Cerebral infarction is a kind of cerebrovascular disease, which is caused by cerebral atherosclerosis and vascular intima injury, and then local thrombosis is formed due to various factors, which aggravates or completely occludes arterial stenosis, leading to ischemia, hypoxia, brain tissue necrosis and neurological dysfunction.

The main factors of cerebral infarction are hypertension, coronary heart disease, diabetes, overweight, hyperlipidemia and eating fat. Many patients have family history. It is more common in middle-aged and elderly people aged 45 ~ 70.

(A) Precursor symptoms of cerebral infarction

Most patients with cerebral infarction get sick during quiet rest. Some patients wake up to find their mouth and eyes askew, hemiplegia, drooling, eating rice grains and unable to lift chopsticks. This is the occurrence of cerebral infarction, which often makes people unprepared. Only some patients have symptoms of transient cerebral ischemia such as numbness of limbs, slurred speech, transient blackness, dizziness or vertigo, nausea, blood pressure fluctuation (which can be increased or decreased) before onset. These premonitory symptoms are generally mild and short-lasting, and are often ignored.

(2) Clinical manifestations of cerebral infarction:

The location and area of infarction are different, and the most common manifestations are as follows:

(1) Sudden onset, often occurring during quiet rest or sleep. The peak of onset is within several hours or 1 ~ 2 days.

(2) Headache, dizziness, tinnitus, hemiplegia, which can be one limb or one limb, and the upper limb is heavier than the lower limb or the lower limb is heavier than the upper limb, with dysphagia, slurred speech, nausea and vomiting. In severe cases, you will soon be unconscious. Every patient can have the above-mentioned clinical manifestations.

(3) Significance of brain CT examination: The accuracy of brain CT examination in showing the size and location of cerebral infarction focus is 66.5% ~ 89.2%, and the accuracy of first cerebral hemorrhage is 65,438+0,000%. Therefore, early CT examination is helpful for differential diagnosis and elimination of diseases such as cerebral hemorrhage. This is very important. The treatment of cerebral hemorrhage and cerebral thrombosis in the early stage of onset is very different. When the onset of cerebral infarction is within 24 hours, or the infarction focus is less than 8 mm, or the lesions are in the brain stem and cerebellum, brain CT examination often cannot provide a correct diagnosis. If necessary, it should be reexamined in a short time to avoid delaying treatment.

(4) There is a disease called "lacunar cerebral infarction", in which patients may have no symptoms or mild symptoms. CT examination of other diseases has found this disease, and some of them are old lesions. This situation is more common in the elderly, and patients are often accompanied by chronic diseases such as hypertension, arteriosclerosis, hyperlipidemia, coronary heart disease and diabetes. Lacunar cerebral infarction can recur, some patients eventually develop into symptomatic cerebral infarction, and some patients have been stable for many years. Therefore, we should pay attention to the "asymptomatic stroke" of the elderly and take a positive preventive attitude.

(3) Rescue measures for cerebral infarction:

Cerebral infarction should be treated as soon as possible. Although it is not as dangerous as cerebral hemorrhage, most patients are old and weak, with many chronic diseases, and there are many cases of careful medication in treatment. In addition, the infarct area can be enlarged in a short time, and there will be many complications, so the mortality rate of cerebral infarction is relatively high, and the disability rate is higher than that of cerebral hemorrhage.

The treatment principle is mainly to improve cerebral circulation, prevent and treat brain edema and treat complications.

1? Proper exercise can improve cerebral circulation, but coma patients should stay in bed and strengthen nursing.

2? Improve cerebral blood circulation, increase cerebral blood flow, promote the establishment of collateral circulation, and reduce the infarct area. Low molecular dextran, 706 generation plasma, Venoruton, compound Danshen injection, ligustrazine, etc. All of them were given intravenous drip of 250-500ml for 7- 10 day. Headache, nausea, vomiting or disturbance of consciousness can be dehydrated with 20% mannitol, 250 ml, twice a day.

3? Thrombolytic therapy commonly uses urokinase and streptokinase to dissolve thrombus. 20000 ~ 50000 units of urokinase made in China were added into 0.56 mol/L 10% glucose solution for intravenous drip, once a day, and each course of treatment was 1 0 day. Some people also use urokinase to treat cerebral infarction through carotid artery, which is usually applied within 24 hours of onset. Because it is difficult to inject drugs through carotid puncture, it must be used in hospitals. Thrombolytic therapy should be applied early because thrombosis 1 day is rich in water, easy to dissolve, quick to take effect and short in course of treatment, but the condition should be closely observed to avoid the serious consequences of cerebral hemorrhage.

