The onset of stroke can lead to a variety of clinical complications that, if not managed in a timely manner, can often lead to exacerbation of the disease or even death. Therefore, the proper management of complications is really up to you!
Fever
Fever is one of the most common clinical symptoms, and there are four main factors: ① infectious fever, including respiratory tract infection, urinary tract infection, decubitus ulcer and thrombophlebitis; ② central fever, mostly due to lesions involving the subthalamic area; ③ dehydration fever; ④ absorption fever. Prevention and treatment measures: ① strengthen nursing care, actively prevent the three major complications leading to infection; ② anti-infection, timely and reasonable administration of an adequate amount of effective antibacterial drugs; ③ reasonable use of dehydration agents, especially effective in the prevention and treatment of central fever; ④ effective cooling, mainly physical cooling, cautious use of antipyretic drugs, if necessary, sub-cold temperature therapy.
Digestive system complications
Gastrointestinal bleeding Stress ulcers and gastrointestinal bleeding are common complications of stroke. Gastrointestinal bleeding is often associated with the severity of stroke. The cause is thought to be mainly related to impaired hypothalamic and brainstem function after stroke; in addition, it is related to heavy use of adrenocorticotropic hormones, thrombolytic therapy, and gastric tube injury. Preventive and curative measures: (1) reduce brain damage and actively treat the primary disease; (2) actively protect the gastrointestinal tract, reasonably apply acid suppressants and gastric mucosal protective agents, and cautiously use adrenocorticotropic hormones; (3) reasonably use hemostatic agents; (4) strengthen supportive treatment and transfusion if necessary; (5) endoscopic hemostasis or surgical treatment if necessary.
Vomiting and eructation Persistent and persistent vomiting should be alerted to the presence of lesions in the posterior cranial recess or abdomen, and the patient should be placed on his or her side during vomiting to prevent aspiration of vomitus into the trachea and lungs. Irritating lesions near the diaphragm, posterior cranial recess lesions involving the medullary respiratory center, as well as dehydration and azotemia should be suspected in patients with persistent emesis.
Circulatory complications
Cerebro-cardiac syndrome Stroke involving the hypothalamus, brainstem and limbic system causes similar myocardial ischemia, myocardial infarction, arrhythmia or heart failure, called cerebro-cardiac syndrome. The main manifestation is electrocardiographic changes, and the abnormal electrocardiogram also improves when the brain lesion improves. Preventive and curative measures: ①Cardiac examination and monitoring, timely identification and treatment of cardiogenic or cerebrogenic ECG abnormalities; ②Early protection of the heart, strengthening myocardial protection treatment, paying special attention to the application of mannitol and correction of electrolyte disorders.
Pulmonary embolism and deep vein thrombosis Pulmonary embolism is related to deep vein thrombosis and is a common complication of stroke. The incidence of deep vein thrombosis can be as high as 60%, mostly within the first week of stroke, and 10% to 30% in patients with pulmonary embolism. Prevention and treatment measures: active and passive activities of the affected limb, prevention of hemoconcentration, wearing tight-fitting leggings, early use of anticoagulants in ischemic stroke, etc. should be used to prevent deep vein thrombosis, and lower limb venous filter should be used in patients with hemorrhagic stroke who cannot be treated with anticoagulation.
Respiratory complications
Pulmonary infections are one of the most common causes of death after stroke. Combined pulmonary infections are associated with impaired consciousness, prolonged bed rest with bruising at the base of the lungs, difficulty swallowing, choking or accidental ingestion of food and upper respiratory secretions. Preventive measures: ① regularly turn and pat the back, encourage the patient to cough hard; ② avoid getting cold, prevent lung infection by nebulized inhalation if necessary; ③ apply antibacterial drugs in a timely manner once lung infection is detected; ④ eat soft food, eat water slowly to prevent aspiration into the trachea.
Pulmonary edema Occasionally seen in patients with large cerebral infarction, mainly due to the release of sympathetic neuromediators in large quantities resulting in high pressure in the body circulation and acute myocardial damage, causing acute left heart failure; too rapid infusion, inappropriate secretion of antidiuretic hormone (ADH) secondary to stroke can be the cause of pulmonary edema, which must be treated urgently, keeping the airway open, high-flow oxygenation, and applying cardiac and diuretic agents.
Hyperosmolar coma
Hyperosmolar coma can occur when blood glucose is ≥33.3 mmol/L and plasma osmolality is ≥350 mmol/L. The higher the blood glucose, the greater the chance of death from stroke. Preventive measures: (1) reduce the brain damage and its resulting stress reaction, and actively treat the primary disease; (2) pay attention to timely adjustment of rehydration and regular monitoring of plasma osmolality; (3) regularly monitor and effectively control blood glucose in a timely manner, keeping it at 1-5 mmol/L and applying insulin therapy if necessary; (4) correct hyponatremia.
