脑卒中的这7大误区坑了很多人,你知道几个?

2021-10-24 Dr.Wu彤 MedSci原创

​脑卒中是由于大脑里面的血管突然发生破裂出血或因血管堵塞造成大脑缺血、缺氧所致的急性疾病。

​脑卒中是由于大脑里面的血管突然发生破裂出血或因血管堵塞造成大脑缺血、缺氧所致的急性疾病。脑卒中是人类健康的“第一杀手”,是世界第二大,中国第一大死亡原因,在我国,每12秒就出现一例脑卒中,每21秒就有一人因其致死。除此之外,中风还是中国第一大致残性疾病,只有不到 20% 的患者可以获得基本痊愈。虽然如此常见,但对脑卒中的认识还有种种误区,

 

我们要认识到这些误区,并走出误区,提高脑卒中的知晓率、防治率和控制率。

 

 

1、误区一:脑卒中发病太急,没有预兆

 

如果及时发现脑卒中征兆,抓紧抢救,75%的脑卒中可以被控制!

 

脑卒中发病虽急,但如果能注意到发病预兆,及时就医大部分(75%)的脑中风是可以被控制的。

 

脑卒中发病预兆:

 

  • 突然出现一侧头面部、手脚麻木的现象;
  • 突然走路不稳、感觉头部眩晕(警惕后循环中风);
  • 突然视物模糊、出现黑朦;
  • 突然说不清楚话、流口水、口角歪斜;
  • 突然失语,讲不出话或者听不懂话;
  • 突然剧烈头痛;
  • 突然感觉身体无力、活动不灵便;
  • 突然昏迷,难以唤醒。
这些脑卒中预警又叫小中风,一定不要轻视,一定要及时去医院进行诊治。
我国70%以上的脑卒中是脑梗死,其最有效的治疗是静脉溶栓和取栓手术治疗。但是,静脉溶栓治疗对“时间”的要求极为苛刻,必须在发病4.5-6小时内接受治疗才能大大提高成功率;而即便是取栓手术,最长时间也只有16-24小时。所以治疗越早效果越好!
 
2、误区二:中青年人不必担心发生脑卒中
 
年轻人甚至儿童都有可能得脑卒中!
 

在人们的印象中,脑血管病与老年人密切相关,而中青年不必为此担心。在我们的临床实践中,中青年人发生动脉瘤破裂并非绝无仅有,中青年时期如果不注意预防,同样会发生脑中风。据临床资料表明,绝大部分中风病人是在60岁以前发病。近年来脑血管病的发病有逐渐年轻化的趋势,发病年龄越来越小,其中的原因是多方面的。部分年轻人一些不良的生活习惯,如熬夜、抽烟、喝酒、过度劳累、肥胖、高脂高糖饮食等生活方式都会使脑卒中在年轻人中高发。因此,中青年人切不可掉以轻心。 
 
3、误区三:定期输液能预防脑卒中
 
所谓的“输液预防“,并不科学。
 
所谓的“输液通血管治疗”,主要是指有些急性脑卒中或心梗的患者可以通过用药或其他方法,把处于缺血边缘状态的组织重新救回来。但是这样的治疗条件限制很严格,溶栓药物只有条件符合了才会给患者使用,根本不可能随便拿来输液。真正能够预防脑卒中的方法是控制好导致脑卒中的危险因素,包括吸烟、酗酒、肥胖、高血压、糖尿病、冠心病和高胆固醇血症等,规律口服二级预防药物,采取健康的生活方式。
 
4、误区四:降压药头晕、头痛才吃,平时不用吃
 
有些高血压患者经常服药不规律,总是凭感觉吃药停药。这种间断和无规律的治疗不但造成血压较大幅度的波动,而且加重了动脉硬化,并对心脏、脑、肾脏等靶器官的损害。最终给血管造成不可逆的损伤,更容易诱发脑卒中。
 
高血压患者的血压控制是一个长期的过程,正确的服药方法是血压降到目标范围后,在医生的指导下坚持规律服药,并定期对血压进行监测,减少血压大幅度波动。
 
5、误区五:阿司匹林可以预防各种脑卒中
 
阿司匹林有增加出血的风险,应在医生指导下服用。临床实践中应用阿司匹林,应当先做好评估获益与风险医生在评估阿司匹林治疗获益和风险的权衡取决于 4 个方面:出血风险基础心血管病发病风险阿司匹林治疗依从性以及年龄。
 
心血管病高危人群服用小剂量阿司匹林可以有效预防脑梗的发生,但是阿司匹林并不是万能的,抗血小板治疗也是一把双刃剑,在抗栓的同时势必会导致出血风险的增加。因此临床医生在进行决策时需要平衡治疗手段的疗效与安全性,也需要尽量纠正出血风险,以达到临床最大获益。
 
