Treatment of cerebral thrombosis

Classification: medical and health care

Analysis:

(1) Improve cerebral blood circulation: To restore blood circulation, dilators can generally improve cerebral blood circulation, increase cerebral blood flow, promote the establishment of collateral circulation, and thus reduce the infarct area.

Commonly used drugs include low molecular dextran, 706 generation plasma, nicotinic acid, papaverine, vincristine, 654-2, compound Danone injection, ligustrazine, antithrombotic pills, pentoxifylline, betadine, sibelium and so on. Low molecular dextran has the functions of expanding blood volume, reducing blood viscosity, improving microcirculation and preventing erythrocyte aggregation. 250-500ml intravenous drip every day for 7- 10 days.

Some people treat acute cerebral infarction by combining dehydration with volume expansion, and the effective rate is 90%.

Specific methods: 20% mannitol 250 ml was injected intravenously after onset, once a day 1 time, and those with headache, nausea, vomiting or disturbance of consciousness twice a day. After 3-5 days, a cerebral vasodilator, such as vinorelbine or papaverine, was slowly injected intravenously, 1 time/day, and 7 7- 10/time was a course of treatment.

(2) Anticoagulation therapy: It is suitable for patients with hypercoagulable state, with the purpose of preventing thrombosis from aggravating the condition. Before anticoagulant therapy, brain CT should usually be performed to prove ischemic lesions. Active ulcer, severe liver and kidney diseases, infectious blood vessel blockage and other people with bleeding tendency should not be used. Coagulation time, prothrombin time and activity should be measured every day. Heparin and coumarin are commonly used. Heparin 12500-25000 units, dissolved in 500- 1000 ml of 5% glucose solution, slowly intravenous drip, usually 5-20 drops per minute/kloc-0. After 24-36 hours, it should be used according to the condition. At the same time, take coumarins orally, 200-300 mg every day/kloc-0, and then 50-1 00mg every day. The number of days of treatment depends on the condition.

In recent years, some people have used hemodilution therapy (that is, releasing appropriate amount of venous blood) to treat cerebral thrombosis, which has a certain effect. According to the patient's weight, blood pressure and hematocrit, the blood volume is generally 200-400 ml, and 500 ml of 706 generation plasma or low molecular dextran is input.

(3) Blood bath thrombosis therapy: streptokinase and urokinase are commonly used to dissolve thrombus. Add 20,000 units of domestic urokinase into 500ml 10% glucose solution, 50 drops per minute, once a day, and l0 days is a course of treatment.

Urokinase has been used to treat cerebral infarction by carotid artery administration, and it has a certain effect. -Generally used within 24 hours after onset. Take 20000 units of urokinase, human normal saline 100 ml, compress the carotid artery, drop 1.5-2O per minute, and treat 1-3 times.

Another method is to inject Agkistrodon halys antithrombotic enzyme into carotid artery, which has also achieved good results.

Thrombolytic therapy, whether intravenous injection or arterial injection, requires strict control of indications and timing of medication. It is generally believed that thrombolytic drugs should be used early (after the onset of cerebral thrombosis 1 day, the thrombus is rich in water and easy to dissolve), with quick onset and short course of treatment. Thrombolytic therapy, like anticoagulant therapy, should pay close attention to bleeding tendency and be used by doctors in hospitals.

4) Prevention and treatment of brain edema: At present, there are three commonly used drugs in clinic, namely hypertonic solution, diuretic and free radical scavenger.

Hypertonic solution can play the role of hypertonic diuresis and dehydration, and mannitol and glycerol are commonly used. ① The effect of 20% mannitol on relieving brain edema and reducing tripod internal pressure is rapid and obvious, and it can scavenge free radicals, such as the most toxic (OH) free radicals, thus protecting brain cells. Some people think that mannitol can reduce whole blood viscosity, reduce vascular resistance, increase cerebral perfusion and improve cerebral circulation. Glycerol has the advantages of long duration and small rebound. Glycerol can be used as energy, which can improve the function of sodium pump and is beneficial to the elimination of cytotoxic brain edema. Promote metabolism and improve brain function; Osmotic diuretic effect is small, and renal damage is small.

Diuretics can also dehydrate and lower blood pressure, especially for patients with cardiac insufficiency. Commonly used drugs are spironolactone, furosemide and uric acid.

The chain reaction of free radicals after hypoxia can damage cell membrane through peroxidation, leading to brain edema and microcirculation disorder, so free radicals should be removed. Commonly used drugs such as dexamethasone (or prednisone), barbiturates, vitamin E, vitamin C, chlorpromazine, mannitol and superoxide dismutase (SOD). Dexamethasone can stabilize cell membrane and lysosomal membrane, inhibit the release of arachidonic acid from cell membrane, and thus inhibit the damage of free radicals to cerebrovascular wall. It is found that dexamethasone can promote gastrointestinal bleeding, especially when combined with new anticoagulant tablets, the incidence of gastrointestinal bleeding increases significantly. So use it with caution.

