1.Why must we race to save the stroke?
In the supply of blood and oxygen, the brain cells are like a “dude”: delicious – the need for blood and oxygen is large, and must not be left; lazy – it will neither make Energy and oxygen, but also can not store them, but completely rely on the cerebral vascular supply moment by moment.
The human brain has two characteristics: first, the size is small, and weight only 2-3% of body weight, but its demand for oxygen accounts for 1/4 of the oxygen we breathe into the lungs. so the heart has 1/5 of the blood displacement per minute are in the brain. Second, it is not like the liver. The liver has no oxygen material to make on its own, and it hides it. When it is done, it hides it and doesn’t use it until there is nothing left to use, like a refrigerator. The brain cell does not have this ability. It needs blood and oxygen supply from the blood vessels of the brain every moment, and is very sensitive to ischemia and hypoxia. Once there is an accident in the cerebral blood vessels and there is a problem with the blood supply, it only takes more than 6 hours for the brain cells to die because they are “deprived of food”. For the brain cells that have already died, even Hua Tuo is alive, but there is no way to return to heaven. This is the reason why we must race against time to save stroke patients. Zhang Peng, Department of Orthopedics, Qingfeng County People’s Hospital
2. How do you know when an old man has had a stroke?
Stroke is called in Chinese medicine, but in Western medicine it is called cerebrovascular disease, and now it is more likely to be called stroke. Stroke includes cerebral hemorrhage, cerebral thrombosis and cerebral embolism. Cerebral thrombosis and cerebral embolism are also combined and called cerebral infarction. Whether it is a cerebral hemorrhage or a cerebral infarction, they all have the same consequence, that is, they can no longer supply blood to the brain cells properly.
To determine whether a person has had a stroke, the following two points are the main basis: first, the urgency of the onset. Stroke is an acute cerebrovascular disease, not a chronic one. Most patients experience hemiplegia, slurred speech, and other symptoms of hemiplegia within minutes, hours, or at most a day or two. If a person develops these symptoms slowly, for example, half a year before one side of the body becomes paralyzed, unclear speech, etc., it is possible that it is a tumor and not a stroke. Strokes usually come very violently. For example, there are patients with brain hemorrhage who are playing tai chi in the morning and then fainted and became paralyzed.
Second, according to the symptoms. Stroke is generally manifested as an acute attack of hemiplegia, unclear speech, or unstable holding things, unstable walking, easy to choke on water. Patients with cerebral hemorrhage also have severe headache and vomiting, and patients usually have a history of hypertension; patients with cerebral thrombosis often lie down well the night before and get up the next morning and become paralyzed, usually without headache, not necessarily vomiting, and with clear consciousness; patients with cerebral embolism mostly have a history of rheumatic heart disease, atrial fibrillation or other diseases, and the blood clots in the heart fall down and reach the cerebral vessels with the blood flow, blocking the small arteries. Because this process is fast, most of the patients also appear hemiplegia suddenly.
3.What should I do if I find out that someone in my family has had a stroke?
Treat stroke like angina pectoris or myocardial infarction, call “120” as soon as you find out, and take the patient to the hospital as fast as possible.
People do not seem to be as determined as they are with angina and myocardial infarction on this issue. If someone in the family has angina or myocardial infarction, both the patient and the family can realize that they should go to the hospital immediately. This is not the case with stroke, which is also related to the onset of stroke. Instead of having half of the body paralyzed all at once, a stroke sometimes may manifest as only half weakness, but still able to move. In some cases, it is only half of the body is numb, or the speech is not very clear, maybe after a while it is better, also not numb, also have strength, also clear speech, and the patient will not go to the hospital. Therefore, there are often cases: after waking up in the morning, the elderly find themselves a little numb, or half of the body can not make the strength, often look first, the family also hold the idea of observation, that if the bad then go to the hospital. The result has been waiting, until half of the body will not move, only to realize that something is wrong, only to go to the hospital. Even if the doctor stops the bleeding and dissolves the blood clot, the dead brain cells cannot be restored and the patient becomes permanently hemiplegic.
Therefore, once a family member is found to have hemiplegia, not necessarily total paralysis, as long as there is weakness and numbness in half of the body and unclear speech, don’t hesitate to call “120” and take the patient to the hospital immediately. On this issue, we should “believe it rather than not believe it”.
