Today, we invite Professor Lou Min, Deputy Director of the Department of Neurology and Director of the Ward of the Second Affiliated Hospital of Zhejiang University School of Medicine and Secretary General of the Zhejiang Stroke Society, to talk about the prevention and treatment of stroke.
Stroke is what the people often call "stroke" and is the "number one killer" who threatens the life and health of our people. The authoritative journal The Lancet published the results of a blockbuster study in June 2019, analyzing the changes in the top 25 causes of death of people in 34 provinces (municipalities directly under the central government, autonomous regions, and special administrative regions) in China from 1990 to 2017, and found that the main cause of death of Chinese residents from 1990 to 2017 has always been stroke.
With the improvement of people's living standards, lifestyle changes and the aging of the population, the risk factors for stroke such as hypertension, diabetes and hyperlipidemia are increasing. The incidence and mortality of stroke are on the rise, which seriously endangers the health and life of middle-aged and elderly people. According to the "China Stroke Prevention and Control Report 2019", at least 1 in every 5 deaths in China died of stroke in 2018, accounting for 22.3% of the total mortality rate of Chinese residents.
Lou Min
Deputy Director, Doctor and Chief Physician of the Department of Neurology of the Second Hospital of Zhejiang University, he has been engaged in clinical, teaching and scientific research in neurology for more than 20 years. The strategy of clinical management and medical quality improvement in the acute stage of stroke was promoted in the province, which improved the treatment capacity and medical quality of stroke centers and benefited more patients; established an individualized multimodal imaging evaluation technology to guide reperfusion treatment decisions; and conducted in-depth clinical research on the pathogenesis and prevention of cerebral leukoplasm hypersignia and microbleeds for the first time in the world. He has rich clinical experience in the diagnosis and treatment of thrombolytic and endovascular therapy in the acute stage of cerebral infarction, as well as the diagnosis and treatment of difficult and critical diseases related to cerebrovascular diseases.
What is a stroke?
Stroke mainly includes two major categories: hemorrhagic and ischemic. Among them, ischemic stroke, also known as cerebral infarction (hereinafter collectively referred to as "cerebral infarction"), and some commonly known as cerebral thrombosis, cerebral infarction, cerebral infarction, cerebral embolism, etc., account for about 70%-80% of the total stroke. Ischemic stroke is due to the sudden blockage of cerebral blood vessels, resulting in cerebral cell ischemia, hypoxia, necrosis in the blood supply area of the blood vessel, resulting in a series of neurological dysfunction, often manifested as weakness in one limb, slurred speech, crooked corners of the mouth, and even delirium. The most frightening thing is the blockage of large blood vessels, which often causes severe disability and even death to patients. Due to the long recovery period and the inability of patients to work, it places a huge financial burden on the patient's family. Cerebral infarction is the most common type of stroke, and the treatment effect has a strong time dependence, so this paper on the brain infarction of this disease for science popularization, hope to give the public professional advice and help.
Cerebral infarction is a disease with high morbidity, high mortality, high disability rate, high recurrence rate, if the patient is not treated in time, it is likely to leave limb paralysis, language impairment, swallowing difficulties, cognitive impairment, anxiety or depression and other sequelae, bringing a heavy burden to the physical and mental and economic burden of patients and their families. Timely detection of stroke and timely treatment are the key.
How is stroke recognized?
The brain is the "headquarters" of our body, with different parts controlling different functions. When a stroke occurs, different symptoms appear depending on the affected part of the brain. The biggest feature of stroke is the sudden change, "the previous minute was fine, suddenly it was not good."
Common symptoms of stroke include confusion (e.g., confusion, unconsciousness), hemiplegia (lack of strength in one limb, sometimes manifested as a sudden fall without warning), hemiparetic disorder (sudden numbness on one side or limb, feeling uncomfortable), hemianism (not being able to see on the same side of both eyes), aphasia (unable to speak, or unable to understand what others and themselves are saying, not understanding and writing words that could be read and written before), dysarthria (dysphony, difficulty swallowing, stupid tongue), and dysphagia (drinking water, Eating and coughing), ataxia (i.e., walking unsteadily, swaying from side to side, uncoordinated movements), etc.
In the chain of stroke treatment, the patient himself or his relatives and friends timely identify the early warning signal of stroke and dial 120 is the key first step.
Some stroke symptoms go unnoticed and are not rushed to the hospital, ultimately delaying treatment. Therefore, it is of great significance to recognize the early symptoms of stroke.
In order to make it easier for everyone to understand and grasp the early symptoms of stroke, the Stroke Prevention and Control Engineering Committee of the National Health Commission is also actively promoting "Stroke 120" to quickly identify stroke in three steps:
"1" Look at a face, whether there is asymmetry, the mouth is crooked. When the sides of the face are asymmetrical or the corners of the mouth are crooked on one side, it is abnormal.
"2" Check both arms, raise both arms flat, and whether one arm is weak. One side of the arm is weak and falls down, which is abnormal.
"0" Listening to the language, whether there is a lack of clarity in speech, difficulty in expression. Asking a patient a question, speaking clearly, not understanding, or unable to speak, is abnormal.
