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Prevention and early rehabilitation of cerebral infarction

   Cerebral infarction is a common and frequently-occurring disease among middle-aged and elderly people. It has the characteristics of high morbidity, high disability rate, high mortality rate and high recurrence rate. Serious disabilities such as paralysis and aphasia in patients with cerebral infarction bring a heavy burden to society and families. Therefore, the prevention and rehabilitation of cerebral infarction is particularly important. To this end, we invite experts to write articles to popularize the knowledge of prevention and rehabilitation of cerebral infarction for you.
  Cerebral infarction is a disorder of blood supply in the local brain tissue area caused by a variety of reasons, resulting in brain tissue ischemia and hypoxic necrosis. Traditional Chinese medicine believes that the formation of this disease is mainly related to “reverse disorder of Qi and blood stasis”, “phlegm and blood stasis blocking collaterals”, “toxic damage to brain collaterals” and “heat poisoning stroke”. Clinically, the main symptoms are sudden coma, unconsciousness, hemiplegia, skewed corners of the mouth, salivation, poor speech, dysphagia, and cognitive and mental disorders. The disease has a rapid onset and changes rapidly. Once the disease occurs, it is necessary to timely treat the patient accordingly. Some patients have a high disability rate after treatment due to missing the best time for treatment, which makes them lose their ability to work, causing great inconvenience to their daily life, and at the same time giving patients and their Families cause a greater psychological and economic burden.    1. Constant yawning and drowsiness    Due to cerebral ischemia and hypoxia, patients with cerebral infarction may experience yawning and drowsiness 5 to 10 days before the
   onset of cerebral infarction.    2. Abnormal blood pressure A sudden increase in    systolic blood pressure above 200 mmHg or a sudden drop below 80 mmHg.    3. Nosebleeds Epistaxis in    hypertensive patients is also a red flag.    4. Limb weakness The    patient ‘s limb weakness, such as unsteady gait and unsteady holding.    5. Dizziness, headache    Sudden dizziness (vertigo) or severe headache accompanied by coma, etc.

   It is very important to quickly identify cerebral infarction, which can be preliminarily determined by observing: ① whether there is sudden slanted mouth, drooling, slurred speech; ② whether there is sudden limb hemiplegia, numbness and other symptoms.
   Do n’t miss the “golden 6 hours” The most important measure to restore blood flow in
   cerebral infarction is “intravenous thrombolysis”, and thrombolysis in the acute phase must be timely! The time window for thrombolysis in acute cerebral infarction is 6 hours, that is, thrombolysis must be performed within 6 hours after cerebral infarction. The sooner “intravenous thrombolysis” is performed, the sooner blood flow to the brain can be restored, tissue metabolism can be improved, and brain tissue necrosis can be reduced. Because the tolerance time of each human brain cell to ischemia is different, there are often patients who undergo thrombolysis within 3 to 4 hours of onset, but there are still obvious sequelae. If “intravenous thrombolysis” fails, vascular interventional therapy can be done. Vascular interventional therapy includes thrombectomy, stent removal, and arterial infusion thrombolysis. Therefore, it is recommended that patients suspected of sudden cerebral infarction should go to the hospital emergency department as soon as possible, so as not to miss the best time for rescue!
   Patients without thrombolysis should take drugs such as aspirin to fight platelet aggregation as soon as possible. Anticoagulation can be used in high-risk patients with hypercoagulability and at risk of deep vein thrombosis and pulmonary embolism. At the same time, drugs such as statins and free radical scavengers can reduce brain metabolism, interfere with the cytotoxic mechanism caused by ischemia, and reduce ischemic brain damage. In clinical practice, Chinese patent medicines such as Salvia miltiorrhiza, Ligustrazine, Panax notoginseng, and puerarin are often used to promote blood circulation and remove blood stasis to improve the symptoms of cerebral infarction.
