In the morning 1, 50-year-old Mr. Ding suddenly had a crooked mouth and could not speak, and his upper right lower limbs were weak and he collapsed to the ground. Was sent to the emergency department of the hospital by his family in time. The emergency neurologist accepted the consultation and started intravenous thrombolysis with the consent of his family. Remove the thrombus from the left middle cerebral artery and reopen the blood vessel. At that time, the patient could lift his right upper limb on the operating table. On the third day after the operation, the patient was able to get out of bed and walk with help. Three months after the illness, the patient basically recovered and returned to work.
Expert review
Stroke (also known as stroke or cerebrovascular accident) is a group of sudden acute cerebrovascular diseases, characterized by focal neurological deficit caused by cerebral blood circulation disorder. Stroke can be divided into ischemic and hemorrhagic types, including rare hypertensive encephalopathy and vascular dementia. The treatment methods of ischemic stroke and hemorrhagic stroke are different. Once it happens, it should be sent to the hospital as soon as possible for early diagnosis and treatment.
20 17 World Stroke Organization put forward six knowledge points about cerebral infarction:
1. It is very important to identify the early symptoms of stroke (fast principle).
2. Stay in a hospital specializing in stroke in time, and 10 people have a good prognosis.
3. Intravenous thrombolysis can improve the good prognosis probability by 30%.
4. Endovascular embolectomy can improve the good prognosis probability by 50%.
5. Rehabilitation is the key measure of treatment.
6.4 stroke survivors, 1 will recur.
Stroke fast principle
Stroke is sudden and its occurrence is unpredictable. However, we can gain time for first aid by identifying the symptoms of stroke early. The fasting principle proposed by the World Stroke Organization is:
F (face) face Observe whether your face or mouth is skewed when you laugh.
One arm. Raise your arms horizontally and observe whether one upper limb is unable to droop.
Speech. Is it inarticulate or unable to speak?
When the above symptoms appear at t (time), you should send them to the hospital as soon as possible, and don't have a "wait and see" mentality. If this time window is missed, the patient will miss the opportunity of vascular recanalization.
The principle of quickness can also be summarized as a simple formula: vague words, crooked mouth, not holding arms to go to the hospital. If one of the above three items occurs, the probability of a new stroke is 72%; If all three items are positive, the probability of stroke is over 85%. Once a stroke is found, you should call 120 as soon as possible and send it to the nearest hospital with the qualification of stroke first aid, and start intravenous thrombolysis and embolectomy as soon as possible.
What is intravenous thrombolysis?
Intravenous thrombolysis is the best drug treatment for acute cerebral infarction, and the treatment time should be within 6 hours (preferably 3 hours). The indications are: brain CT excludes intracranial hemorrhage, the age is above 18 to below 80 years old, and the blood pressure is below 180/ 100 mm Hg.
What is intravascular interventional embolectomy?
Endovascular embolectomy, as its name implies, is to remove the embolus from intracranial blood vessels through interventional surgery. Through a 2 mm incision in the thigh, the stent was sent into the blood vessel, and the thrombus was taken out after reaching the thrombus position. Intravascular embolectomy is suitable for acute cerebral infarction patients with great vascular occlusion within 6 ~ 24 hours after onset.
Clinically, doctors will decide whether to implement intravenous thrombolysis or interventional embolectomy according to the patient's condition. Occasionally, both of them will be carried out at the same time: firstly, patients will be given thrombolytic drugs for intravenous thrombolysis, and at the same time, they will be prepared for interventional embolectomy to shorten the time of blood vessel opening and minimize the harm caused by stroke. Whether intravenous thrombolysis or intravascular embolectomy, its benefits will gradually decrease with the passage of time. Every delay of 1 min will result in10.9 million neurons and10.40 billion synapses dying. Therefore, we must race against time to establish the concept that "time is the brain" in stroke first aid.
Authors: Wang Min, distinguished expert and deputy chief physician of the Second People's Hospital of Jingzhou City, Hubei Province.
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