New methods to prevent stroke (June 2002 18)

Liu Guorong: Chief physician, vice president of Baotou Central Hospital, engaged in neurology for 25 years, and has been studying the diagnosis and treatment of cerebrovascular diseases. Completed 25 scientific research projects and won the Ministry, provincial and municipal scientific and technological progress award 17. (Left)

Li Yuechun: Chief physician, vice president and director of the Department of Neurology, Baotou Central Hospital, specializing in the prevention and clinical treatment of cerebrovascular diseases, completed 22 scientific research projects, won the provincial and municipal scientific research progress award 15, and published 80 papers. (right)

Hello, audience friends! This is CCTV's live program "The Road to Health". Today we are going to talk about the early prevention of stroke.

Moderator: What kind of pathological changes occurred in the brain when the stroke occurred?

Liu Guorong: The onset of stroke is very fast, sometimes even a few seconds will make people hemiplegic or unconscious. Many of them are caused by cerebral hemorrhage or cerebral infarction, which is commonly called stroke. Among them, cerebral infarction accounts for about 80% of stroke. Cerebral infarction is caused by the sudden interruption of blood vessels supplying the brain, which leads to ischemia and hypoxia of brain tissue. At this time, the brain tissue lost its function, and the patient showed sensory disturbance or hemiplegia. As shown, this is a patient with cerebral infarction. Ischemic necrosis of the dark tissue is characterized by paralysis of the contralateral limb and loss of consciousness.

Compere: Will there be any other circumstances leading to a stroke?

Li Yuechun: Cerebral hemorrhage can also lead to stroke. The onset of cerebral hemorrhage is rapid, which can lead to hemiplegia, coma and even death within a few minutes. As shown in the picture, this is a brain specimen of cerebral hemorrhage. Cerebral hemorrhage is an aneurysm caused by many factors. After rupture, blood suddenly flows into normal brain tissue, destroying normal brain tissue. The dark part of the picture is the bleeding cavity, surrounded by some tissue death and edema zones caused by pressing brain tissue after bleeding. Compression of brain tissue after cerebral hemorrhage, contralateral compression will lead to midline displacement, downward compression will compress brain stem, leading to coma and even death.

Moderator: What if the patient is not sent to the hospital in time for emergency treatment in the acute stage of stroke?

Liu Guorong: No matter cerebral hemorrhage or cerebral infarction, they should be sent to the hospital for emergency treatment. The consequences of rescuing and not rescuing are completely different. Actively rescuing patients can avoid paralysis and get maximum treatment. If you don't send it to the hospital in time, the consequences will be unimaginable.

Moderator: Why do some patients leave different degrees of sequelae after rescue?

Li Yuechun: After the hospital's active rescue, most stroke patients can save their lives, but 70% of them will leave different degrees of sequelae, such as loss of working ability, and about 40% of them have serious sequelae and can't take care of themselves at all. At present, medical methods can not make these damaged brain tissues recover quickly. Although they can recover to varying degrees after long-term rehabilitation treatment, they will inevitably leave sequelae.

Moderator: Do all stroke patients have sudden onset?

Liu Guorong: Not all stroke patients have sudden symptoms. Some patients have premonitions, but most patients have sudden symptoms.

Moderator: What are the specific manifestations of stroke?

Li Yuechun: There are many manifestations of stroke, some are hemiplegia, unable to speak, some can't understand others, walk sideways and keep moving their hands.

Moderator: Some patients didn't know it was a stroke before they were sent to the hospital. Why?

Li Yuechun: Most patients have premonitory symptoms before stroke, such as dizziness, headache, dizziness, poor memory, sudden increase in sleep and unclear language. Some patients know nothing about this, or ignore that these symptoms may be a stroke, which is likely to delay the illness.

Moderator: Can stroke be prevented?