We had a patient who came with only one degree of muscle strength, that is, he could only move his fingers and toes. Since he came in time, we immediately sent him to the operating room for thrombolytic therapy. As a result, he was able to lift his arm and leg with one injection. Later the patient walked back to the ward by himself without any after-effects, so much so that there was a problem when he went back for reimbursement and the plant manager said, “What kind of injection did you give? 20,000 yuan for 1 injection, not to be reimbursed.” He explained half a day: “I have a brain
I had a stroke.” But the factory manager said, “Then how come you don’t have any after-effects?” This shows how good the effect of early treatment is.
4. What is the best hospital to send the patient to?
Send to a tertiary care hospital, send to the provincial hospital, send to the largest hospital you can send.
If you have the conditions, it is best to send to a tertiary care hospital. Why? Firstly, tertiary care hospitals are better equipped to do CT and digital subtraction cerebral angiography, which can immediately determine the cause of the patient’s illness, whether it is cerebral hemorrhage or cerebral embolism. Secondly, tertiary care hospitals are equipped to give patients thrombolytic therapy. This is very important because the most direct treatment for a thrombus in a blood vessel is to dissolve it. Third, tertiary care hospitals have set up “stroke units”, or stroke wards, specifically for new stroke patients. There are various monitoring devices to keep track of the patient’s overall condition, and a team of neurologists, neurosurgeons, anesthesiologists, care unit doctors and rehabilitation doctors. Here, patients can receive comprehensive and regular treatment, including rehabilitation. For example, our patients have been undergoing rehabilitation since the third day of their illness. If a patient can’t move, we give him movement, every joint; if a patient has difficulty swallowing and chokes easily, which induces pneumonia, we train his swallowing function; and if a patient can’t speak, we teach him pronunciation in a scientific way. Early rehabilitation is very important and can directly reduce the sequelae of stroke.
5.Is there any aura before a stroke occurs? What should I do when aura occurs?
Headache, dizziness; difficulty seeing; numbness and weakness of the body. Do not hesitate to go to the hospital.
Stroke is usually preceded by an aura.
If you are a patient with high blood pressure and now you are experiencing more severe dizziness and headache, be careful because this may be a precursor to a stroke;
If you have high blood pressure and sticky blood, and when you wake up in the morning, you feel that your eyes are a little blurry (doctors call it black) and you can’t see clearly, and after a while they are fine again. This is also to be careful, this is often a precursor to a stroke;
If you find yourself with sudden numbness or weakness in half of your body, this is a precursor to a stroke.
What should I do if I have an aura? No matter how good it is after a while, go to the hospital to see a neurologist and ask the doctor to help you determine if there is a problem.
6.What is a mini-stroke? What should I do if I have a mini-stroke?
Patients who have had a mini-stroke, 1/3 of them must have a brain infarction within a year.
A mini-stroke is actually when a patient has the above-mentioned stroke aura, which doctors call transient cerebrovascular ischemia, abbreviated as TIA, and the symptoms of a mini-stroke are no different from those of a stroke aura, such as headache, dizziness, half-body numbness, or sudden half-body weakness, poor speech and blurred vision. The difference between it and the stroke aura is that a mini-stroke must return to normal within 2 hours. If the brain tissue of a mini-stroke patient is examined, it will be found that there is no brain cell death. After the mini-stroke has passed, the patient’s brain cells should be completely normal. If it takes more than 2 hours, the patient will have brain cell death and it should then be called a cerebral infarction.
Patients should not take minor strokes lightly. You can’t think you’re fine when you’re “well” and just leave it alone. That will be a big deal. The correct attitude is: treat small strokes should be treated like a brain infarction, so as not to become a brain infarction later.
7.What is the difference between cerebral hemorrhage, cerebral thrombosis and cerebral embolism?
Cerebral hemorrhage has a dangerous onset and high mortality rate, but as long as you get through it, the sequelae are light; cerebral infarction has a slow onset and low mortality rate, but most of them will leave sequelae.
First, the pathogenesis is different. Cerebral hemorrhage is the rupture of cerebral blood vessels, and blood flows into the surrounding brain tissue, which, on the one hand, raises the intracranial pressure; on the other hand, the brain cells supplied by the ruptured blood vessels will die of ischemia and hypoxia because of the lack of blood supply. Patients usually have a history of hypertension and often develop when they are excited. For example, some patients are giving a speech, spitting and frothing, and suddenly fall down and die. Other patients collapse when they are having a New Year’s Eve dinner and drinking. These are all due to emotional excitement, causing a surge in blood pressure, resulting in blood vessel rupture. Therefore, hypertensive patients, must not be very happy and sad, do not engage in excessive physical work.