   Rehabilitation therapy is of great benefit Early comprehensive rehabilitation therapy for patients with
   acute cerebral infarction refers to observing the patient’s vital signs and clinical symptoms within 48 hours after the onset of the disease to see if it has stabilized. Taking rehabilitation measures as soon as possible after the condition is stable can minimize the occurrence of disability and impairment. Within 6 months of the onset of the disease is the golden period of rehabilitation treatment, and the rehabilitation effect is the best, and rehabilitation treatment after 1 year will leave various degrees of dysfunction. Therefore, for patients with cerebral infarction, the earlier the rehabilitation treatment is started, the better. The early implementation of comprehensive rehabilitation training is of great significance for the recovery of patients’ limb function, which can effectively improve their muscle tension and avoid muscle atrophy.
   Early rehabilitation training mainly includes:
   1. Psychological nursing
   To carry out psychological rehabilitation for patients with acute cerebral infarction, nurses should use simple words to communicate with patients, exchange some daily things, and relax their tension and fear; if patients have doubts about certain problems, nurses should actively Answers and relieves the doubts in the patient’s heart; Nursing staff can introduce successful cases of treatment to patients and enhance the patient’s confidence in curing.
   2. Rehabilitation training of swallowing function and language function
   If the patient has dysphagia and coughs, he should be instructed to carry out corresponding exercises; if the patient has speech dysfunction and dysarthria, the patient should be instructed to perform tongue stretching exercises and gill drumming exercises Rehabilitation training, such as baring teeth and knocking teeth, tongue flicking, mouth circle movement, and mouth-to-mouth exercises, each exercise reciprocates 10 to 15 times, 3 times a day. When the above exercises can be successfully completed by the patient, it means that the patient’s facial muscles have recovered well, and the patient can be guided to carry out pronunciation rehabilitation training until they can speak normally.
   3. Bedside limb rehabilitation training The
   so-called bedside limb rehabilitation refers to the therapist instructing the patient to carry out training such as sitting, lying, turning over, stretching and flexing the elbow on the bed, and instructing the patient to perform squatting, leg raising and other training on the bedside. . In the early stage, passive training was mainly used, and the training forms mainly included joint activities, limb placement, and body position transfer. train. Standing exercise requires the patient to be in a standing position and instructs him to correctly perform left and right swinging exercises of both upper limbs. The left and right swinging of the limbs helps the patient to rotate the trunk, promotes the improvement of limb function, and instructs the patient to carry out walking rehabilitation training; Keep the standing balance state and perform weight-bearing rehabilitation training on the lower side of the affected limb, and repeat the rehabilitation training such as the transfer of the affected side’s center.
   4. Motor imagery therapy
   Motor imagery therapy is a rehabilitation therapy technique that promotes the recovery of limb function by repeatedly simulating and rehearsing specific movements in the mind without obvious physical activity. It requires patients to have appropriate cognitive function and imagination. Currently, it is widely used in the recovery of hand function, walking and balance after cerebral infarction.
   5. Brain-computer interface
   Motor imagery can improve functional impairments such as movement and swallowing after cerebral infarction. However, because the imaging process is difficult to be supervised by physicians or therapists, physicians or therapists cannot intuitively judge whether patients can effectively complete motor imagery tasks. Therefore, motor imagery is difficult to be widely used in practical applications. promotion. Brain-computer interface technology makes up for this technological gap. At present, it is believed that motor imagery should be targeted to select some actions from functional training activities and implement them in combination with computers. The brain-computer interface successfully provides real-time monitoring, measurement and feedback for the motor imagery process. Brain-computer interface technology is a central intervention treatment, which can promote the compensation or recovery of injured cranial nerve function, activate the neuroplasticity of the brain, and from the central to the periphery, patients can actively participate in rehabilitation training, and use the brain’s strong motor intention to complete motor imagery The task is to use brain-computer interface technology to stimulate the corresponding cerebral cortex, promote the remodeling of the central nervous system, and send signals to control the movement of the limbs through the spinal cord and peripheral nerves. It is believed that the continuous development of brain-computer interface technology will bring great benefits to patients.