Liu Guorong: Stroke can be prevented, but the prevention of stroke should start from the prevention of arteriosclerosis, that is, from children, teenagers and daily life. We should cultivate a regular and orderly life, avoid drinking and smoking, eat more fresh fruits and develop a cheerful personality. At present, the incidence of cerebrovascular diseases is rising every year, and there is a trend of youthfulness. Therefore, China attaches great importance to this work and proposes effective three-level prevention.

Moderator: What is tertiary prevention?

Li Yuechun: Tertiary prevention means blocking the occurrence of cerebrovascular diseases through three different stages. Primary prevention is to carry out health education in the community, so that everyone can understand the basic knowledge of cerebrovascular diseases and avoid some risk factors such as hypertension, hyperlipidemia and diabetes. Secondary prevention means that once these risk factors of cerebrovascular disease exist, they should be controlled, such as long-term regular treatment of hypertension to prevent the occurrence of cerebrovascular disease, that is, to control the occurrence of cerebrovascular disease. Tertiary prevention is to actively control and effectively treat patients with early signs of cerebrovascular diseases.

Moderator: What measures does tertiary prevention specifically include?

Liu Guorong: Tertiary prevention is mainly aimed at high-risk groups, among which hypertension and diabetes are the most dangerous. Both diseases can lead to arteriosclerosis. Stroke occurs in a short time, but the process of pathological formation is a long process, as shown in the figure. This is a cross-sectional view of a normal blood vessel. From the picture, we can see that the intima of blood vessel is smooth and the blood flow is unobstructed, which leads to the damage of intima of blood vessel under the influence of risk factors such as hypertension. The naked eye can see the yellow lipid stripes on the intima of blood vessels, that is, arteriosclerosis is formed, the lesions gradually develop and proliferate the surrounding fibrous tissues and connective tissues, and the lesions gradually protrude from the intima, forming hardened plaques. The formation of this plaque is constantly developing, which can make some fibrous tissues form gray spots. The formation of fibrous plaque can affect the collapse and necrosis of normal tissues, and the collapsed tissues form atherosclerotic plaques, thus forming arteriosclerosis. After the formation of arteriosclerosis, the bane of hemiplegia was planted. At this stage, if effective measures are taken for treatment, cerebrovascular diseases can also be avoided.

Li Yuechun: Let's look at a schematic diagram of a thrombus: this is a normal arterial lumen. If atherosclerotic plaque is formed in the lumen, it will continue to develop into ulcer plaque, and blood will easily gather when it flows through the ulcer plaque. When platelets aggregate to a certain extent, a lysophosphatidic acid will be released. The release of lysophosphatidic acid indicates that thrombus is about to form. When the lumen is occluded, the brain tissue supplied by blood vessels will be necrotic, resulting in cerebral infarction.

Moderator: Is it because of the appearance of lysophosphatidic acid that thrombosis is formed?

Liu Guorong: Yes, the appearance of lysophosphatidic acid indicates that thrombosis has begun, which should be highly valued.

Moderator: How can we know that lysophosphatidic acid has increased in the body?

Liu Guorong: If the patient has the above risk factors for stroke, such as hypertension, diabetes, hyperlipidemia, etc. , or have stroke aura, such as dizziness, numbness of limbs, Lickitung, etc. He should go to the hospital to check lysophosphatidic acid. Middle-aged and elderly people should have an examination of lysophosphatidic acid every six months, and the examination cost is not high, about tens of yuan each time.

Moderator: What measures should be taken when lysophosphatidic acid is found to be relatively high?

Li Yuechun: Specifically, different treatment methods should be adopted according to the severity of patients' symptoms. If it increases slightly, you can take aspirin orally. If it is a moderate increase, some anticoagulants should be used. If it is seriously increased, a stronger dose of anticoagulant should be used. The examination of lysophosphatidic acid provides doctors with a basis for treatment, and the treatment can be targeted.

Moderator: What is the effect of tertiary prevention in practical work?

