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Ischemic stroke is the most common subtype of stroke, and its morbidity, mortality, and disability rate are relatively high.
The active participation of primary general practitioners in comprehensive prevention and treatment is one of the key measures to control ischemic stroke
.
The "Guidelines for Primary Diagnosis and Treatment of Ischemic Stroke (2021)" detailed the definition, classification, epidemiological trends, etiology, identification, diagnosis, treatment, referral and primary management of ischemic stroke
.
Regarding the treatment principles and basic treatment methods in the acute phase of ischemic stroke, the guidelines mainly involve the following
.
1 Principles of treatment in the acute phase of ischemic stroke 1.
Monitor and maintain vital signs, prevent and treat life-threatening complications and the occurrence and development of complications, and maintain the normal function of the body's main organs and the stability of the internal environment
.
2.
Prevent and reverse the pathophysiological process of the occurrence and development of ischemic stroke as soon as possible, that is, recanalize the stenosis or obstruction as soon as possible, restore effective cerebral blood perfusion, and prevent the further development of thrombus and the further decline of cerebral blood perfusion
.
3.
reversal of the pathological outcome of ischemic stroke caused prevention of ischemia-reperfusion injury, improve brain cell metabolism, prevention and treatment of cerebral edema
.
4.
Learn more about the risk factors, etiology and pathogenesis of ischemic stroke, and initiate secondary prevention as soon as possible
.
5.
Initiate rehabilitation as soon as possible, repair the pathological outcome of neurological deficits, restore impaired physical function, evaluate and improve language, cognition, emotion and other functions, and return to society as soon as possible
.
2 Basic treatment in the acute phase of ischemic stroke (1) Maintain airway patency, avoid asphyxia, and maintain oxygen saturation >94% as much as possible
.
(2) Cardiac monitoring and heart disease treatment: ECG should be monitored routinely within 24 hours after ischemic stroke to detect heart diseases such as paroxysmal atrial fibrillation or severe arrhythmia as soon as possible, and avoid using drugs that increase the heart load
.
(3) Maintain the function of cerebral blood circulation: the key is to manage blood pressure
.
①Patients with elevated blood pressure within 24 hours after ischemic stroke should be handled with caution.
Tension, anxiety, pain, nausea and vomiting, urinary retention, and increased intracranial pressure should be dealt with first
.
For patients with systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥100 mmHg, or patients with severe cardiac insufficiency, aortic dissection, or hypertensive encephalopathy, refer to the patient’s previous blood pressure and treatment conditions, and use antihypertensive drugs with caution and closely observe blood pressure Change, pay attention to avoid low blood pressure or insufficient blood volume
.
②For patients who are preparing for thrombolysis and bridging intravascular mechanical thrombectomy, blood pressure should be controlled at systolic blood pressure <180 mmHg and diastolic blood pressure <100 mmHg
.
③The condition is stable after ischemic stroke.
If the blood pressure continues to be ≥140/90 mmHg and there are no contraindications, you can resume using the pre-onset blood pressure lowering drugs or start the blood pressure lowering treatment a few days after the onset of the disease
.
④Patients with hypotension after ischemic stroke should actively search for and deal with the cause, and if necessary, use expansion and pressure increase measures
.
0.
9% sodium chloride solution can be injected intravenously to correct hypovolemia and treat heart diseases that may cause decreased cardiac output
.
(4) Blood sugar: Hyperglycemia or hypoglycemia in the acute phase is harmful to brain tissue, and blood sugar should be restored to the normal range in time
.
(5) Body temperature control: For any increase in body temperature caused by any cause, the cause of fever should be searched for and dealt with, and symptomatic treatment should be actively performed; patients with a body temperature of >38 ℃ should be given antipyretic measures
.
(6) Monitoring of intracranial pressure to avoid brain herniation death caused by excessive intracranial pressure
.
The head of the bed can be raised 15°~30°, and treated with mannitol if necessary
.
(7) Maintain water and electrolyte balance and strengthen nutritional support
.
(8) Actively prevent and treat various complications, and deal with the accompanying diseases
.
The above content is excerpted from: Chinese Medical Association, Chinese Medical Association Journal, Chinese Medical Association General Practice Branch, etc.
Guidelines for Primary Diagnosis and Treatment of Ischemic Stroke (2021)[J] .
