Treatment of a patient with a stroke includes a pre-hospital stage, an intensive care stage in an intensive care unit or an intensive care unit, a treatment stage in a neurological hospital, and then a suburban or rehabilitation outpatient department, and the final stage is the dispensary stage.
At the pre-hospital stage, before the arrival of the ambulance doctors, it is necessary to provide the patient with the following assistance:
1) be sure to lay the patient on his back, while, if possible, without moving his head;
2) open a window so that fresh air can enter the room; it is necessary to remove restrictive clothing from the patient, unbutton the shirt collar, tight belt or belt;
3) at the first signs of vomiting, it is necessary to turn the patient's head to one side so that the vomit does not enter the respiratory tract, and place a tray under the lower jaw; it is necessary to try as thoroughly as possible to clean the oral cavity from vomit;
4) it is important to measure blood pressure, if it is elevated, to give the drug that the patient usually takes in such cases; if this medicine is not at hand, lower the patient's legs into moderately hot water.
At the first - pre-hospital - stage, the patient must be provided with complete rest. The doctor must correctly assess the severity of the patient's condition and ensure early hospitalization in a specialized neurological department or in a hospital that has a ward or intensive care unit. Only in the conditions of a specialized neurological hospital, if necessary, surgical treatment and specialized resuscitation care are possible. There are restrictions on hospitalization of patients at home: a deep coma with severe impairment of vital functions, pronounced psycho-organic changes in persons who have suffered repeated cerebrovascular accidents, as well as terminal stages of chronic somatic and oncological diseases.
All stroke patients require strict bed rest. The room in which the patient is located should be well ventilated. Strict care must be taken when transporting the patient early. The patient should be carried while maintaining balance when going up and down stairs and, if possible, avoiding shocks.
In the intensive care unit of the hospital, therapy is carried out aimed at eliminating vital disorders, regardless of the nature of the stroke - this is the so-called undifferentiated, or basic therapy. Differentiated therapy is a measure that is specifically taken depending on the nature of the stroke. These types of therapy must be carried out simultaneously.
Indications for basic therapy are the following conditions: the presence of epileptic seizures, shallow impairment of consciousness, a combination of stroke with cardiac arrhythmias, myocardial infarction, etc.
Basic therapy is a set of measures aimed at emergency correction of violations of vital functions: normalization of respiratory disorders, hemodynamics, swallowing - all this includes the ABC program (Ak - "air", VyuosS - "blood", Cor - "heart"), changes homeostasis, the fight against cerebral edema, and, if necessary, the correction of autonomic hyperreactions, hyperthermia, psychomotor agitation, vomiting, persistent hiccups. Also, this type of therapy includes measures to care for the patient, the normalization of nutrition and the prevention of complications.
First of all, it is necessary to maintain the patency of the airways. If, after restoration of airway patency, ventilation of the lungs is insufficient, start auxiliary artificial ventilation of the lungs, the parameters of which are determined on the basis of clinical and biochemical data. The most commonly used mode is moderate hyperventilation. The appointment of respiratory stimulants for stroke of any kind is contraindicated.
The most important stage is the relief of manifestations of violation of vital functions. This stage includes the following activities.
1. Normalization of the respiratory function consists in restoring the patency of the respiratory tract, sanitation of the oral cavity, the introduction of an elastic air duct, tracheal intubation, and transfer to artificial ventilation of the lungs. All these measures are necessary to prevent early complications of stroke, reduce cerebral hypoxia, and also prevent cerebral edema.
2. Maintaining an optimal hemodynamic level includes the choice of antihypertensive agents. With a sharp increase in blood pressure after the development of a stroke, the choice of these funds should be carried out taking into account 3 factors: the optimal level of heart function, determined by the indicators of minute blood volume; volume of circulating blood; the level of the linear velocity of the blood flow. For this purpose, the following drugs are used: nifedipine, corinfar drops, captopril.
It is possible to use in the absence of the above drugs other drugs with similar properties.
It is forbidden to use drugs that sharply force diuresis immediately after the development of a stroke, these include furosemide and manitol, they have the ability to reduce the minute volume of blood, disrupt microcirculation and increase plasma osmolarity.
A separate category of patients with stenosing lesions of the arterial system, with signs of latent heart failure and cardiogenic hypodynamic syndrome, gradually adapted to high blood pressure. Taking this into account, such patients should be given antihypertensive therapy in such a way that the blood pressure figures decrease by 20% from the initial level. To do this, use drugs that have a predominant effect on peripheral vessels. These drugs are calcium channel blockers, as well as angiotensin-converting enzyme inhibitors. In young and middle-aged patients without signs of latent heart failure, systolic blood pressure should be reduced to a level exceeding only 10 mm Hg. Art. "Working Numbers"
After the development of a stroke, severe arterial hypotension may occur, which may be due to a simultaneously developed myocardial infarction or a sharp decompensation of cardiac activity. In this case, the appointment of drugs such as dopamine, glucocorticoid hormones and gutron is indicated to increase blood pressure.