4? Hyperbaric oxygen therapy has been proved to be very effective in treating cerebral infarction, which can greatly reduce the disability rate of cerebral infarction. Suitable for early application, once a day, 10 is 1 course of treatment, and the oxygen inhalation time is 90 ~ 1 10 minutes each time, which must be carried out in a closed pressurized room, subject to conditions.

5? The purpose of regulating blood pressure and controlling hyperlipidemia and hyperglycemia is to control the risk factors of diseases. But if the blood pressure is too high, don't step down too fast; When blood pressure is too low, it should be raised appropriately. Patients with cerebral infarction often have high blood sugar, which is not conducive to treatment and must be actively controlled.

6? Coma patients should pay attention to keep the respiratory tract unobstructed, suck sputum in time, turn over and pat their backs, and move their limbs to prevent pneumonia and bedsore.

(4) Preventive measures for cerebral infarction:

Cerebral infarction is easy to recur, and it gets worse every time.

It is recommended to take low-dose aspirin orally, 0. 1 ~ 0.3g per day. Other drugs such as Kangshuan Pills, Sibelium, Vinorelbine, etc. can be used for a long time.

When premonitory symptoms appear, low molecular dextran, compound Danshen injection and 4% sodium bicarbonate injection can be given intravenously, once a day, for 7 ~ 1 0 days.

Actively treat hypertension, diabetes and coronary heart disease, maintain an optimistic and open-minded attitude towards life, and avoid emotional excitement and excessive fatigue.

Limit sodium salt, control weight and avoid alcohol and tobacco. Pay attention to the prevention and treatment of fever, dehydration, diarrhea, sweating and other situations that are prone to cerebral infarction.

Cerebral infarction is commonly called "stroke" or "stroke". Stroke is divided into hemorrhagic stroke and ischemic stroke. "Ischemic stroke" refers to cerebral infarction, including cerebral thrombosis and cerebral embolism. Cerebral infarction accounts for 70% to 80% of all strokes, which has increased significantly in recent years and is developing towards youthfulness. Some patients are only 27 years old, but most of them are middle-aged and elderly people over 45 years old.

The main pathological change of cerebral infarction is that on the basis of cerebral arteriosclerosis, thrombosis forms in blood vessels, blocking blood flow, causing ischemia, hypoxia and necrosis of brain tissue, making patients suffer from hemiplegia, aphasia, unilateral limb numbness, walking instability, incontinence, insanity, dementia, and even becoming a vegetative state. Some brain stem infarction and massive cerebral infarction can be fatal. Early treatment and early intervention can improve the prognosis of patients and reduce disability. Because a large number of clinical data show that effective thrombolytic therapy within 6 hours after onset can recanalize thrombus and make the cure rate of cerebral infarction reach 70% to 80%, and some reports can reach nearly 90% without any sequelae.

[Treatment]: invigorating qi and blood, dredging collaterals and lowering blood fat, promoting blood circulation and resolving phlegm.

[Prescription]: Radix Astragali 30, Radix Salviae Miltiorrhizae 20 lumbricus 12, Rhizoma Chuanxiong 15, Radix Paeoniae Rubra 15, Rhizoma Acori Graminei 15, Radix Puerariae 20 leeches 10, Fructus Crataegi/kloc-0.

[Chemical cutting]: 1. Gastrodia elata 10 Uncaria 122. Prunella vulgaris 18 concha Haliotidis 203. Too much phlegm, Tianzhu Huang 124. Dry stool, yellow 105. Appear. Polygala 12, Radix Curcumae 127, Ramulus Mori 15, Rhizoma Curcumae 128, Herba Taxilli 15, and Cortex Eucommiae 15.

Take aspirin statins for a long time. Treatment principle of acute cerebral infarction: individualized, classified and staged treatment (1) thrombolytic therapy: within 3 days after onset. Thrombolysis can be administered intravenously or intraarterially. Intra-arterial thrombolysis is not widely used in clinic. Commonly used drugs are urokinase and plasminogen activator (T-PA). The main risks and side effects of thrombolytic therapy are intracranial hemorrhage, and the probability of cardiogenic embolism in cerebral hemorrhage is high.

