How to treat cerebral ischemia

The treatment of cerebral ischemia needs to choose the appropriate way according to the state of the disease, for the onset of patients within 6 hours of the emergency thrombolytic therapy, more than 6 hours of patients can be surgical removal of thrombus or stenting, patients need to auxiliary aspirin, dextrose anhydride, heparin, vasodilator drugs such as treatment, the majority of patients need to be long-term persistent treatment.

I. Emergency treatment

Thrombolytic therapy: Thrombolytic therapy refers to the injection of thrombolytic agent into the body to dissolve the thrombus in the cerebral blood vessels, so that the cerebral blood vessels are reopened to improve the cerebral perfusion and rescue the affected brain tissues, and it has the effect of lowering the rate of disease and death. The best time for thrombolytic treatment of cerebral ischemia is within 3~6 hours. Thrombolytic therapy is rapid, simple and economical.

Second, drug therapy

1, aspirin: platelet aggregation has an inhibitory effect, can prevent thrombosis, suitable for all thrombolytic therapy patients, bleeding symptoms of ulcer disease or other active bleeding is prohibited.

2, dextrose anhydride: belongs to the expansion agent, mainly used to replenish the blood ring blood volume, promote the recovery of cerebral blood flow, suitable for persistent hypotension, hypovolemia patients.

3, heparin: thrombolytic effect, suitable for patients with combined cardiovascular disease, the main adverse reaction is easy to cause spontaneous bleeding, manifested in a variety of mucous membrane bleeding, blood accumulation in the joint cavity and wound bleeding. The activated partial thromboplastin time should be monitored.

4, vasodilator: through the expansion of blood vessels in the brain, there is an increase in cerebral blood flow, to avoid long-term cerebral ischemia and hypoxia leading to serious complications, the use of attention to monitoring blood pressure.

Three, surgical treatment

1, interventional angiolysis: interventional angiolysis is a minimally invasive neuroradiological interventional endovascular procedure, which is based on thrombolytic therapy, the application of neuroradiological interventional method of super-selective arterial thrombolysis. It has higher recanalization rate, and also has the advantages of high local concentration and small dose of thrombolytic drugs. The use of interventional vascular thrombolysis has been proven to be effective in patients with embolization of the internal carotid artery system (including the middle cerebral artery) within 6 hours of onset.

2, arterial stenting: arterial stenting, on the one hand, makes the narrowed blood vessels dilated to improve the blood flow of brain tissue, on the other hand, through the stent covered in the original plaque to reduce the unstable plaque shedding. The main purpose of arterial stenting is to prevent the reoccurrence of cerebral ischemia caused by cerebral arterial stenosis. Although this technique is more mature, there are certain surgical risks.

3. Thrombolytic therapy: It is applicable to patients with obvious neurological deficits within 3h after the onset of the disease, but with clear consciousness. Those with the following criteria can be considered for thrombolysis within 6h of onset of disease, cranial CT did not see cerebral hemorrhage or cerebral infarction foci have not been visualized. Those who are over 18 years old and under 75 years old. Those who have not had major surgery in the last 3 months, no history of gastrointestinal and other bleeding disorders, blood pressure below 185/1.10mmHg, normal blood glucose, platelet count of 10,5 or more, and no obvious liver or renal function impairment. Commonly used drugs include tissue-type fibrinolytic plasminogen activator.