At present, cerebrovascular diseases have become the main diseases that endanger the health and life of middle-aged and elderly people in China. The death of cerebrovascular disease in urban residents has risen to the first and second place, and the death of cerebrovascular disease in rural areas ranked third in the early 1990 s and rose to the second place in the late 1990 s. There are about 2 million new stroke cases in China every year; About 6.5438+0.5 million people die of cerebrovascular diseases every year; There are 6 million to 7 million surviving patients (including those who have recovered). At present, China's annual expenditure on the disease is close to 20 billion yuan, which has caused a heavy economic burden to the country and many families.

Section 2 Risk factors of cerebrovascular diseases and their intervention management

First, hypertension.

Hypertension is the most important risk factor for cerebral hemorrhage and cerebral infarction. Domestic research shows that after controlling other risk factors, the relative risk of stroke increases by 49% for every increase of systolic blood pressure of 65438±00 mmHg, and by 46% for every increase of diastolic blood pressure of 5mmHg. A randomized controlled clinical trial on systolic hypertension in the elderly in China showed that after four years of follow-up, the stroke mortality rate in the antihypertensive treatment group was 58% lower than that in the placebo control group.

Suggestion:

(1) Further strengthen publicity and education, strive to raise residents' awareness of stroke prevention and take the initiative to care about their blood pressure; It is suggested that people over the age of 35 should take blood pressure 1 time every year, and patients with hypertension should take blood pressure regularly (at least 1 time every 2 ~ 3 months) to adjust the dose (see Table 9).

(2) Hospitals at all levels should establish the system of blood pressure measurement for the first visit of adults as soon as possible;

(3) All localities should actively create conditions, establish demonstration communities of a certain scale, regularly screen hypertensive patients in the population and give them appropriate treatment and follow-up.

(4) For patients with early or mild symptoms, lifestyle changes should be taken first, and those with poor effect after 3 months should be treated with antihypertensive drugs (see Appendix II- 1).

Second, heart disease.

People with heart disease are more than twice as likely to have a stroke as people without heart disease. The risk of stroke in patients with nonvalvular atrial fibrillation is 3% ~ 5% every year, accounting for about 50% of thromboembolic stroke.

Suggestion:

(1) Adults (≥40 years old) should have regular physical examinations to detect heart disease as early as possible;

(2) Patients diagnosed with heart disease should actively seek specialized treatment;

(3) For patients with nonvalvular atrial fibrillation, warfarin can be used in hospitals with conditions, but the international normalized ratio (INR) must be monitored, and the range should be controlled between 2.0 and 3.0; Yes, age >; For those over 75 years old, INR should be between1.6 and 2.5; Or oral aspirin 50 ~ 300 mg/d, or other anti-platelet aggregation drugs. (See Table 9).

(4) Patients with high risk of coronary heart disease should also take low-dose aspirin 50 ~ 150 mg/d or other antiplatelet drugs.

Third, diabetes.

Diabetes mellitus is an important risk factor for cerebrovascular diseases. The risk of stroke in patients with type 2 diabetes has doubled.

Suggestion:

(1) People with risk factors of cardiovascular and cerebrovascular diseases should regularly check their blood sugar, and if necessary, check their glycosylated hemoglobin (HbA 1c) and glycosylated plasma albumin. The diagnostic criteria of diabetes are consistent with the Guidelines for Prevention and Treatment of Diabetes in China (Tables 3 and 4).

(2) Diabetic patients should first control their diet and strengthen physical exercise. Those who are still dissatisfied with blood sugar control for 2 ~ 3 months should choose oral hypoglycemic drugs or insulin treatment. The control targets of diabetes are shown in Table 5.

(3) Diabetic patients should actively treat hypertension, control their weight and lower their cholesterol level.

Fourthly, a large number of studies on dyslipidemia confirmed that serum total cholesterol (TC) and low density lipoprotein (LDL) increased, while high density lipoprotein (HDL) decreased, which was closely related to cardiovascular diseases.

Suggestion:

(1) Patients with dyslipidemia, especially those with risk factors such as hypertension, diabetes and smoking, should first change their unhealthy lifestyle and check their blood lipids regularly. Those who failed to change their lifestyle received medication.

(2) Patients with transient ischemic attack, ischemic stroke or coronary heart disease and TC higher than 5mmol/L were treated with statins. Patients with elevated TG were treated with butyric acid drugs.

Verb (short for verb) Smoking.

Regular smoking is a recognized risk factor for ischemic stroke. Its pathophysiological effects on the body are various, mainly affecting the blood vessels and blood systems of the whole body, such as accelerating arteriosclerosis, increasing fibrinogen level, promoting platelet aggregation, and reducing high-density lipoprotein level. Long-term passive smoking also increases the risk of stroke.

Suggestion:

(1) Persuade smokers to quit smoking (mobilize smokers' relatives to participate in persuasion and provide effective ways to quit smoking).

(2) Mobilize the participation of the whole society, take comprehensive measures to control smoking and intervene in community smokers.

(3) Promote local government departments to enact smoking ban laws as soon as possible, such as setting up smoke-free areas in offices, conference rooms, airplanes, trains and other public places, and smoking can only be done in designated places to reduce the harm of passive smoking.

Sixth, drinking alcohol.

Population research evidence shows that alcohol intake has a direct dose correlation with hemorrhagic stroke. However, the correlation between ischemic stroke is still controversial.

Suggestion:

(1) For people who don't drink, it is not recommended to use a small amount of alcohol to prevent cardiovascular and cerebrovascular diseases; Pregnant women should avoid drinking alcohol.

(2) drinkers must be moderate and don't drink too much; The alcohol content of men should not exceed 20 ~ 30g, and that of women should not exceed 15 ~ 20g.

Seven, carotid artery stenosis

Studies abroad have found that 7% ~ 10% of men over 65 years old and 5% ~ 7% of women have carotid artery stenosis greater than 50%.

Suggestion:

(1) Patients with asymptomatic carotid stenosis generally do not recommend surgery or intravascular intervention, and antiplatelet drugs such as aspirin or statins are preferred.

(2) For severe carotid stenosis (>; 70%) patients, if conditions permit, can consider carotid endarterectomy or intravascular interventional therapy (but it must be determined after comprehensive analysis and discussion according to the wishes of patients and their families, whether there are other complications and the physical condition of patients before operation).

Eight, obesity

A prospective study in China 10 showed that the relative risk of ischemic stroke in obese people was 2.2. In recent years, several large-scale studies show that abdominal obesity is more closely related to stroke than the increase of body mass index (BMI) or even obesity.

Suggestion:

(1) Persuade overweight and obese people to lose weight and reduce the risk of stroke by adopting a healthy lifestyle and increasing physical activity.

(2) Promote a healthy lifestyle and good eating habits. Adult body mass index (kg/m2) should be controlled at

IX. Other risk factors

Hyperhomocysteinemia; Metabolic syndrome; Lack of physical activity; Irrational diet and nutrition; Oral contraceptives; Coagulation risk factors

Section III Contents and Methods of Health Education

First, the content of health education

Three main aspects:

(1) Let people know the serious harm of cerebrovascular diseases, arouse enough attention and take the initiative to prevent them;

(2) Tell people the main risk factors and inducing factors of cerebrovascular diseases, and know how to prevent them;

(3) How to deal with stroke.

Second, the methods of health education

Hospital health education; Community health education; Using mass media to carry out health education