Drug treatment of cerebral infarction;
Improve cerebral blood circulation
1, thrombolytic therapy
① Urokinase: 1 10,000 IU ~1.5,000 iu, dissolved in normal saline 100 ~ 200 mL, continuous intravenous drip for 30min.
② rtPA: The dose was 0.9mg/kg (the maximum dose was 90mg), and 65,438+00% (65,438+0 min) was injected intravenously first, and the rest doses were continuously dripped for 60min.
2. Defibration therapy
(1) batroxobin
Batroxobin is effective in the treatment of acute cerebral infarction, which can significantly reduce the level of fibrinogen, improve symptoms rapidly and obviously, and have mild adverse reactions, but we should also pay attention to bleeding tendency.
(2) Defibrase
The application of domestic defibrase can effectively reduce the level of fibrinogen in the blood of patients with cerebral infarction, improve neurological function and reduce the recurrence rate of stroke, and the effect is better within 6 hours of onset. It is worth noting that when fibrinogen drops below 130mg/dl, the bleeding tendency increases.
(3) Other defibrillators
Such as lumbrokinase, Agkistrodon acutus enzyme, etc.
3. Anticoagulation therapy
(1) unfractionated heparin, UFH)
Randomized controlled trial (IST) of low or medium dose UFH subcutaneous injection in the treatment of acute cerebral infarction shows that heparin can reduce the early recurrence of stroke, but it also increases the risk of bleeding.
(2) Low molecular weight heparin (LMWH)
Some foreign studies have different opinions on the efficacy of low molecular weight heparin in the treatment of ischemic stroke.
(3) Heparinoid
TOAST test in the United States shows that heparin-like can not reduce the recurrence rate of stroke, nor can it alleviate the development of the disease. However, in the analysis of stroke subtypes, it is found that heparin-like may be effective in atherosclerotic stroke.
(4) Anticoagulation as adjuvant therapy.
The use of heparin after intravenous thrombolysis can increase the recanalization rate of blood vessels, but the bleeding complications also increase. More clinical trials are needed to prevent vascular re-occlusion. Most foreign studies believe that anticoagulation therapy is not advocated within 24 hours after thrombolysis. When using anticoagulant therapy, it should be closely monitored, and the dosage of anticoagulant should vary from person to person.
4. Antiplatelet preparation
(1) aspirin
Large-scale research results (IST, CASTER) show that the early use of aspirin in ischemic stroke can reduce the mortality and disability rate, but it has no obvious increase in symptomatic cerebral hemorrhage, but it can increase the risk of bleeding when used together with thrombolytic drugs.
(2) Other antiplatelet preparations
There are studies on the treatment of cerebral infarction by using glycoprotein IIb/IIIa receptor inhibitors alone or in combination. Small sample studies show that this preparation is still safe.
5. Capacity expansion
For the general patients with ischemic cerebral infarction, there are not enough randomized clinical controlled studies to support that volume expansion and pressure increase can improve the prognosis. However, for acute cerebral infarction caused by cerebral hypoperfusion, such as watershed infarction, volume expansion therapy can be considered as appropriate, but it should be noted that complications such as brain edema and heart failure may be aggravated.
6, Chinese medicine treatment
Animal experiments show that some traditional Chinese medicines, such as Salvia Miltiorrhiza, Ligustrazine, Panax Notoginseng, Puerarin and Ginkgo biloba, have the effects of reducing platelet aggregation, anticoagulation, improving cerebral blood flow and reducing blood viscosity. Clinical experience also shows that it is helpful for the prognosis of ischemic stroke. However, there is no large sample, randomized controlled study showing clinical efficacy and safety.
(2) Neuroprotective agent
Many experiments and clinical studies have been conducted to explore the effects of various neuroprotective agents. Many neuroprotective agents are effective in animal experiments, but there is a lack of convincing large-scale clinical observation data. At present, choline cytidine diphosphate, Naofukang and calcium channel blockers are commonly used.
(3) Enbip
Recently, Butylphthalide-Enbip, a new national drug, has been proved to be very effective in treating ischemic cerebrovascular disease.
