefore easy to form thrombosis.
6, alcoholism: a large number of references to strong alcohol, harmful to the blood vessels. According to the survey, alcohol abuse is one of the triggers of cerebral infarction.
7, rage or depression: bad mood, especially rage or long-term depression, anxiety, can cause vascular neuroregulation malfunction, or lead to cerebral vasoconstriction, is an important trigger for cerebral infarction.
8, cold stimulation, seasonal changes: not only can cause small blood vessel constriction, but also cause an increase in blood viscosity, which can easily induce cerebral infarction.
9, high-fat, high-calorie diet: If you enter a high-fat, high-calorie diet for a long time, it can further increase blood lipids and blood viscosity, which can easily lead to recurrence of cerebral infarction.
10. Dehydration caused by violent vomiting and diarrhea: Since dehydration can increase blood viscosity, dehydration caused by various reasons can trigger recurrence of cerebral infarction, and patients and their families should be alert to this, and should be treated early if there is a tendency of dehydration.
Second, how to prevent the recurrence of cerebral infarction
1.Regular checkup and consultation
After suffering from cerebral infarction, patients should regularly check blood pressure, electrocardiogram, blood sugar and blood lipids, and consult with neurologists according to their examination results to help solve various problems encountered.
2.Change the bad life style
Quit smoking completely and control the amount of alcohol consumption. Male patients with cerebral infarction should not drink more than one tael of alcohol per day on average, and female patients should not drink more than half a tael, and of course it is best if they can not drink alcohol.
Weight control. Obesity is a risk factor for cerebral infarction, and weight should be controlled through diet (especially high-energy food) and physical exercise. Eat a balanced diet, more vegetables, fruits and cereals, and reduce the intake of saturated fatty acids and cholesterol; control salt intake to less than 6 grams per day. Adhering to exercise can reduce the risk of recurrence by 20%. Perform at least 30 minutes of moderate physical activity, such as walking, jogging, tai chi, cycling, etc., 5-7 times a week. In addition, adjust your mentality, treat yourself and others correctly, and try to maintain a positive, open and relaxed mood. For people with depressive tendencies should be treated with additional antidepressants.
3.Control risk factors
There are many risk factors for cerebral infarction, mainly hypertension, hyperlipidemia, diabetes, obesity, smoking, coronary heart disease and so on. For patients with cerebral infarction with hypertension, blood pressure should be controlled to below 140/90mmHg, and antihypertensive drugs can be chosen according to the specific conditions of patients.
There are also some misconceptions about hyperlipidemia. Many patients with cerebral infarction whose blood lipids, especially total cholesterol, are within the normal range, think that they do not need oral lipid-lowering drugs, which is a wrong understanding. In fact, what is closely related to atherosclerotic cerebral infarction is LDL and HDL in total cholesterol, so patients with cerebral infarction should not only look at the total cholesterol level, but should check both HDL and LDL. The higher the HDL, the better. Patients with cerebral infarction need to take relevant oral lipid-lowering drugs even if their blood lipids are normal. Many studies have shown that statin lipid-lowering drugs can not only lower lipids, but also slow down the progression of atherosclerosis and stabilize atherosclerotic plaques and prevent plaque shedding. Therefore, as long as atherosclerotic cerebral infarction is present, regardless of lipid levels, long-term oral statins (such as simvastatin or atorvastatin) should be taken, but attention needs to be paid to their side effects, such as liver function damage and muscle damage. Liver function and myocardial enzyme profile should be checked 1-2 months after starting statin drugs, especially in patients who develop muscle weakness and soreness.
Patients with cerebral infarction with concomitant diabetes should strictly control blood glucose at normal level, regularly test blood glucose and glycosylated hemoglobin, and control glycosylated hemoglobin less than 7%.
4.Adhere to antiplatelet drug treatment
Except for patients with cerebral embolism caused by cardiac reasons such as atrial fibrillation who need long-term oral warfarin to prevent re-embolism, patients with atherosclerotic cerebral infarction need lifelong oral antiplatelet drugs to prevent re-embolism. The commonly used antiplatelet drug is enteric aspirin at a dose of 50-100 mg once daily, preferably taken orally after dinner. Oral clopidogrel 75 mg once daily is also an option, but is more expensive. Clopidrel is recommended for patients with coexisting hypertension, diabetes, hyperlipidemia, obesity, or allergy to aspirin.
The main side effects of aspirin are bleeding, such as gastrointestinal bleeding and nosebleeds, but the incidence is extremely low. Studies have shown that the benefits of aspirin application in patients with atherosclerotic cerebral infarction far outweigh its side effects of bleeding. Unless oral aspirin is contraindicated by severe gastrointestinal ulcers and hematologic disorders, patients with cerebral infarction should take oral aspirin for life.
Patients who have suffered from cerebral infarction must avoid the triggers of recurrence, adhere to the treatment of oral medication, moderate activities and regular review to prevent the recurrence of the disease. I believe that through your own efforts and under the guidance of your doctor cerebral infarction will not haunt you anymore.