Li Yuechun: Let's look at a clinical comparison: 988 patients with prodromal symptoms of cerebral infarction were examined at 1.200, and 9 patients had cerebral infarction after intervention, while the control group had 1.200 patients, which fully demonstrated the preventive effect.

Moderator: How to prevent recurrence of cerebral infarction?

Liu Guorong: The recurrence rate of cerebral infarction or stroke is very high. We should avoid some causes of stroke, such as smoking and drinking, and check lysophosphatidic acid regularly.

Moderator: How to check lysophosphatidic acid? What should I pay attention to?

Li Yuechun: The test requires 3 ml of blood on an empty stomach. Don't drink alcohol for 24 hours before the exam, don't eat anything too greasy, especially don't eat eggs.

Moderator: What is the clinical situation of preventing the disease from getting worse by checking lysophosphatidic acid?

Liu Guorong: Let's look at a comparison table:

Test group control group

1800 cases of cerebral infarction, 2000 cases of cerebral infarction.

Lysophosphatidic acid increased in 657 cases and stroke aggravated in 263 cases.

23 cases of stroke aggravation

Moderator: Ms. Zhang, a native of Hebei, has a 68-year-old father and high blood pressure for 6 years. Recently, I can't hold chopsticks with my right hand, and I recovered quickly in about 1-2 minutes. What happened? Do you need treatment?

Liu Guorong: We should go to the hospital to check lysophosphatidic acid, and then treat the symptoms.

Moderator: Ms. Zhou from Beijing, my husband is often dizzy, bloated and sleeps a lot. What tests need to be done? Is there a risk of cerebral infarction?

Li Yuechun: This manifestation is an early sign of cerebrovascular disease. We should check lysophosphatidic acid. If it is too high, different anticoagulants should be used according to the specific situation.

Moderator: Mr. Han from Shanghai, 62 years old. I suffered from a cerebral infarction in March this year. At first, my upper right lower limb was weak, but I could still lift it. My family can walk with it. After hospitalization 1 day, not only did it not get better, but it got worse. My upper right lower limb can't move at all. What happened?

Liu Guorong: It is possible that lysophosphatidic acid was not checked during the first treatment, because the condition will not get worse after interventional therapy, and lysophosphatidic acid should still be checked.

Moderator: Mr. Zhang from Henan, a relative of mine suddenly felt that his mind was blank and he could not remember anything, but he could still drive. He often asks me where I am, and it will take about 4 hours. How did this happen?

Li Yuechun: This is a manifestation of transient cerebral ischemia. At this time, besides the examination of lysophosphatidic acid, various risk factors should be examined. Active use of anticoagulants can block the development of the disease.

Moderator: Mr. Guo from Guangzhou is 55 years old. I have always been in good health. I can't say what I want to say recently, and I can't say the names of the common ones. Should I see a doctor?

Liu Guorong: This situation may be caused by a stroke. If we actively intervene, there is still great hope for recovery.

Moderator: Ms. Liu from Hebei, 50 years old. Mouth numbness and tongue numbness, sometimes accompanied by dizziness. My blood pressure is normal. Do I need treatment?

Li Yuechun: This is also a manifestation of insufficient blood supply. We should go to the hospital as soon as possible for various examinations, and then intervene according to the examination results.

Moderator: Mr. Tian, Gansu, a friend of mine recently appeared to be unable to speak clearly, with a deep voice, inflexible right hand and being stupid in doing things. Is this a cold?

Liu Guorong: You should go to the hospital for a comprehensive physical examination. Don't think it's a cold.

Moderator: Mr. Ma from Xinjiang, aged 57. I once took a bus. When I got off the bus, my eyes suddenly went black, my legs went weak and I fell down. A similar situation occurred later. Is this a cerebral infarction?

Li Yuechun: This is a manifestation of vertebrobasilar insufficiency, which is called subclavian artery perfusion syndrome. We should go to the hospital to check all kinds of risk factors, and do cerebral angiography to see the degree of subclavian artery stenosis and carry out targeted treatment.

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