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Treating hypertension and preventing stroke;
Hypertension is easy to cause stroke, which is not alarmist. Stroke includes cerebral hemorrhage and cerebral infarction. Among the patients with cerebral hemorrhage, 93% had a history of hypertension before the onset; Among patients with cerebral infarction, 86% had a history of hypertension before the onset. Thus, the risk of stroke is closely related to the level of blood pressure.
The main cause of stroke caused by hypertension is the change of cardiovascular and cerebrovascular structure. When blood pressure rises, it will cause systemic arterial spasm. If blood pressure rises for a long time, the artery will also spasm for a long time. The blood vessel wall will be deformed due to hypoxia, the wall will thicken, the lumen will narrow, and the elasticity will decrease, thus forming or aggravating the formation of arteriosclerosis. Coupled with factors such as hyperlipidemia, hyperglycemia, and increased blood viscosity, it is easier to accelerate thrombosis.
If the antihypertensive effect is not good, or the patient does not take the medicine according to the doctor's advice, the blood pressure fluctuates too much, causing repeated arterial spasm, causing cerebral hemorrhage, edema or hyalinization of arterial wall, forming dissecting aneurysm and causing cerebral hemorrhage.
As far as patients with hypertension are concerned, it is not that hypertension will lead to stroke. On the contrary, not taking medicine according to doctor's advice and incorrect eating and living habits are the root causes of the disease. For example: hypertension has not been properly treated for a long time; Although taking medicine on time, blood pressure is still at a high level for a long time; Or intermittent antihypertensive treatment, blood pressure often rises suddenly; Do not pay attention to the influence of climate and emotional changes, physical fatigue and other inducing factors; Excessive hypotension often leads to ischemic stroke due to nighttime hypotension; In addition, diseases such as diabetes, hyperlipidemia and obesity are more likely to cause stroke.
In fact, strict antihypertensive treatment is very beneficial to patients with mild, moderate and severe hypertension, which is conducive to preventing the first occurrence or recurrence of stroke, alleviating the course of stroke or reducing pathogenic stroke. The method of lowering blood pressure is not difficult to master, as long as you are patient, serious and persistent. You might as well copy the precautions for lowering blood pressure in an obvious position and follow suit.
1, and strictly control the blood pressure below140/90mmhg. The younger the age, the stricter the control. It is best to monitor blood pressure changes every day and measure blood pressure at least once a week.
2, insist on taking antihypertensive drugs, do not stop taking drugs at will, should increase or decrease antihypertensive drugs according to the doctor's advice.
3, 24 hours of stable control of blood pressure, so that blood pressure fluctuations are small, blood pressure should not drop too low.
4. Control blood sugar, blood lipid and blood viscosity.
5. Lose weight and reach normal standards.
6. Quit smoking and drinking, and eat a low-salt and low-fat diet.
7. Insist on aerobic physical exercise, such as jogging, swimming, cycling and practicing Tai Ji Chuan. More than 30 minutes a day, at least 5 times a week.
Eight, the signal before the stroke
Continuous yawning: yawning reflex will be caused when the cerebral arteriosclerosis is aggravated, the lumen is narrower and narrower, and cerebral ischemia and hypoxia are aggravated, especially when the respiratory center is hypoxic. About 80% people yawn frequently within 5 ~ 10 days before the onset of ischemic stroke, which is an important warning signal.
Stuttering: Salivation symptoms are drooling, drooling, signs of stroke and sudden onset.
After crossing the darkness: suddenly, my eyes are black and I can't see anything, and I will recover after a few seconds or minutes, accompanied by nausea, vomiting, dizziness and disturbance of consciousness. Recently, Norwegian doctor Huang Fengying found that 18 patients with transient amaurosis had carotid atherosclerosis.
Blurred vision: that is, transient visual impairment or visual field defect, usually recovered within 1 hour. Huang Fengying performed fundus examination and cerebral blood flow measurement on 10 patients with transient visual impairment, and found that there were 3 cases of central retinal artery occlusion and 7 cases of branch retinal artery occlusion.
Razor landing: refers to shaving with a knife, turning your head to one side and suddenly feeling weak in your arm. The razor fell to the ground, 1 fully recovered after 2 minutes. This is due to the distortion of the neck, which leads to the distortion of the already hardened carotid artery and aggravates the stenosis, resulting in insufficient blood supply to the brain.
