I. Concept of cerebrovascular disease
Cerebrovascular disease refers to a group of diseases in which various causes cause lesions in human cerebral blood vessels, resulting in the disruption of intracranial blood supply, thus causing damage to brain tissue. Chinese medicine is called “stroke”. The Japanese follow our traditional medicine and call it “stroke”. Foreign scholars call it cerebral vascular disease (CVD). The disease is most common in middle-aged and elderly people. The most common cause is atherosclerosis, followed by arterial lesions associated with hypertension, heart disease, blood disorders, cerebral aneurysms, arteriovenous malformations, tumors, trauma and various cerebral arteritis. The disease often causes limb paralysis, speech impairment, intelligence decline, and in serious cases, vegetative state, or even death. It seriously affects people’s life and working ability, and brings heavy burden to individuals, families and society. Therefore, cerebrovascular disease has aroused great concern.
Second, the classification of cerebrovascular disease
1, according to the different nature of cerebrovascular damage, cerebrovascular disease is generally divided into two categories: ischemic cerebrovascular disease and hemorrhagic cerebrovascular disease. The former refers to the pathological changes in brain tissue due to cerebral arteriosclerosis and other reasons, making the local cerebral arteries narrow or completely blocked and the blood supply impaired; the latter is mostly due to long-term hypertension and other factors, making the small arteries in the brain form rice-sized microaneurysms, which can easily rupture and bleed, producing brain dysfunction. The specific classification is as follows.
Transient cerebral ischemic attack: refers to a transient insufficiency of blood supply to the carotid artery or vertebrobasilar system, resulting in focal neurological dysfunction in the blood supply area. Clinical symptoms generally peak in 5 minutes and resolve in 5 to 20 minutes, with a maximum of 24 hours, but can recur, and about 1/3 of patients can develop into cerebral infarction.
Cerebral infarction: refers to the necrosis of local brain tissue due to lack of blood supply, also called cerebral infarction.
Cerebral thrombosis: refers to the lesion of the blood vessel wall of cerebral artery, the inner wall of the blood vessel is not smooth, especially on the basis of atherosclerosis, slow blood flow, change of blood composition, increase of blood viscosity and cause significant narrowing or occlusion of the artery wall thus leading to ischemic necrosis of brain tissue in the corresponding area.
Cerebral embolism: It refers to the blockage of blood flow caused by the flow of abnormal substances (solid such as atheromatous plaque of aortic arch, liquid such as amniotic fluid, and gas such as air) into cerebral arteries along the blood circulation, causing ischemic necrosis and brain dysfunction of brain tissue in the corresponding blood supply area.
Cerebral hemorrhage: Non-traumatic cerebral vascular rupture or exudation causing bleeding in the brain parenchyma, 80% in the cerebral hemisphere and 20% in the brainstem or cerebellum, accounting for about 20%-30% of all strokes.
Subarachnoid hemorrhage: A collective term for blood flowing into the subarachnoid space after bleeding from various causes. It is usually divided into two categories: spontaneous and traumatic, and spontaneous is divided into primary and secondary. Primary refers to the rupture of soft meningeal vessels and blood flowing into the subarachnoid space; secondary refers to brain parenchymal hemorrhage penetrating brain tissue into the subarachnoid space.
2.According to the occurrence of cerebrovascular disease can be divided into acute and chronic cerebrovascular disease. We usually say cerebrovascular disease, generally refers to acute cerebrovascular disease. Because of its fierce and rapid onset, it is also called cerebrovascular accident, including cerebral embolism, cerebral thrombosis, transient ischemic attack, cerebral hemorrhage, subarachnoid hemorrhage, etc. The onset of chronic cerebrovascular disease is insidious and gradually progresses, such as cerebral arteriosclerosis and vascular dementia.