(5) Hyperbaric oxygen therapy: Hyperbaric oxygen therapy may be effective in acute cerebral infarction. The treatment was carried out in a closed pressure chamber. The total oxygen inhalation time was 90- 1 10 minutes, once a day, and 1 0 times was 1 course of treatment. Some people use 5% diammonium carbon high pressure mixed oxygen to treat cerebral infarction, and the effect is better than that of oxygen alone. Although hyperbaric oxygen and mixed hyperbaric oxygen have been reported in the treatment of cerebral infarction, some people think that the effect is unreliable, so they have not been widely developed at present.

(6) Surgical treatment: Strict selection of indications. Indications are: ① Thrombosis in the external segment of the internal carotid artery, complete occlusion or stenosis of more than 50%, thrombectomy and endarterectomy. If there is thrombosis in the extracranial segment of both internal carotid arteries, the side with severe stenosis can be selected, and embolectomy should be performed first to increase blood flow. ② If the collateral circulation of internal carotid artery thrombosis has not been well established, the superficial glume artery can be anastomosed with the middle cerebral artery. ③ Treatment of cerebral infarction with omentum transplantation and cerebral temporal muscle flap covering. Through clinical observation, the omentum with vascular pedicle was transplanted into the brain. It is superior to free omentum transplantation and temporal muscle flap covering the brain surface. ④ If the encephalomalacia focus has formed, there are clinical manifestations of increased intracranial pressure or signs of cerebral hernia, and the therapeutic effect of drugs for lowering intracranial pressure is not significant, the softened necrotic tissue should be removed quickly by surgery, or infratemporal decompression should be performed. ⑤ Cervical lesions can be treated surgically according to specific conditions when the pulse is pushed.

(7) Chinese medicine treatment, Chinese medicine has accumulated rich clinical experience in the treatment of this disease. According to the patient's pulse condition, judge the severity of the disease, the depth of the disease location, the imbalance of yin and yang, the rise and fall of the gas disk, and treat both the symptoms and root causes.

(8) Acupuncture treatment: It can dredge meridians, regulate qi and blood, and promote the rehabilitation of diseases. Some research data show that acupuncture can reduce blood viscosity, inhibit platelet aggregation and adhesion, inhibit erythrocyte aggregation and reduce hematocrit, increase cerebral blood flow, improve oxygen supply to brain cells and promote brain cell recovery. The most commonly used is body acupuncture, which selects points according to paralyzed limbs and combines reinforcing and reducing methods for treatment. In recent years, scalp acupuncture has been widely used in the treatment of cerebral thrombosis, and the method of pricking collaterals has also been used in the treatment of cerebral thrombosis, which has achieved certain results. If cerebral thrombosis can be treated with acupuncture at an early stage and the function of paralyzing glue is properly exercised, the effect will be better.

(9) Brain ultrasound therapy: When the ultrasound penetrates the skull and the brain parenchyma, the mechanical oscillation wave is absorbed by the tissue and converted into heat energy. After tissue heating, local blood flow increases and blood circulation improves, which is beneficial to the establishment of collateral circulation in ischemic area. Each treatment lasts for 20 minutes, 1 time every day, and1time is l courses of treatment. No pain, no side effects, and can be used in rehabilitation period.

(10) Application of nerve activator: Nerve activator can improve brain metabolism, prevent brain necrosis and degeneration, and prevent post-infarction dementia. Commonly used drugs include ATP, cytokinin C, choline cytidine diphosphate, γ-aminocaproic acid, and brain rejuvenation. In recent years, the treatment of cerebral infarction with Huoxuesu has been paid attention to, but it is difficult to determine which drug is more effective.

(ll) Regulating blood pressure and controlling congestion and hyperglycemia: the purpose is to control the risk factors of stroke. Both hypertension and hypotension should be treated properly. However, when blood pressure is too high, be careful not to reduce blood pressure too fast, so as not to affect cerebral blood perfusion; When blood pressure is too low, it should be raised appropriately. Hyperlipidemia increases blood viscosity and affects microcirculation, so it is necessary to limit lipid intake and increase consumption, such as functional exercise. Can give blood-lowering wax drugs, such as inositol nicotinate, atropine and so on. Impaired glucose tolerance is one of the risk factors of cerebrovascular diseases. Most patients with cerebrovascular disease have impaired glucose tolerance in acute phase, and the incidence rate tends to increase with age. Hyperglycemia should be properly handled. At the same time, if you want to use mannitol and corticosteroids, you should be especially cautious.

(12) Treatment of Neurovisceral Syndrome. After cerebral infarction, many visceral symptoms, such as ECG changes (including myocardial infarction), abnormal respiratory rhythm, upper gastrointestinal bleeding, intractable hiccups, etc., affect the recovery and prognosis of cerebral infarction to varying degrees and should be treated.

(13) general support therapy: patients with acute cerebral thrombosis should stay in bed and strengthen nursing. If there are cardiopulmonary complications, take oxygen and rehydration if necessary. Coma patients pay attention to airway patency. Suction sputum and turn over in time.