Unilateral paralysis: transient ischemic attack, strictly speaking, this is the lightest stroke. According to follow-up observation, more than half of people have ischemic stroke 3 ~ 5 years after transient ischemic attack.
Anyone with one of the above symptoms should be examined as soon as possible, diagnosed clearly and treated systematically, so as to avoid the occurrence of stroke.
9. What are the possible complications after a stroke?
After cerebral hemorrhage or massive cerebral infarction, diseases of other organs of the body are often complicated, such as acute gastrointestinal bleeding, brain-heart syndrome, lung infection and acute pulmonary edema, bedsore, central dyspnea, central hiccup, post-stroke depression and so on. , described as follows:
1, lung infection: brain lesions may lead to pulmonary and respiratory vascular dysfunction, pulmonary edema and congestion; If you don't turn over for a long time, it will lead to the accumulation of lung secretions; And the accidental inhalation of vomit into the trachea will all promote the occurrence of pneumonia. Nursing should be strengthened, such as gently changing the patient's position every 3-4 hours and patting his back, so that lung secretions will not accumulate for a long time and will be easily discharged. Be especially careful when feeding and try to prevent pneumonia as much as possible.
2. Bedsore: Due to the limited movement of paralyzed limbs, the bony protuberance is easily compressed, and the blood circulation and nutrition of local skin are damaged, so bedsore is prone to occur, and the prone parts are the back, sacrococcygeal region, femoral trochanter, lateral ankle and heel. In order to avoid bedsore, patients can be helped to change their body position every 2 hours 1 time; Place balloons, sponge pads, etc. Keep the skin dry in the parts prone to bedsore; Local massage can also be performed to improve blood circulation.
3. Acute gastrointestinal bleeding: Most of the bleeding occurs within 1 week after onset, and more than half of the bleeding comes from the stomach, followed by the esophagus, showing hematemesis or melena.
4. Brain-heart syndrome: After onset 1 week, ECG examination can find ischemic changes, arrhythmia and even myocardial infarction.
5, central dyspnea: more common in coma patients. Breathing fast, shallow, weak, irregular, or sigh-like breathing or apnea, because the respiratory center of the brain stem is affected, indicating that the condition is serious.
6, central hiccup: seen in the acute and chronic stages of stroke. In severe cases, intractable seizures are also signs of serious diseases.
Ten, the drug treatment of stroke
Thrombolytic therapy: Thrombolytic therapy is the key to the treatment of ischemic stroke, and it is also the focus of current research. Its purpose is to dissolve thrombus and quickly restore microcirculation in the infarcted area, so as to obtain early cerebral blood flow reperfusion, reduce the degree of ischemia and limit the damage of nerve cells and functions. However, the risk of thrombolytic therapy is high. For some areas with long ischemic time, ischemic center and vulnerable areas are prone to reperfusion injury, post-infarction hemorrhage and severe brain edema. Therefore, strict indications and medication time must be mastered, preferably within three hours. Commonly used thrombolytic drugs include first-generation thrombolytic agents such as streptokinase and urokinase, second-generation thrombolytic agents such as tissue plasminogen activator and recombinant streptokinase. Other commonly used drugs include snake venom preparations and batroxobin. Urokinase is a non-directional fibrinolytic preparation, which is easy to cause systemic fibrinolysis, has good thrombolytic effect and low price, and is still widely used. T-PA is a kind of fibrinolytic preparation with directional characteristics, which has been applied in clinic and its curative effect has been confirmed by most people. According to the research on t-PA by National Institutes of Health, patients with cerebral infarction should receive t-PA thrombolytic therapy within three hours or more after onset. The risk of reperfusion injury is high, the price is expensive and the adaptation spectrum is narrow.
2. Anticoagulant therapy: It is particularly important for patients with acute ischemic stroke in China, because most patients are difficult to carry out thrombolytic therapy in the ultra-early stage, so anticoagulant therapy has special significance. For patients with acute or progressive cerebral infarction, anticoagulation therapy is generally accepted within 72 hours of onset. At present, low molecular weight heparin is widely used, which plays an anticoagulant role mainly through its strong anticoagulant factor Xa activity, and its antithrombin activity is weak. Compared with ordinary heparin, it has strong antithrombotic effect, little influence on platelet function and relatively low bleeding risk. Aspirin has anti-platelet aggregation effect and has been widely used in the treatment of ischemic cerebrovascular diseases. After taking it, the recurrence rate and mortality rate can be significantly reduced.