3. In recent years, according to the progression of acute cerebrovascular disease, there are three clinical categories.
① Transient cerebral ischemic attack: it is often a neurological dysfunction that lasts for a few minutes to a few hours, not more than 24 hours, after which no sequelae remain. It is mostly a prodromal symptom of cerebral thrombosis. Reversible ischemic attack: the symptoms last more than 24 hours after the attack, mostly 48 to 72 hours, a few last up to three weeks, can be fully recovered without sequelae, and the substance is minor cerebral infarction;
(ii) Progressive stroke: neurological dysfunction peaks within a day or longer (can be more than 2 weeks) and can jump or progress in a stepwise manner, often with cerebral thrombosis, occasionally with a small amount of hemorrhage;
(3) Complete stroke: neurological dysfunction peaks within a short time (2-6 hours), often with coma, mostly cerebral hemorrhage and subarachnoid hemorrhage, occasionally with faster developing cerebral thrombosis and cerebral embolism.
Third, the epidemiological characteristics of cerebrovascular disease
Epidemiology of cerebrovascular disease is a discipline that studies the distribution and dynamic characteristics of the disease population from an objective point of view, as well as the relevant factors affecting the above characteristics, to explore the causes and develop preventive and curative measures.
Cerebrovascular disease is a common and frequent disease, characterized by high morbidity, mortality and disability rates. It is imaginatively compared to an “earthquake in the brain”. Together with heart disease and malignant neoplasm, it constitutes the three most deadly diseases in most countries. In China, cerebrovascular disease ranks second after malignant tumors in the causes of death, and rises to the first place in northern cities such as Beijing and Harbin.
1.Incidence rate is generally calculated as the number of new cerebrovascular patients per 100,000 population per year. Recent epidemiological surveys show that the annual incidence of cerebrovascular patients in China is about 200/100,000 in urban areas and 180/100,000 in rural areas, and the annual increase of cerebrovascular patients is about 2.5 million according to the national population of 1.3 billion. This large stroke cohort exceeds the total population of many European countries. The trend of incidence change from 1983 to 1989 shows an increasing trend in male incidence and a slight but not significant increase in female incidence; the northern regions are higher than the southern regions, with the highest incidence in Harbin and Beijing and the lowest in Zhejiang and Guangxi farmers.
2, the prevalence rate refers to a specific point in time before the disease (including has been cured), and must be in the specified point in time is still alive in the ratio of the population at the time. For example, a patient had a stroke 30 years ago, has long since recovered and is still alive, the survey should be counted in the prevalence statistics. The average prevalence of cerebrovascular disease worldwide is 500 to 600 per 100,000. In 1983, it was 719/100,000, and in 1985, it was 344/100,000, of which Harbin and Beijing were the highest and Guangxi Zhuang Autonomous Region the lowest.
3, the rate of death Cerebrovascular disease is one of the main causes of serious threats to human life worldwide. With the improvement of medical conditions, the improvement of people’s living standards and the enhancement of people’s health care awareness, the mortality rate of many diseases, including many infectious diseases and infectious diseases, is decreasing, but the mortality rate of cerebrovascular diseases is on the increase. The average annual mortality rate in urban areas is 89/100,000, and the mortality rate in rural areas is 78/100,000, and more than 1 million people die from cerebrovascular disease every year nationwide.
4. Disability rate About 3/4 of the survivors of cerebrovascular disease are incapacitated to varying degrees, and more than 40% of the severely disabled require care. In our community, one in every hundred people suffers from cerebrovascular disease, and many people have limited physical activity and cannot take care of themselves completely, which has a serious impact on patients, society and families.
5, the economic loss caused by cerebrovascular disease According to statistics, more than 4 million people with severe disability cerebrovascular disease in China, according to the average need for a person to take care of each person, the country has more than 4 million people can not work and study normally, calculated by the per capita output value of 4,000 yuan, the annual cost of lost wages amounted to 16 billion, if each patient’s medical expenses calculated at an average of 500 yuan, the annual medical expenses amounted to 2 billion yuan, the patient and family caused by the The mental burden on patients and families is difficult to estimate.