The development of a stroke may be accompanied by severe tachycardia, manifestations of circulatory failure of varying degrees, as well as atrial fibrillation. In this case, cardiac glycosides can be prescribed: strophanthin or cor-glycon in appropriate dosages. The drugs are used under the control of pulse and blood pressure.
Given the fact that a stroke is not accompanied by hypovolemia, solutions that increase the volume of circulating blood are not used to lower blood pressure in this disease.
In the event of status epilepticus or a series of seizures, sodium hydroxybutyrate or seduxen are used to stop them, which are diluted in isotonic sodium chloride solution before their use. If the use of these drugs did not lead to the relief of seizures, then non-inhalation anesthesia with sodium thiopental is prescribed. If the desired result is not achieved and after these measures, mechanical ventilation and intravenous administration of this drug are prescribed. If all these measures are ineffective, the patient in the intensive care unit must be given inhalation anesthesia with a mixture of nitrous oxide and oxygen. If status epilepticus is prolonged in time, then in order to prevent cerebral edema, glucocorticoids are prescribed intravenously in a stream.
In order to correct violations of water-salt metabolism and acid-base state, including to combat cerebral edema, it is necessary to maintain optimal indicators of water-salt metabolism. This is ensured by rehydration, and when the first signs of cerebral edema appear, by dehydration. For this, it is important to control the osmolarity and the content of cations in the blood serum, as well as the diuresis of the patient. It has been proven that cerebral edema develops in 24–48 hours in hemorrhagic stroke, and in 2–3 days in ischemic stroke. Taking into account these data, dehydration or rehydration of the body of a patient with a stroke is carried out.
For dehydration therapy, the following drugs are widely prescribed: osmotic diuretics, saluretics, corticosteroid hormones, in some cases artificial ventilation of the lungs is carried out in the mode of moderate hyperventilation. In the initial stage of the formation of cerebral edema, an important role is played by the stimulation of venous outflow from the cranial cavity, the normalization of respiration and hemodynamics. Currently, neurosurgeons have developed methods of intraventricular drainage, which consist in the introduction of a catheter into the anterior lateral ventricle. With the help of these measures, the possibility of a controlled outflow of cerebrospinal fluid is achieved. In the intensive care unit, the acid-base and electrolyte balances are being normalized. All this is carried out under dynamic laboratory control.
For the treatment of cerebral edema and increased intracranial pressure, a number of measures are carried out. General measures include the following actions: it is necessary to raise the head end and limit external stimuli, limit the flow of free fluid, do not use glucose solutions. The total volume of injected fluid should not exceed 1000 ml/m2 of the patient's body surface per day. In some cases, if it is not possible to deal with increased intracranial pressure by other methods, and the patient's condition is threatening, they resort to barbituric coma, which is carried out under constant control of intracranial pressure.
The following measures taken for strokes are: correction of autonomic hyperreactions, psychomotor agitation, vomiting, persistent hiccups. In strokes, hyperthermia is central in nature, i.e., due to pathology of central thermoregulation. For this, voltaren, aspizol, reopirin, lytic mixtures consisting of solutions of analgin, diphenhydramine, haloperidol are actively used. Physical methods of cooling the patient's body are of great importance. To do this, ice packs are placed in the projection of large arteries, which are wrapped in 2 layers of towels. In addition to this method, you can rub the patient's skin (torso and limbs) with a 20-30% solution of ethyl alcohol.
In case of vomiting and persistent hiccups, etaperazine, haloperidol (it must be borne in mind that this drug is not compatible with hypnotics and analgesics), seduxen, cerucal, as well as vitamin B6 and torecan are used. When prescribing all these drugs, it is necessary to take into account the comorbidity of the patient, since many of the listed drugs are contraindicated in gastric and duodenal ulcers.
Often, with acute disorders of cerebral circulation, vestibular disorders develop. The following drugs are used for their relief: vasobral, which stops the aggregation and adhesion of erythrocytes and platelets, improves the rheological properties of blood and microcirculation, and betaserk, which affects the histamine receptors of the vestibular nuclei of the brain stem and inner ear.
If pulmonary edema develops, then the patient has a number of symptoms: suffocation; possible tachycardia; when examining the skin, acrocyanosis; tissue hyperhydration; when examining the respiratory organs, inspiratory dyspnea, dry whistling, and then moist rales are revealed; profuse and frothy expectoration. This clinic is stopped by a complex of general measures, regardless of the level of blood pressure. First of all, oxygen therapy and defoaming are carried out. If the patient's blood pressure indicators are kept at normal levels, then, in addition to all of the above measures, lasix and diazepam are included in therapy. In hypertension, additional nifedipine must be administered. In the case of developed hypotension, all these appointments are supplemented by intravenous administration of lobutamine.
