Keywords: cerebral infarction
We often encountered in outpatient sequelae of cerebral infarction or cerebral infarction history of treatment requires a course of intravenous infusion every six months (about two weeks), called “dredge antithrombotic therapy. I recently received a number of letters from primary care doctors, they found that the new infarct patients in the infusion process, I do not know how to explain to patients. Above access to domestic and international literature, and have yet to find a course of six months infusion theoretical basis for the prevention of cerebral infarction. Six months after thrombolysis to open it is impossible to dissolve blood clots, especially arterial thrombolysis best time in less than three hours after the illness, now Intro thrombolysis methods, indications and side effects.
Cerebral infarction prevention and control high blood pressure: systolic blood pressure> 160mmHg or diastolic blood pressure> 95mmHg, the relative risk of stroke. The choice of drugs to follow due to the principle of individual people easily.
Prevention and treatment of heart disease: The main drugs aspirin and warfarin. Aspirin is mainly used for non-cardiac emboli caused cerebral infarction, warfarin is used for rheumatic heart disease associated with atrial fibrillation who. Warfarin daily maintenance dose of 2 ~ 4mg, prothrombin time and activity should be detected, start tested daily to once in 10 days, after testing 3 times a week, prothrombin and stability in the treatment of the
Need indicators, measured every 7 to 10 days. But also aggressive treatment of diabetes; prevent hyperlipidemia. Have a reasonable lifestyle: diet, exercise, and maintain a good attitude, caution contraceptive drugs, less smoking or non-smoking, no alcohol.
Treatment of acute cerebral infarction principles: individual, sub-type, staging treatment
(A) thrombolytic therapy: i.e., within 3 to 6 hours after the onset. Intravenous administration of thrombolysis, the arterial administration thrombolysis, intra-arterial thrombolysis is not widely used in clinical. Commonly used drugs urokinase plasminogen activator (t-PA). The major risks and side effects of thrombolytic therapy is intracranial hemorrhage, and a better chance of cardiogenic embolism cerebral hemorrhage.
(B) anticoagulant therapy: the commonly used drug heparin, low molecular weight heparin, coagulation tests must be made. The main side effects are bleeding, low molecular weight heparin safer than unfractionated heparin.
(C) antiplatelet drugs: (1) aspirin, economic, affordable, safe and most conventional antiplatelet prophylaxis, the lowest effective dose of 50 mg or 75mg / day. The acute phase increase the dose to 300mg / day. The medication the process does not require hematological aspects detection. Aspirin can significantly reduce the side effects. (2) Ticlid, as drug treatment and prevention of medication, dose and route of administration is oral 125 ~ 250mg / day, meals. The course of medication should be detected in the blood, liver function and coagulation. The small number of patients may appear neutropenia, side effects such as jaundice and elevated transaminases, prolonged bleeding ulcer disease, thrombocytopenia and
Bleeding disorders caution. Drug prices than aspirin expensive. (3) clopidogrel: Europe and the United States have begun to use, drug same 75mg and 250mg Ticlid efficacy.
(D) Defibrase treatment: the role of increased fibrinolytic activity and inhibition of thrombosis, commonly used drugs defibrase DF-pure gram suppository enzymes viper antithrombotic enzymes. Onset within 24 hours
With. The course of medication should detect fibrinogen.
(E) hemodilution therapy: the purpose is to reduce blood viscosity, improve microcirculation and complement hypovolemia, dextran and 706 plasma commonly used drugs.
Brain protective agent (f): (1) calcium antagonists: prevent intracellular calcium overload to prevent spasm of blood vessels, increase blood flow. Commonly used drug nimodipine, nicardipine, flunarizine and cerebrovascular cinnarizine etc.. (2) Citicoline: stable membranes. (3) glutamate antagonists and GABA enhancer. (4) Other: vitamin E, vitamin C and mannitol also has antioxidant and free radical scavenging.
(G) TCM: traditional Chinese medicine compound Danshen Sichuan dome triazine. Supplemented by acupuncture and massage therapy.
(H) rehabilitation: foreign primary treatment of cerebrovascular disease, usually in 3 to 7 days after the onset will begin a systematic, specification and individualized rehabilitation.
(9) General treatment: (1) to adjust blood pressure, antihypertensive drugs should be used with caution in the cerebral infarction, such as blood pressure of 150 to 160/100 does not require use of antihypertensive drugs. A drop in blood pressure is too low can aggravate cerebral ischemia. (2) to maintain smooth breathing, difficulty breathing give oxygen, tracheotomy if necessary. (3) reducing intracranial pressure and cerebral edema, acute especially massive cerebral infarction, cerebral edema, and 1 week after the onset of the common causes of death. Mannitol should be used to reduce intracranial pressure, kidney dysfunction, the available glycerol fructose and furosemide. (4) prevention and treatment of respiratory and urinary tract infections, and rational use of antibiotics. (5) to prevent pulmonary embolism and deep vein thrombosis line into the subcutaneous injection of low-molecular-weight heparin or heparin preparations. (6) early activities to prevent the formation of bedsores, every 2 hours stand back and passive activities paralyzed limbs. To avoid the pressure and the formation of bedsores. (7) to strengthen nutrition. Line nasogastric, intravenous nutrition, according to the specific circumstances of the patient and give the patient the opportunity to create a recovery.