(2) Anticoagulation therapy: Commonly used drugs include heparin, low molecular weight heparin, etc. Coagulation test must be done. The main side effect is bleeding, in which low molecular weight heparin is safer than ordinary heparin.

(3) Antiplatelet drugs: (1) Aspirin is an economical, affordable, safe and most routine antiplatelet preventive drug, with the minimum effective dose of 50mg or 75mg// day. serious

The dosage can be increased to 300 mg/day. There is no need for hematological examination during medication. Enteric aspirin can significantly reduce the side effects. (2) Ticlopidine can be used as a therapeutic drug.

Preventive medication, dosage and usage: 125 ~ 250mg/ day, taken orally with meals. Hemogram, liver function, bleeding and coagulation should be detected during medication. A few patients may have neutropenia and jaundice.

Side effects such as jaundice, increased transaminase and prolonged bleeding time, as well as patients with ulcers, thrombocytopenia and hemorrhagic diseases should be used with caution. This medicine is more expensive than aspirin. (3) Clopidogrel: Europe and America

It has been used, and its curative effect is the same as that of ticlopidine 250 75mg.

(4) Defibrillation therapy: the function is to increase the activity of fibrinolytic system and inhibit thrombosis. Commonly used drugs are defibrase, batroxobin and Agkistrodon halys antithrombotic enzyme. Within 24 hours of onset

Use. Fibrinogen should be detected during medication.

(5) hemodilution therapy: the purpose is to reduce blood viscosity, improve microcirculation and supplement blood volume deficiency. Commonly used drugs are low molecular dextran and 706 generation plasma.

(6) Brain protectant: (1) Calcium antagonist: prevent intracellular calcium overload, prevent vasospasm and increase blood flow. Commonly used drugs are nimodipine, nicardipine and fluoride hydrochloride.

Cinnamazine and zinc for strengthening brain, etc. (2) cytidine diphosphate choline: it has the function of stabilizing cell membrane. (3) Glutamate antagonist and GABA enhancer. (4) Others: vitamin E, vitamin C and manna.

Alcohol also has antioxidant and free radical scavenging effects.

(7) Traditional Chinese medicine: Traditional Chinese medicine includes compound salvia miltiorrhiza and Ligustrazine. At the same time supplemented by acupuncture and massage.

(8) Rehabilitation: It is the most important method to treat cerebrovascular diseases abroad. Generally, systematic, standardized and individualized rehabilitation treatment begins 3 ~ 7 days after onset.

(9) General treatment: (1) Adjust blood pressure, and use antihypertensive drugs with caution when cerebral infarction occurs. If the blood pressure is150 ~160/100, there is no need for antihypertensive drugs. Blood pressure will get worse if it drops too low.

Cerebral ischemia. (2) Keep breathing unobstructed. If it is difficult to breathe, oxygen inhalation and tracheotomy can be given when necessary. (3) Reduce intracranial pressure and brain edema, especially in acute cerebral infarction.

Brain edema is a common cause of death within 1 week after onset. Mannitol should be used to reduce intracranial pressure, and glycerol fructose and furosemide can be used for patients with abnormal renal function. (4) prevention and treatment of respiratory tract and

Urinary tract infection, rational use of antibiotics. (5) To prevent pulmonary embolism and deep venous thrombosis of lower limbs, low molecular weight heparin or heparin preparation can be injected subcutaneously. (6) Early activities to prevent bedsore formation, turning over and patting the back every 2 hours, passive activities paralyzing limbs. Avoid pressure and bedsore formation. (7) Strengthen nutrition. According to the specific situation of patients, nasal feeding, intravenous high nutrition, etc. To create opportunities for patients to recover.

Prescription for treating cerebral infarction

Prescription: 50g of lean pork, 20g of garlic cloves, 6g of tail vegetables, 0g of auricularia auricula10g, 0g of ginger10g, 5g of jujube, 4g of refined salt, 2g of monosodium glutamate, and add appropriate amount of water to boil. Drink soup, one meal a day.

Cerebral infarction is a common and frequently-occurring disease in the elderly, often accompanied by blood circulation diseases such as hypertension, hyperlipidemia, arteriosclerosis, cerebral thrombosis and coronary heart disease. Once it happens, it needs long-term medication and maintenance treatment. Drug reactions are also common. The advantages of dietotherapy remedies are that they are beneficial and harmless to the body, can be eaten for a long time, and have little toxic and side effects. Patients may wish to observe carefully and try according to the prescription to verify the curative effect.