Complications of urinary system
Acute renal failure Most patients with cerebrovascular disease have a history of chronic hypertension. The long-term effect of hypertension can lead to sclerosis of small renal arteries and impair renal function to varying degrees. The joint participation of various factors such as the use of dehydrating agents, insufficient blood volume and the application of certain nephrotoxic drugs can lead to acute renal failure. Preventive and curative measures: ① emphasize prevention, prevent excessive dehydration, and pay attention to replenishment of blood volume; ② cautiously use or disable nephrotoxic drugs; ③ strengthen nutrition, timely correction of water-electrolyte disorders and acid-base balance imbalance; ④ dialysis treatment if necessary.
Urinary tract infection Most commonly seen in female patients. Clinical manifestations are urinary frequency, urinary urgency, urinary pain or urinary incontinence. The perineum should be kept clean, patients should be encouraged to urinate on their own, catheterization should be avoided as much as possible, catheterization should be strictly aseptic, and appropriate antibiotics should be used promptly once urinary tract infection is detected.
Urinary incontinence After stroke, there are various causes of urinary incontinence. The common ones are impaired urinary centers such as the paracentral lobule, patients with impaired consciousness, and partly those with bladder dysfunction due to expression disorders. Prevention and treatment measures: ① strengthen care, non-consciousness-impaired male patients can use penis sleeve, also local hot compress or massage, try to avoid indwelling catheter; ② consciousness-impaired people should be indwelling catheter; ③ strengthen care to prevent the occurrence of decubitus ulcers; ④ apply antibiotics to prevent urinary tract infection if necessary.
Symptomatic epilepsy
The incidence of post-stroke epilepsy is about 10%, which may be related to local scar formation. Epilepsy leads to the release of excessive excitatory amino acids, causing secondary hypoxia and ischemia of neurons, which aggravates neurological dysfunction and increases the morbidity and mortality rate. Post-stroke epilepsy is generally easier to control, one is to actively treat the primary disease, and the other is to give an adequate amount of effective antiepileptic drugs for early treatment. If a drug is still not well controlled, a combination of drugs can be used. The first choice is Valium to control the persistent status epilepticus as soon as possible.
Shoulder-hand syndrome
Shoulder-hand syndrome is a group of clinical symptoms such as pain, swelling and limitation of movement in the shoulder and finger-wrist joints of the paralyzed upper limb within 3 months after stroke. Shoulder-hand syndrome is usually seen in the upper extremity with severe paralysis. The first symptom is persistent pain and limitation of movement in the scapular region, and the affected upper extremity is obviously limited in abduction and external rotation, followed by pain and swelling in the hand and limitation of finger flexion. The most effective treatment for shoulder-hand syndrome is early prevention, keeping the affected limb in its functional position, strengthening the passive and active activities of the affected limb, especially the shoulder and hand, and applying painkillers, local physiotherapy or local closure therapy when the pain is severe.
Post-stroke dysphagia
Dysphagia is a common post-stroke complication and is associated with increased disability and death rates. Most post-stroke dysphagia is related to oropharyngeal dysfunction. Preventive and curative measures: ① Enhancement of the afferent pre-swallowing sensory impulses by mechanical stimulation of the tongue or pharyngeal gate or by cold, acid and electrical stimulation can lower the threshold of pharyngeal motor initiation and shorten the delay of pharyngeal response; ② Some trials suggest that pharmacological treatment (nifedipine) may be effective, but further research is needed; ③ Adopting chin down (chin inward) with the epiglottis backward to narrow the entrance to the pharynx and enhance the protection of the airway can have some effect on The delayed pharyngeal phase has a certain effect; ④ if necessary, a nasogastric tube or nasogastric tube is given to ensure the patient’s gastrointestinal nutrition.
Post-stroke depression
About 30% to 50% of post-stroke patients have varying degrees of depression, which can occur within 1 week to 2 years after the stroke. The symptoms include headache, insomnia, sadness, depression, sleep disturbance, restlessness, anxiety, disappointment, and even suicide attempts. Post-stroke depression is significantly associated with anterior brain damage such as frontal lobe or left basal node. In addition to psychotherapy, antidepressants such as promethazine or amitriptyline may be used for treatment.
Electrolyte disorders
There are many reasons for electrolyte disturbance in stroke, including inappropriate rehydration and fasting, application of dehydrating agents and adrenocorticotropic hormone, and abnormal secretion of antidiuretic hormone (ADH) due to the involvement of hypothalamus.
Multi-organ failure
MOF refers to the simultaneous or sequential failure of two or more organs, and the death rate can be over 70%. According to statistics, if only one organ fails, the mortality rate is 30%, two is 60%, three is 80%, and four is nearly 100%. Treatment measures: ① actively strengthen nursing care and monitor vital organs; ② actively anti-infection and anti-shock treatment; ③ strengthen nutritional support to ensure energy supply; ④ actively prevent further progression of the original brain disease and prevent hypothalamic and brainstem dysfunction; ⑤ strictly control the application indications of dehydrating agents, antihypertensive drugs, adrenal corticosteroids and other drugs, and avoid the application of nephrotoxic drugs; ⑥ maintain water, electrolytes and acid-base balance is very important to prevent MOF.
In conclusion, patients with acute stroke can have potential complications of various systems, which must be recognized early and managed effectively in a timely manner to reduce their morbidity and mortality rates.