3. Neuroprotectant therapy: The mechanism of neuroprotective agent is mainly to prevent further damage of neurotoxic substances in penumbra caused by acute cerebral infarction. At present, it is considered that the main ways of neuroprotective agents are: preventing the influx of calcium channels, eliminating the neuronal damage caused by free radicals, regulating the excitability of excitatory amino acids and regulating the microvascular inflammatory response.
(1) Calcium antagonist: Calcium antagonist can effectively increase cerebral blood flow, reduce brain edema and repair damaged nerve cells. Commonly used drugs are nimodipine, cinnarizine, flunarizine and so on. It should be given within 6~ 12 hours after onset. These drugs have been widely used in clinic because of their small side effects and safety. Pay attention to the change of blood pressure when using.
(2) Free radical scavenger: During acute cerebral infarction, a large number of free radicals are produced in the brain, which destroys the membrane structure and leads to neuronal damage. Free radicals can also cause vasoconstriction and intravascular coagulation in ischemic penumbra, enlarge infarct area and aggravate brain tissue damage. Vitamin E, vitamin C, SOD, hormones and dehydrating agent (mannitol) are all free radical scavengers, which can provide protection for ischemic brain cells.
XI。 How to prevent cerebral hemorrhage? (Ten Essentials for Preventing Cerebral Hemorrhage)
Most of the causes of cerebral hemorrhage are hypertension and cerebral arteriosclerosis, and the blood pressure suddenly rises due to mental stress, emotional excitement, strenuous exercise and forced defecation, which leads to blood vessel rupture. Cerebral hemorrhage is often fierce and sudden. Its symptoms are: headache, dizziness, vomiting, then falling, coma, deep breathing, snoring in the throat, hemiplegia, urinary incontinence, and sometimes convulsions. In severe cases, it can lead to death. Even after cure, patients often leave sequelae. So, how can we prevent cerebral hemorrhage? Relevant medical experts suggest that the following "ten musts" should generally be achieved:
1. Hypertension must be found early and treated in time. Middle-aged and elderly people should have regular health checks. Once diagnosed with hypertension, we must insist on taking medicine to lower and stabilize blood pressure to prevent rebound and excessive fluctuation.
2. We must prevent atherosclerosis as soon as possible. If you have arteriosclerosis, you should treat it as soon as possible and pay attention to your daily diet to reduce blood lipid and cholesterol and maintain the elasticity of blood vessels.
You must be very happy. In daily life and work, we should maintain an optimistic mood, pay attention to calm down when we encounter happy or unhappy things, avoid excessive emotional excitement and prevent sudden increase in blood pressure.
4. Work and rest. It is necessary to reasonably arrange the time and intensity of work (labor), pay attention to rest, especially rest time, and avoid physical and mental overwork; At night, we should also ensure adequate sleep, maintain vigorous energy and enhance the body's disease resistance.
5, be sure to pay attention to the diet structure. The daily diet should be light, you can eat more beans, vegetables, fruits and fish, eat less foods with high animal fat or cholesterol, and should not eat more sugar (sweets). This is especially important for people with hypertension, arteriosclerosis and hyperlipidemia.
You must give up smoking and drinking. People who like alcohol and tobacco should give up or refrain. Because cigarettes will accelerate the development of arteriosclerosis, which is harmful to hypertension; Long-term heavy drinking will also promote arteriosclerosis.
7. Be sure to develop the habit of regular defecation. Keep defecation unobstructed and defecate regularly; Avoid overexertion when defecating to prevent sudden increase of blood pressure.
8, be sure to pay attention to cold and summer. According to the change of seasons, we should adjust our body temperature, increase or decrease clothes in time, and prevent the stimulation of cold and high temperature to the body, so as to avoid the disorder of vasomotor function and the increase of blood pressure fluctuation and accidents.
9. You must change your posture slowly. When squatting, bending over, lying in bed, getting up and other postures change greatly, you must move slowly, especially when changing from squatting posture to straight posture, you can get up gradually with your head down and eyes down, and don't stand up suddenly to prevent accidents caused by insufficient blood supply to your head.
10, we must insist on proper physical exercise. Choose the exercise you like and can do, persevere, and avoid strenuous labor or excessive fatigue during exercise. In addition, we must have a correct attitude towards the disease and establish confidence and perseverance in fighting the disease. Keep in mind the "Ten Essentials", adhere to rational drug use, pay attention to the law of incidence, and take preventive measures. In this way, the incidence of cerebral hemorrhage will be greatly reduced.
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