   6. Physical factor therapy
   Local mechanical stimulation (such as hand tapping on the corresponding part, etc.), ice stimulation, functional electrical stimulation, electromyography biofeedback and local air pressure therapy, etc., can make the muscles of the paralyzed limbs contract and relax passively. , and gradually improve its tension; music therapy can facilitate movement, increase the range of limb movement, regular movement rhythm, improve exercise efficiency, and improve exercise endurance; transcranial magnetic stimulation can change the excitability of cerebral cortex, change cortical metabolism and cerebral blood flow. Neurons play a facilitation or inhibition role; transcranial direct current stimulation can play a role by regulating the activity of the neural network, using anodal stimulation and cathodal stimulation to stimulate different brain functional areas, thereby achieving different therapeutic effects.
   7. Traditional Chinese
   Medicine The commonly used methods of traditional Chinese medicine include massage and acupuncture. Through deep and shallow sensory stimulation, it helps local muscle contraction and blood circulation, thereby promoting the improvement of the function of the affected limb.
  Targeted to reduce complications After
   cerebral infarction often lead to a series of complications, such as shoulder joint problems, muscle and joint contractures, pressure ulcers, lower extremity venous thrombosis, depression and so on. Early recovery can reduce or even avoid such problems.
   1. Shoulder problems
   About 70% of patients with cerebral infarction develop shoulder pain and related dysfunction within 1 to 3 months after the onset of cerebral infarction, which limits the functional activities and improvement of the upper limb on the affected side. Common shoulder-hand syndrome, shoulder joint subluxation and shoulder Soft tissue injury (eg, rotator cuff injury, bursitis, tenosynovitis), etc. Shoulder-hand syndrome is manifested as shoulder pain, shoulder movement disorder, hand swelling and pain, hand muscle atrophy and finger joint contracture deformity in the later stage. Commonly used treatment methods include elevating the upper limb on the affected side, dorsiflexing the wrist joint, and encouraging the patient to take the initiative to move. ; When patients have limited or no active activities, passive activities, concentric air pressure therapy or wire wrapping compression therapy, hand cold therapy, local injection of steroid preparations, etc. should be added. Shoulder subluxation is characterized by limited movement of the shoulder, local muscle atrophy, and obvious depression between the acromion and the humeral head. The commonly used treatment methods include correcting the retraction of the scapula and stimulating the active contraction of the deltoid and supraspinatus muscles. (such as joint extrusion, local slapping or ice stimulation, electro-acupuncture treatment, etc.), the Bobath shoulder support is conducive to the active and passive activities of the shoulder joint on the affected side and prevents shoulder injuries. Shoulder soft tissue injury is manifested as shoulder pain during active or passive shoulder movement, and local muscle atrophy may occur later. In treatment, shoulder activities should be performed in the external rotation of the humerus, and local physiotherapy, external use of traditional Chinese medicine and oral non-steroidal anti-inflammatory drugs can be added. Inflammatories, etc.
   2. Muscle spasm and joint contracture
   Most patients with cerebral infarction will have varying degrees of increased skeletal muscle tone during the recovery of motor function, mainly due to stretch hyperreflexia caused by damage to upper motor neurons. Increased tension in the flexors of the lateral upper extremities and extensors of the lower extremities. Commonly used treatment methods include antispasmodic methods in neuromuscular facilitation techniques, correct body positioning (including supine and sitting) and the use of tonic reflexes, oral muscle relaxation Drugs (such as baclofen, etc.), local injection of botulinum toxin, etc. Contracture is the increase of skeletal muscle tension for a long time in stroke patients, and the immobility of the affected joint or the small range of motion makes the soft tissue around the joint shorten and reduce its elasticity, which is manifested as joint stiffness. With active participation (weight-bearing on the affected limb), application of orthopedic braces, and surgical treatment if necessary.
   3. Lower extremity deep vein thrombosis
   In patients with cerebral infarction, due to poor active movement of the lower limbs on the affected side, long-term bed rest or prolonged lower limb sagging, the effect of limb muscles on venous pumps is reduced, resulting in slow blood flow of the lower limbs, high blood coagulation, and vascular endothelial damage, and platelet deposition is formed. thrombus. The clinical manifestations include swelling of the lower limbs on the affected side, slightly higher local temperature, limited passive motion of the affected joints, and severe necrosis of the distal limbs. If the thrombus falls off, it can cause pulmonary embolism, and the patient suffers from sudden dyspnea, chest tightness, and acute heart failure, which is life-threatening. Ultrasonography can help with diagnosis. Early prevention can prevent deep vein thrombosis of the lower extremities. Commonly used methods: ①active and passive movement of lower limbs; ②elevating lower limbs (while in bed) and wearing elastic stockings; ③external air pressure circulation treatment of lower limbs; Venous thrombosis can be treated with heparin anticoagulation, urokinase thrombolysis, vascular surgery or interventional therapy.