6、误区六:他汀类药物在血脂达标后即可停用
 
他汀类药不仅仅是降脂药,也是抗动脉粥样硬化的药物。
 
抗动脉粥样硬化治疗需要长期服用他汀才能见效,若中途停药会导致粥样硬化斑块继续增长、斑块脱落或不稳定的斑块发生破裂,上述情况都会引发卒中再次发生。
因此,
如果没有其他禁忌证,一般他汀类药物应该长期坚持服用。
 
7、误区七:脑卒中康复要靠「养」
 
发生脑卒中后,要尽早让患者进行适当的康复锻炼。
 
不少人认为,发生了脑卒中,应当让患者在床上完全静养,少活动。殊不知,这种完全静养会严重影响患者偏瘫肢体的功能恢复,甚至可能使偏瘫肢体出现肌肉萎缩或者关节僵硬。
 
而正规的康复治疗训练开始得越早,康复效果越好。
 
脑卒中偏瘫的康复治疗应尽早实施,一般应在病情稳定后1周内开始。最佳康复期在发病后3个月之内。对3个月以上再进行康复治疗的患者(脑卒中后遗症期)也有一定的效果,关键在于方法正确。
对于脑卒中的诊治,需要“集体智慧”,面对现实,卒中可治,多关注、早接触、快行动,全面认识脑卒中的危害、科普脑卒中知识、提高预防意识,预防复发是关键!

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    2021-10-30 soong07

    预防是关键

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1065293, encodeId=f3941065293af, content=预防是关键, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/04/22/aca158650c3fcc25df7af56b9f1f338f.jpg, createdBy=75455322219, createdName=soong07, createdTime=Sat Oct 30 15:48:24 CST 2021, time=2021-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064386, encodeId=7e5610643863f, content=学到啦, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1ae15305421, createdName=张应磊, createdTime=Wed Oct 27 15:39:56 CST 2021, time=2021-10-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063448, encodeId=68761063448b3, content=预防是关键, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4gCIdSaEkahCNuUWZv4iaKmqvUKHyKnBiarBM9RStQKBeV5Lh6GYYFiamdV5KlSfbLvmAgZTLtq81XA/0, createdBy=13511650672, createdName=谭桂峰, createdTime=Sun Oct 24 14:32:50 CST 2021, time=2021-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1308890, encodeId=c69c1308890d7, content=<a href='/topic/show?id=aa7291842d9' target=_blank style='color:#2F92EE;'>#误区#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91842, encryptionId=aa7291842d9, topicName=误区)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Sun Oct 24 07:46:57 CST 2021, time=2021-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1063145, encodeId=dcea10631459d, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=855c5638296, createdName=绿箩, createdTime=Sat Oct 23 11:41:11 CST 2021, time=2021-10-23, status=1, ipAttribution=)]
    2021-10-27 张应磊

    学到啦

    0

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    2021-10-24 谭桂峰

    预防是关键

    0

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    2021-10-23 绿箩

    学习

    0

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AF与广泛的脑血管病变有关。需要进一步研究以确定是否可以将脑血管MRI标志物添加到当前的治疗指南中,以进一步个性化AF患者的抗凝治疗,并进一步归纳AF与脑血管疾病以及痴呆之间关联的潜在发病机制。

JAHA:卒中和颅内动脉狭窄患者采用西洛他唑的双重抗血小板治疗效果

使用西洛他唑的DAPT在预防卒中复发和血管事件方面优于使用氯吡格雷或阿司匹林的SAPT,并且不会增加卒中后颅内动脉狭窄患者的出血风险。

JAMA N:NIHSS评分4和5分患者双抗治疗的证据

双联抗血小板治疗(Dual antiplatelet therapy,DAPT)是轻型非心源性缺血性卒中和TIA早期管理的关键策略。在 CHANCE 和 POINT 试验中已经评价过基线NIHSS评分

JACC:同时考虑收缩压和舒张压,控制目标该如何定?

JACC:ALLHAT研究中收缩压和舒张压对心血管事件结果的贡献

Cardiovasc Diabetol:葡萄糖处理率越低,糖尿病患者的卒中风险越高!

胰岛素抵抗会促进 2 型糖尿病 (T2D) 的发展,也是心血管事件的危险因素。葡萄糖处理率越低,糖尿病患者的卒中风险越高!

JAMA Neurology:脑出血后卒中的抗血小板治疗,效果如何

本研究发现抗血小板治疗对复发性ICH或所有主要血管事件没有统计学上的显著影响