Cerebral thrombosis is the formation of blood clots in the cerebral blood vessels, blocking them and causing ischemia and hypoxia death of the brain cells supplied by it. As atherosclerosis can make the vessel wall bumpy and not smooth, blood components are easily deposited down to form thrombus; people with high blood viscosity, blood flow is slow, and things inside the blood are also easily deposited down to form thrombus. Therefore, atherosclerosis and high blood viscosity are both high-risk factors for cerebral thrombosis.
Although cerebral embolism is also a blockage of blood vessels in the brain by emboli, the emboli come from somewhere else. For example, atrial fibrillation patients often have blood clots in the heart, and when the clots are dislodged, they may flow down the blood stream to the brain, blocking the cerebral vessels. It can be seen that cerebral thrombosis is a “local product” and cerebral embolism is an “imported product”.
Second, the performance is different. Hemiplegia is their common symptom. No matter what the cause is, it will eventually lead to the death of brain cells due to blood supply obstruction. However, in the case of cerebral hemorrhage, the onset is rapid, accompanied by severe headache and vomiting. In the case of cerebral embolism, the onset is also rapid because the embolus is also suddenly dislodged, but there are usually no headache or vomiting symptoms. Cerebral thrombosis, on the other hand, has a relatively slow onset, mostly after sleeping overnight and waking up the next day to find paralysis, mostly without headache and vomiting symptoms.
Third, the prognosis is not the same. Cerebral hemorrhage occurs viciously, and the patient can easily form brain herniation and die. However, as long as the patient is treated in time and passes the dangerous period safely, the sequelae are relatively mild, which is called “if you do not die, you will be blessed later”. Cerebral thrombosis and cerebral embolism are different, although the mortality rate is low, the possibility of sequelae is high and the disability rate is high.
Fourth, the treatment is different. Cerebral hemorrhage is mainly treated with hemostasis, dehydration (to prevent the formation of brain herniation) and blood pressure reduction. Cerebral thrombosis and cerebral embolism, on the other hand, are treated mainly with thrombolysis, fibrin-lowering, anticoagulation, and anti-platelet coagulation. The key to treatment is to be early, the earlier the better, especially not more than 6 hours.
8, the blood vessel is open, why is still paralyzed?
Before liberation, the family was poor and some people died of hunger. After liberation, the living conditions are better, but the dead people are dead, they are no longer possible to come back to life.
In the clinic, I often meet patients who have had a stroke and ask me, “Doctor, after this period of treatment, have my blood vessels opened up?”
”Yes, it has.”
”But if the blood vessels are open, how come I still can’t move? Didn’t you say that stroke is a cerebrovascular disease? Now that my blood vessels are open, why is my hemiplegia still bad?”
They forget that if the normal blood supply is not restored within 6 hours after a stroke, the brain cells die. The direct cause of hemiplegia and aphasia is not because the blood vessels are blocked, but because the brain cells have lost their function. In fact, even without any treatment, stroke patients can usually pass their blocked blood vessels after 1 month, because the blood clot itself is autolytic. Only at this time, the brain cells supplied by this blood vessel are already dead, and it is useless even if the blood vessel is open. That’s why it is emphasized that thrombolysis should be early for stroke, and patients should be sent to hospital early.
9.What should stroke patients pay attention to in their life after recovery?
Activity, activity, activity again.
Because no one can replace your paralysis, doctors or relatives can’t get into your body and help you lift your arm.
It is up to you to move.
The most important thing to note is to move more. We are most afraid of patients lying in bed and not moving. If you don’t move, you will never be able to stand up. Even if you are hemiplegic, you have to bite the bullet and get up and move. We have observed three groups of patients.
The first group of patients, after a stroke, went home after a visit to the emergency room because there was no bed in the hospital and no one at home to take care of them.
The second group of patients, who stayed in the emergency room. In the hospital, there is always a part of care.
The third group of patients, hospitalized.
So, how did these three groups of patients recover?
The one who went home was the best. Because there was no one to take care of him, he had to do everything by himself. The ones who took initiative were able to go out on their own at the end.
The one who stayed in the emergency room was fine. Because after a few days he also went home, the patient was forced out.