   4. Pneumonia Pneumonia in patients with
   cerebral infarction mainly includes aspiration pneumonia and hypostatic pneumonia. The former can be prevented by treating the primary disease and swallowing function training, and the latter can be reduced by respiratory function training, active coughing and postural expectoration. .
   5. Pressure ulcers Pressure ulcers in patients with
   cerebral infarction are mainly due to maintaining a certain position for too long, which makes the local skin compressed for a long time, and blood circulation disorders cause skin tissue ischemia and necrosis. Attention should be paid to reducing local pressure, turning over regularly (once every 2 hours), applying inflatable cushions, cleaning the bed surface and skin care, and paying attention to nutrition can prevent the occurrence of pressure ulcers. For existing pressure ulcers, the pressure should be relieved in time, the sore surface should be treated, ultraviolet rays should be treated, and nutrition should be increased. If necessary, surgical treatment should be considered.
   6. Depression
   The incidence of depression after cerebral infarction is 30% to 60%. Most depressed patients are often crying, sad, taciturn, tired or weak almost every day, insomnia or sleep too much, reduced attention and judgment ability, self-blame and inferiority complex, etc. . Commonly used treatment methods: ① Psychological rehabilitation treatment: two methods of individual treatment and group treatment can be used. At the same time, social members such as family members and friends or colleagues of the patient should be involved. Psychotherapists should pay attention to establishing a good doctor-patient relationship, so that Relax the patient’s body and mind, relieve their inner pain, correct or reconstruct a certain behavior, etc.; ②Drug treatment: tricyclic or tetracyclic antidepressants (such as doxepin, mianserin), serotonin reuptake inhibition agents (such as fluoxetine).
   In short, the prevention and treatment of cerebral infarction is urgent, and early rehabilitation cannot be ignored!
  Precautions
   for the high morbidity, mortality and disability rates of cerebral infarction, the prevention of cerebral infarction should be strengthened in daily life. First, the risk factors for cerebral infarction must be identified. The formation of cerebral infarction is often the result of the joint action of multiple risk factors, which are related to age, gender, race and genetics, and these factors cannot be controlled and intervened artificially. Therefore, in daily life, it is necessary to strengthen the control of risk factors that can be intervened, such as hypertension, diabetes, hyperlipidemia, atrial fibrillation, carotid artery stenosis, lack of exercise, unreasonable diet, obesity, smoking, excessive drinking, unhealthy lifestyle, etc. .
   To prevent the occurrence or recurrence of cerebral infarction, you should first develop a healthy lifestyle, such as a light diet, eat more vegetables, less salt and less sugar, moderately increase physical exercise, maintain emotional stability, and feel happy; prevent overwork, overcome bad habits, such as Quit smoking and alcohol, control weight, avoid sedentary, etc. Regular screening of risk factors for cerebral infarction, early detection, early prevention, early diagnosis, and early treatment can effectively prevent cerebral infarction. For patients with basic diseases such as hypertension, it is necessary to control blood pressure, blood lipids, and blood sugar. The blood pressure of ordinary hypertensive patients should be controlled below 140/90 mmHg; for hypertension complicated by diabetes or kidney disease, the blood pressure is generally controlled at 130. /80 mm Hg or less. The systolic blood pressure in the elderly (age > 65 years) should generally be reduced to below 150 mmHg, and if tolerated, the systolic blood pressure can be further reduced. The general goal for people with diabetes is to have an glycated hemoglobin of less than 7%. Standardize the use of antihypertensive, hypoglycemic, lipid-lowering and other drugs, do not arbitrarily stop or change drugs, regularly monitor relevant indicators, and follow up in outpatient clinics.

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