Patient care is of great importance in the treatment of stroke patients. Adequate nutrition is an important component of the treatment of stroke patients, in some cases resorting to tube feeding with nutrient mixtures. If the patient is conscious and the act of swallowing is not disturbed, then on the first day he can be given sweet tea, fruit juices, and on the second day they give easily digestible foods. Every 2-3 hours the patient must be turned on his side. This is necessary to prevent congestion in the lungs and the formation of bedsores. Also, a rubber vessel is placed under the sacrum, and dense and soft rings are placed under the heels. If the patient has no signs of heart failure, then he is given circular jars and mustard plasters. To prevent contractures, the patient's limbs are placed in a position opposite to the Wernicke-Mann position. In order to prevent congestive pneumonia, antibiotics, aspisol are prescribed. In the case of hyperthermia, the patient's skin is rubbed with a solution of equal parts of vinegar, water and vodka, and the temperature in the room where the patient is located should be no more than 18-20 ° C. Be sure to daily carry out the toilet of the oral cavity: the teeth and oral mucosa are wiped with a swab soaked in a solution of boric acid. In case of violation of the functions of the pelvic organs - urinary incontinence, constipation - it is also possible to help the patient. In case of constipation, a laxative is used, and in some cases, oil enemas or hypertonic enemas.
In case of urinary incontinence, a heating pad is placed on the bladder area, if there is no effect, a catheter is placed 2 times a day.
In the event of psychosis, the patient is prescribed antipsychotics and antidepressants, the doses of these drugs are selected strictly individually. Tranquilizers are rarely prescribed, especially for people over 60 years of age, since drugs in this group often cause muscle relaxation.
Differentiated treatment includes individual approaches to patients depending on the type of stroke: hemorrhagic or ischemic, since each of them has its own mechanism of occurrence and course.
Therapy of hemorrhagic stroke is mainly aimed at eliminating edema, reducing intracranial pressure, lowering blood pressure, in case of its increase, increasing the coagulation properties of the blood and reducing vascular permeability.
Therapy of hemorrhagic strokes is carried out in neurology, neurological hospitals, but there is a category of patients who are treated in neurosurgical departments.
The first step in the treatment of hemorrhagic stroke is the correct position of the patient in bed - the head should occupy an elevated position. An ice pack is applied to the patient's head, and warm, but not hot, heating pads are applied to the legs. With cerebral hemorrhage, blood pressure is often elevated, so special attention is paid to its reduction when prescribing treatment. First of all, dibazol and magnesium sulfate, which are used in the complex of basic therapy, have a hypotensive effect. If the effect of their action is not pronounced, then neuroleptics can be used, such as a solution of chlorpromazine 2.5% at a dose of 0.5–1 ml, ganglioblockers - pentamine at a dose of 1 ml of a 5% solution. Conducting antihypertensive therapy should be combined with ongoing dehydration therapy.
In hemorrhagic stroke, as a rule, fibrinolysis is activated and the coagulating properties of the blood decrease, therefore, drugs are prescribed that inhibit fibrinolysis and activate the formation of thromboplastin. To increase the rate of blood clotting, calcium gluconate or calcium chloride is prescribed at 10–20 ml of a 10% solution intravenously, vikasol at 0.5–1.0 ml of a 1% solution intramuscularly, ascorbic acid and gelatin are also administered intramuscularly. Given that the fibrinolytic activity of the blood is increased, for 2-3 days, under the control of indicators of the blood coagulation system, aminocaproic acid is prescribed intravenously. In the next 3-5 days, the therapy includes inhibitors of proteolytic enzymes - Gordox and Contrical. If there are clinical signs of concomitant atherosclerosis, then this therapy is combined with the use of low doses of heparin to prevent thrombosis. This is most important in subarachnoid hemorrhages. An effective hemostatic drug is etamsylat, which activates thromboplastin and improves microcirculation and normalizes the permeability of the vascular wall, and in addition is a strong antioxidant. In case of cerebral hemorrhage in patients with thrombocytopenia, they are prescribed an intravenous injection of platelet mass. If the stroke has developed as a complication of hemorrhagic diathesis, the patient is given intravenous vitamin K and plasma protein fractions. In the event of a hemorrhagic stroke associated with hemophilia, emergency replacement therapy with factor VIII concentrate or cryoprecipitate is necessary.
With manifestations of severe cerebral edema, meningeal signs, including to clarify the diagnosis, it is necessary to perform a lumbar puncture. This procedure is carried out with caution, without sharply turning the patient, using a mandren, extracting cerebrospinal fluid in small portions of 5 ml. In deep coma, with severe disorders of stem functions in the form of a violation of the activity of the heart and respiration, a lumbar puncture is contraindicated.
