How to treat cerebral ischemia?

The treatment of cerebral ischemia needs to choose the appropriate way according to the condition. Patients can be treated with thrombolysis within 6 hours of onset, and surgical embolus or stent treatment can be performed more than 6 hours. Patients need aspirin, dextran, heparin, vasodilators and other drugs, and most patients need long-term continuous treatment.

First, first aid

Thrombolytic therapy: Thrombolytic therapy refers to injecting thrombolytic agent into the body, dissolving thrombus in cerebral blood vessels, reopening cerebral blood vessels, improving cerebral perfusion, rescuing affected brain tissues and reducing mortality. The best time of thrombolytic therapy for cerebral ischemia is within 3~6 hours. Thrombolytic therapy is fast, simple and economical.

Second, medication.

1. Aspirin: can inhibit platelet aggregation and prevent thrombosis. It is suitable for all patients after thrombolytic therapy, and it is forbidden when ulcer with bleeding symptoms or other active bleeding occurs.

2. Dextran: It belongs to volume expanding agent, which is mainly used to replenish circulating blood volume and promote the recovery of cerebral blood flow, and is suitable for patients with persistent hypotension and hypovolemia.

3. Heparin: It has thrombolytic effect and is suitable for patients with cardiovascular diseases. The main adverse reactions are easy to cause spontaneous bleeding, which is manifested as various mucosal bleeding, joint cavity bleeding and wound bleeding. The time of activating partial thromboplastin should be monitored during use.

4. Vasodilator: By dilating blood vessels in the brain, it can increase cerebral blood flow and avoid serious complications caused by long-term cerebral ischemia and hypoxia. Pay attention to monitoring blood pressure when using.

Third, surgical treatment.

1. Interventional vascular thrombolysis: Interventional vascular thrombolysis is a minimally invasive neuroradiation interventional intravascular therapy, which is super-selective arterial thrombolysis based on neuroradiation interventional therapy. It has the advantages of high recanalization rate, high local concentration and low dosage of thrombolytic drugs. Interventional thrombolysis has been proved to be effective for patients with internal carotid artery embolism (including middle cerebral artery) within 6 hours after onset.

2. Arterial stenting: On the one hand, arterial stenting can improve the blood flow of brain tissue after dilation of narrow blood vessels, on the other hand, it can cover the original plaque with stents to reduce the shedding of unstable plaque. The main purpose of arterial stenting is to prevent the recurrence of cerebral ischemia caused by cerebral artery stenosis. Although this technique is mature, there are certain surgical risks.

3. Thrombolytic therapy: it is suitable for patients with obvious neurological deficit but clear consciousness within 3 hours after onset. Those who meet the following criteria can consider that the onset time of thrombolysis is within 6 hours, and there is no cerebral hemorrhage or undeveloped cerebral infarction on CT of the head. /kloc-more than 0/8 and less than 75. Those who have not undergone major surgery in recent 3 months have no history of digestive tract and other hemorrhagic diseases, their blood pressure is below185/1.10mmhg, their blood sugar is normal, their platelet counts are above10 and 5, and their liver and kidney functions are not obviously damaged. Commonly used drugs are tissue plasminogen activator.