Primary prevention is source prevention, mainly to control the causes and risk factors of stroke before the onset, also known as fundamental prevention or etiological prevention.
(1) prevention and treatment of hypertension: actively controlling hypertension can reduce the incidence and mortality of stroke by more than 40% respectively. Therefore, controlling hypertension is the most important primary prevention of stroke. At present, the measures to be taken are: paying attention to the harm of hypertension; Strengthen publicity and education, so that the masses, especially medical staff, fully realize that hypertension is the most important cause and risk factor of stroke. Strengthening the prevention and treatment of hypertension: reasonable diet, reducing sodium intake, moderate exercise, weight control, smoking cessation and alcohol restriction, and maintaining a stable mentality can reduce the incidence of hypertension by 55%. Hypertension patients should use antihypertensive drugs appropriately, and their blood pressure should be controlled below 140/90mmHg. Improve the pressure measurement rate: half of stroke patients in China did not know that they had been hypertensive for many years at the beginning. Therefore, normal people over the age of 40 should have their blood pressure measured at least once every six months or once a year. At the same time, hospitals at all levels should vigorously implement the blood pressure measurement system recommended by WHO, that is, any medical unit (including primary health centers, community health service stations and private clinics) and any specialist must measure blood pressure and record it when they first treat patients over 40 years old. Patients with hypertension who are found for the first time should register and notify the community prevention and control institutions. In the future, blood pressure will be monitored regularly and treated regularly. Improve the compliance of drug treatment: the compliance of hypertensive patients in China is poor, and many patients stop taking drugs without authorization once their blood pressure returns to normal after taking drugs. Apart from economic factors, many patients and medical staff do not realize that hypertension is a chronic disease and must be treated regularly for a long time before it can be effectively controlled.
(2) Prevention of cardiogenic stroke: Patients with rheumatic valvular disease and myocardial infarction are high-risk groups of patients with cardiogenic cerebral infarction, so long-term oral anticoagulants or antiplatelet aggregation drugs should be taken to prevent stroke, and surgery should be performed as soon as possible when there are indications for surgery. Atrial fibrillation: non-rheumatic atrial fibrillation is an important cause of cardiogenic cerebral infarction, which is more common in the elderly. With the increase of the proportion of the elderly population, the cerebral embolism caused by atrial fibrillation also increases, mainly to embolize the trunk of the middle cerebral artery, causing a large area of cerebral infarction. Therefore, patients with chronic atrial fibrillation over 75 years old should take warfarin orally for a long time if they have decreased left ventricular function or thrombus attached to the heart, or have thromboembolic diseases in the past. Patients with chronic atrial fibrillation under 75 years old who do not have the above risk factors should take aspirin orally to prevent cerebral embolism.
(3) Prevention and treatment of diabetes: Diabetes can lead to microangiopathy and promote atherosclerosis, which is a risk factor for stroke. Screening diabetic patients in the population and actively treating and controlling diabetes.
(4) Prevention and treatment of hyperlipidemia: hyperlipidemia accelerates atherosclerosis.
(5) Reasonable diet, reducing sodium intake, proper exercise, weight control, and quitting smoking and drinking.
Secondary prevention is also called "three early prevention", that is, early detection, early diagnosis and early treatment. Secondary prevention is the main measure to prevent or slow down the development of the disease during the onset period. It is mainly aimed at those who have had transient ischemic attack or mild stroke and recovered completely in a short time (3 weeks) to prevent complete stroke. Control diseases and prevent complications. The main measures are:
① Control the development of heart disease and diabetes;
② Intracranial vascular malformations and aneurysms with surgical indications should be treated in time;
③ The secondary prevention of ischemic cerebrovascular disease is mainly antiplatelet drugs, and aspirin is the main commonly used drug.
Three-level prevention mainly includes active treatment after onset, preventing the disease from getting worse, taking preventive measures to reduce complications and prevent recurrence.