Enbip was successfully developed by China Academy of Medical Sciences and Shijiazhuang Pharmaceutical Group for 24 years. It is the first national first-class new drug with independent intellectual property rights in the field of cerebrovascular diseases in China, and the only cerebral microcirculation remodeling agent with mitochondrial protection in the world. Its main component is a very small amount of natural monomer butylphthalide found by Chinese scientists from southern cress rapeseed, which has a good therapeutic effect on cerebral ischemia.
As the world's first therapeutic drug specifically for ischemic stroke, EMBEP has been listed as a major project of the Ministry of Science and Technology 1035, a major project of the National Natural Science Foundation, a high-tech industrialization demonstration project of the National Development and Reform Commission, and a national? Eight-five? And then what? Ninth Five-Year Plan? Key research projects and countries? Fifteen? 863? Innovative drugs and modernization of traditional Chinese medicine? Major scientific and technological projects, and obtained 12 domestic patents and 5 international patents. It has been included in the "Guidelines for the Prevention and Treatment of Cerebrovascular Diseases in China" to guide drug use.
How to take Enbip:
Patients with acute cerebral infarction (usually from onset to stable condition) are taken orally on an empty stomach (30 minutes before meals), 2 capsules/time, 3 times/day. One course is 3 bottles, and 2-3 courses are recommended. A large number of clinical studies show that patients with acute cerebral infarction can obtain remarkable therapeutic effect by taking Enbip for 2-3 courses continuously.
If the patient's condition is stable after treatment and he is in the recovery period, he should still take 2 capsules/time, 3 times/day, preferably for three months. Clinical trials have proved that the probability of sequela is greatly reduced in patients with cerebral infarction who continue to take EMBIPUDA for more than three months.
In addition, patients with cerebral infarction can also take it in the high incidence season of cerebral infarction (winter and spring, alternating autumn and winter seasons), 2 capsules/time, 3 times/day for 2 courses, which can effectively prevent the recurrence of cerebral infarction.
Prevention methods of cerebral infarction:
1, dizziness, headache suddenly aggravated.
Or from intermittent headache to persistent severe headache. It is generally believed that headache and dizziness are the precursors of ischemic cerebral infarction, while severe headache with nausea and vomiting is the precursor of hemorrhagic cerebral infarction.
2. Short-term visual impairment,
It is characterized by blurred vision, or visual field defect and incomplete vision. This phenomenon usually recovers itself within one hour, which is an early prediction signal of cerebral infarction.
3. Language and spiritual changes,
Refers to difficulty in pronunciation, aphasia and writing; Personality mutation, reticence, indifference or impatience, irritability, or momentary judgment or mental retardation, lethargy.
4. Other premonitory manifestations,
Such as nausea, vomiting or colic, or blood pressure fluctuation accompanied by dizziness or tinnitus, unexplained recurrent nasal congestion is often a recent precursor to hypercholesterolemia and cerebral congestion.
5, drowsiness and lethargy,
It is characterized by repeated yawning, especially the reaction of hypoxia in the respiratory center. With the aggravation of cerebral arteriosclerosis, the arterial lumen becomes narrower and narrower, and cerebral ischemia becomes worse? About 80% people yawn frequently 5 ~ 10 days before the onset of ischemic cerebral infarction. Don't ignore this important warning signal.
6. Abnormal body sensation and movement,
Such as paroxysmal unilateral limb numbness or weakness, loss of grip, unexplained syncope or fall, unilateral facial paralysis, lasting less than 24 hours. Follow-up observation shows that more than half of people have ischemic cerebral infarction 3~5 years after this phenomenon.
7. the phenomenon that the razor falls to the ground,
Refers to the process of shaving stubble, when the head turns to one side, the arm holding the razor suddenly feels weak, and the razor falls to the ground, which may be accompanied by slurred speech, but it completely returns to normal in about 1~2 minutes. This is because when the neck rotates, it aggravates the already hardened carotid stenosis, leading to insufficient blood supply to the brain and transient cerebral ischemia. It is suggested that ischemic cerebral infarction may occur at any time.
8. Short black lemon,
It means that normal people suddenly turn black in front of their eyes, can't see objects, and return to normal after a few seconds or minutes without nausea, dizziness or any disturbance of consciousness. This is caused by transient retinal ischemia, suggesting that intracranial hemodynamic changes or tiny thrombus temporarily block retinal artery, which is the earliest warning signal of cerebrovascular disease.