Chinese Journal of General Practitioners, 2021, 20(9 ): 927-946.
The active participation of primary general practitioners in comprehensive prevention and treatment is one of the key measures to control ischemic stroke
.
The "Guidelines for Primary Diagnosis and Treatment of Ischemic Stroke (2021)" detailed the definition, classification, epidemiological trends, etiology, identification, diagnosis, treatment, referral and primary management of ischemic stroke
.
Regarding the treatment principles and basic treatment methods in the acute phase of ischemic stroke, the guidelines mainly involve the following
.
1 Principles of treatment in the acute phase of ischemic stroke 1.
Monitor and maintain vital signs, prevent and treat life-threatening complications and the occurrence and development of complications, and maintain the normal function of the body's main organs and the stability of the internal environment
.
2.
Prevent and reverse the pathophysiological process of the occurrence and development of ischemic stroke as soon as possible, that is, recanalize the stenosis or obstruction as soon as possible, restore effective cerebral blood perfusion, and prevent the further development of thrombus and the further decline of cerebral blood perfusion
.
3.
reversal of the pathological outcome of ischemic stroke caused prevention of ischemia-reperfusion injury, improve brain cell metabolism, prevention and treatment of cerebral edema
.
4.
Learn more about the risk factors, etiology and pathogenesis of ischemic stroke, and initiate secondary prevention as soon as possible
.
5.
Initiate rehabilitation as soon as possible, repair the pathological outcome of neurological deficits, restore impaired physical function, evaluate and improve language, cognition, emotion and other functions, and return to society as soon as possible
.
2 Basic treatment in the acute phase of ischemic stroke (1) Maintain airway patency, avoid asphyxia, and maintain oxygen saturation >94% as much as possible
.
(2) Cardiac monitoring and heart disease treatment: ECG should be monitored routinely within 24 hours after ischemic stroke to detect heart diseases such as paroxysmal atrial fibrillation or severe arrhythmia as soon as possible, and avoid using drugs that increase the heart load
.
(3) Maintain the function of cerebral blood circulation: the key is to manage blood pressure
.
①Patients with elevated blood pressure within 24 hours after ischemic stroke should be handled with caution.
Tension, anxiety, pain, nausea and vomiting, urinary retention, and increased intracranial pressure should be dealt with first
.
For patients with systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥100 mmHg, or patients with severe cardiac insufficiency, aortic dissection, or hypertensive encephalopathy, refer to the patient’s previous blood pressure and treatment conditions, and use antihypertensive drugs with caution and closely observe blood pressure Change, pay attention to avoid low blood pressure or insufficient blood volume
.
②For patients who are preparing for thrombolysis and bridging intravascular mechanical thrombectomy, blood pressure should be controlled at systolic blood pressure <180 mmHg and diastolic blood pressure <100 mmHg
.
③The condition is stable after ischemic stroke.
If the blood pressure continues to be ≥140/90 mmHg and there are no contraindications, you can resume using the pre-onset blood pressure lowering drugs or start the blood pressure lowering treatment a few days after the onset of the disease
.
④Patients with hypotension after ischemic stroke should actively search for and deal with the cause, and if necessary, use expansion and pressure increase measures
.
0.
9% sodium chloride solution can be injected intravenously to correct hypovolemia and treat heart diseases that may cause decreased cardiac output
.
(4) Blood sugar: Hyperglycemia or hypoglycemia in the acute phase is harmful to brain tissue, and blood sugar should be restored to the normal range in time
.
(5) Body temperature control: For any increase in body temperature caused by any cause, the cause of fever should be searched for and dealt with, and symptomatic treatment should be actively performed; patients with a body temperature of >38 ℃ should be given antipyretic measures
.
(6) Monitoring of intracranial pressure to avoid brain herniation death caused by excessive intracranial pressure
.
The head of the bed can be raised 15°~30°, and treated with mannitol if necessary
.
(7) Maintain water and electrolyte balance and strengthen nutritional support
.
(8) Actively prevent and treat various complications, and deal with the accompanying diseases
.
The above content is excerpted from: Chinese Medical Association, Chinese Medical Association Journal, Chinese Medical Association General Practice Branch, etc.
Guidelines for Primary Diagnosis and Treatment of Ischemic Stroke (2021)[J] .
Chinese Journal of General Practitioners, 2021, 20(9 ): 927-946.