The effect of stroke treatment has a great relationship with the speed of time and cannot be delayed. If any of the above symptoms occur, call the 120 emergency number immediately and quickly send it to a nearby hospital with stroke treatment capabilities.
Time is life, and time is the brain
Be sure to go to the hospital emergency department as soon as possible after the onset of the disease
For patients with suspected stroke, good treatment opportunities should be sought as soon as possible after the onset of the disease. If symptoms are found, it is necessary to go to a hospital with stroke treatment capacity as soon as possible. There must be no "procrastination" and "waiting" ideas, even if you wake up at night or at night, you must go to the hospital in the shortest possible time, do not delay until the next day, which will not do any good for the disease.
Stroke treatment is highly time-dependent, and normal brain tissue can undergo irreversible changes soon after ischemia, and necrosis of ischemic brain cells. For every 1 minute delay, 190 million neurons and 13.8 billion synapses will be lost.
Therefore, in the event of a stroke, it is necessary to treat it as soon as possible! The first time to seek medical treatment in the hospital, you must not have the following thoughts: "Think that after a while it will be fine and ignore it", "Lie down and sleep well", "Rest at home may be good", "Now it is not stable to wait a little better to go again", "So late do not want to trouble children, children still have to go to work during the day", "The hospital is inconvenient at night, wait until dawn to talk", thus delaying treatment.
As for which hospital to choose, you should choose a hospital that has the conditions to provide standardized early diagnosis, early vascular assessment, and early treatment for diagnosis and treatment, and be treated by a professional neurologist. The hospital should be able to provide 24-hour CT examination, magnetic resonance, cerebral angiography instruments and equipment, and professional neurosurgery and radiologists.
Zhejiang Province will conduct spot checks on the stroke treatment level of the hospital every year, and carry out the qualification identification of the stroke center, usually everyone can pay attention to the surrounding stroke center, and go to the hospital emergency department as soon as the onset of the disease.
Since 2012, the Stroke Center of the Second Hospital of Zhejiang University is the affiliated unit of the Zhejiang Stroke Medical Quality Control Center, and since 2012, it has taken the lead in building an emergency platform and quality improvement platform covering more than 150 stroke centers in Zhejiang Province, carried out regular feedback analysis and standardized target management for stroke centers at all levels, realized the dynamic and information management of medical data, strengthened the construction of regional stroke prevention and control networks, and improved the rescue capacity and medical quality of stroke centers.
Stroke treatment has a "golden time window"
Cerebral infarction is caused by the sudden blockage of cerebral blood vessels, so after acute cerebral infarction, it is crucial to open the blocked blood vessels as soon as possible! In this way, it is possible to restore oxygen and blood supply before the brain cells are completely dead, thereby restoring all or part of their function.
Currently, the most effective treatments for stroke are intravenous thrombolysis and intravascular therapy.
Intravenous thrombolysis requires the drug to be injected intravenously into the body within 4.5 hours of illness to dissolve the thrombus. Endovascular therapy is interventional surgery, using special instrument materials to directly remove the thrombus, suitable for patients with large vascular occlusion, but need to be within 6 hours of onset. Patients who are more than 4.5 hours or more onset require special tests before a decision can be made on intravenous thrombolytic or endovascular therapy.
Stroke patients are mostly elderly, and it is best to have children present at the time of admission. On the one hand, after the patient comes to the hospital, the neurologist first conducts a history inquiry and physical examination, which is a very critical part. Because the medical history involves the patient's specific onset time, symptoms after the onset of the disease, and usual diseases such as hypertension, diabetes, arrhythmias, etc., this is essential for the diagnosis of the disease and the determination of the next step of treatment, at this time, the family needs to accurately inform the doctor of the above important information.
On the other hand, after asking about the condition, the doctor will perform a vital signs, consciousness, pupil, language, limb strength and sensations to determine the severity of the condition. The doctor will then arrange a blood test, CT or magnetic resonance imaging. Then, the doctor will recommend a treatment plan according to the condition, which requires the family to sign the informed consent form in a very short period of time.
Intravenous thrombolytic and endovascular therapy
How to choose?
Patients often ask, is intravenous thrombolysis or intravascular treatment good for cerebral infarction?
Some patients have clogged blood vessels that are relatively thin, which is suitable for intravenous thrombolysis. Some patients block the blood vessels are relatively thick, the effect of intravenous thrombolysis is not ideal, only 6%-30% can be blood vessel re-pass, and intravascular treatment using special instrumental materials to put the vascular blockage, like a "net pocket" to pull the blood clot, or use a tube to pull out the thrombus, so as to open the occluded blood vessels, the successful re-passage rate of blood vessels can reach more than 80%, and the long-term good prognosis rate can reach 50%. Both methods are not effective for all patients and may be risky in a small number of patients, but they are already the best treatments available. As for which treatment is suitable for patients with cerebral infarction, it is necessary to undergo a detailed evaluation by the doctor and analyze the specific situation.
Written by Lou Min
Orange Persimmon Interactive City Express reporter Yu Xixi
Correspondent Fang Xu Zhu Junjun sorted out
Source: City Express