The worst is to stay in the hospital for treatment. Because there is something he rang the bell on the line, feeding, taking the urinal, everything is helped. They go home after discharge and recover the slowest because they need to relearn various abilities.
This shows that the patient’s initiative is very important and exercise is very important. Doctors can only teach you how to do it, not move instead of you. Exercise can only be done by yourself.
10.How to prevent stroke?
Control high blood pressure, control diabetes, treat various heart diseases, quit smoking and alcohol.
First, treat hypertension. Preventing stroke is actually preventing the risk factors that can cause stroke. Among all the risk factors, the first one is hypertension. Poorly controlled hypertension can cause stroke at any time, especially cerebral hemorrhage. Therefore, hypertensive patients, it is important to control their blood pressure in the normal range through comprehensive therapy.
Second, prevention of mini-stroke. If a minor stroke occurs, make sure to go to the hospital and ask the doctor for systematic treatment to avoid another stroke.
Third, treat diabetes. Diabetic patients with high blood sugar have a 5 to 7 times higher chance of developing cerebrovascular disease than the general population. And it is not easy to get well when you have cerebrovascular disease. Therefore, diabetic patients must keep their blood sugar under control.
Fourth, actively treat various heart diseases, such as wind heart disease, coronary heart disease, pulmonary heart disease, etc.. These diseases can cause atrial fibrillation, which is prone to the formation of blood clots. The blood clot is dislodged and flows downstream into the brain, which can cause brain embolism.
Fifth, quit smoking and alcohol. People who smoke plus hypertension are 3 to 7 times more likely to have cerebrovascular disease than those who simply have high blood pressure and do not smoke. Alcohol abuse is an important precipitating factor for cerebrovascular disease.
Sixth, people who are at risk of stroke should not take the 22-day oral contraceptive pill because it can cause ischemic strokes.
Other than that, it is to establish a healthy lifestyle, such as eating right, taking more physical exercise and avoiding mental tension.
11.Can regular infusion prevent stroke?
Regular infusion is supposed to be a treatment for specific patients. It is like a saw, a planer and a file, all of which are useful tools, but each has its own purpose and should not be used indiscriminately.
In recent years, there are some specious “new therapies”, regular infusions “to prevent” stroke is one of them.
It is specious because it was originally a treatment for a specific condition, but it has been exaggerated by some people and has become completely different.
Decades ago, doctors found that for some patients in the acute stage of cerebrovascular blood supply deficiency, the rapid intravenous input of vincristine, salvia, low molecular dextran or 706 plasma can eliminate the “string state” of blood cells gathering in bunches in the blood flow by changing the negative charge on the surface of blood cells and other mechanisms, reducing This reduces the resistance to blood flow and improves the blood supply to the brain. Clinical practice has proven that this therapy is effective for this condition. On this basis, doctors recommend such patients to take a course of infusion after six months or a year, in addition to oral medication, in order to consolidate the effect and prevent recurrence. Perhaps, this is the origin of regular infusion. However, consolidation and disease prevention, resistance reduction and blood thinning are two different concepts that should not be confused.
Excessive blood viscosity increases circulatory resistance and has adverse effects on cardiovascular disease. But the above-mentioned transfusion can only reduce blood cell aggregation, and people imagine that “dilute” blood is a completely different matter. In fact, if you really want to thin your blood, you might as well drink more water, which is safe and saves you time and money.
In the past few years, people have paid great attention to blood viscosity, but there are many reasons for the increase of blood viscosity, such as high blood lipids, high blood sugar, increased red blood cells, and the increase of various macromolecules in the blood, all of which can lead to the increase of blood viscosity. The causes are different, the treatment methods are also different, and it is never possible to just rely on “one loss”. In addition, some patients with heart disease, blind transfusion will increase the burden on the heart, causing heart failure. In this case, if you want to thin the blood, you can take oral aspirin-type drugs, which are much safer than infusions. In the clinic, we often see patients with atrial fibrillation, heart failure or even myocardial infarction caused by improper infusion, which shows that infusion is not without danger. Moreover, infusion is usually given only for about 14 days, and even if it works, it only lasts for these 14 days, and there is still a possibility of stroke during the rest of the time. I have seen such a patient who had a stroke just after returning home from the hospital with an infusion. Therefore, from the perspective of stroke prevention, we should start with the prevention of risk factors as mentioned above.