Currently, surgical treatment is widely used to treat hemorrhagic stroke. But this type of treatment is not suitable for all groups of patients, it is indicated for young and middle-aged people, in the presence of lateral hematomas and hemorrhages in the cerebellum. The essence of the operation is to remove the hematoma.
In hemorrhagic stroke, the following factors are indications for surgery: satisfactory results have not been achieved during conservative therapy; increasing compression of the brain by hematoma and / or progressive perifocal edema; the adverse effect of the focus of hemorrhage on cerebral blood flow is determined, which worsens microcirculation and develops the possibility of developing secondary diapedetic hemorrhages in the brain stem and hemispheres. Important indications for surgical intervention are the reversibility of disorders that occur on the first day after a stroke, and the risk of hematoma breakthrough into the ventricular system of the brain. Hematoma subcortical or localized in the region of the subcortical nuclei, with a volume of more than 20 cm3 or a diameter of more than 3 cm, which is accompanied by a neurological deficit and leads to dislocation of the brain, is also an indication for surgical treatment. The last indicator for surgery is ventricular hemorrhage, which leads to occlusion of the CSF pathways.
There are a number of factors, the presence of which suggests an unfavorable outcome of the treatment of hemorrhagic stroke. These include the following: the age of the patient over 60 years; oppression of consciousness of the patient to a coma; the volume of ventricular hemorrhage is more than 20 cm3; the volume of intracerebral hematoma is more than 70 cm3; the appearance of signs of dislocation syndrome; high, uncontrolled pressure and severe comorbidity.
The best time for surgery is 1-2 days after a stroke. The formed intracerebral hematoma is emptied by puncture aspiration of its liquid contents or by opening the cavity, in which, in addition to the liquid contents, blood clots are removed. If the blood has broken into the ventricles, then it is washed out through the hematoma cavity and a defect in the wall of the ventricle. In the case when the operation is performed for rupture of arterial and arteriovenous aneurysms, which is clinically manifested by intracerebral or subarachnoid hemorrhage, the surgeon's actions are reduced to shutting off the aneurysm from the cerebral circulation. In the first 3 days of the disease, surgical removal of the hematoma and clipping of the aneurysm are performed. If the patient has a violation of consciousness, then the operation is usually postponed until the patient's condition improves.
The tactics of treating hemorrhagic stroke is determined in each case individually. The decision is made jointly by a neurosurgeon and a neurologist. When the hemorrhage is localized in the cerebellum, surgical treatment is indicated by draining or removing the hematoma. If the size of the hematoma is more than 8-10 mm3, then early surgical treatment is indicated. It is produced even before the development of clinical signs of compression of the brain stem. If the size of the hematoma is small, and the patient is conscious, or if more than 7 days have passed since the hemorrhage, then conservative treatment is recommended. However, emergency surgical treatment is carried out when symptoms of compression of the brain stem appear.
In some patients, medial localization of the hemorrhage is found, in this case, stereotactic drainage of the hematoma and subsequent fibrinolysis of the remnants of the blood clot can be used. This option of surgical treatment will be the least traumatic in this situation. Sometimes, to save the life of a patient with obstructive hydrocephalus, the imposition of a ventricular or external shunt is used.
In case of suspicion of amyloid angiopathy in a patient with hemorrhagic stroke, surgical treatment is not recommended, since surgery can lead to re-hemorrhage.
Antifibrinolytics are given before surgery or for 4 to 6 weeks if surgery is not performed. Currently, there is an opinion about the need for their use only in cases of recurrent or ongoing subarachnoid hemorrhage. E-aminocaproic acid is prescribed at 30-36 g / day intravenously or orally every 3-6 hours, tranexamic acid is used at 1 g intravenously or 1.5 g orally every 4-6 hours. It has been proven that the use of antifibrinolytic agents significantly reduces the likelihood of re-hemorrhage, but still significantly increases the risk of ischemic stroke, deep vein thrombosis of the lower extremities, as well as the likelihood of pulmonary embolism. It is believed that the use of a combination of calcium channel blockers and antifibrinolytic agents significantly reduces the risk of ischemic complications.
From the first hours of the disease, nimodipine is used intravenously at a dose of 15-30 mg / kg / h for 5-7 days, and then 30-60 mg of nimodipine 6 times a day for 14-21 days.
In the treatment of ischemic stroke, unlike hemorrhagic, the patient should be laid flat in bed, and the head should be raised only slightly. Therapy for ischemic stroke is aimed at improving the blood supply to the brain, increasing the degree of resistance of brain tissues to hypoxia and improving metabolism. With the correct treatment of ischemic stroke, there should be an improvement in cerebral circulation, the conditions for the functioning of cells that have survived from death. Timely and correctly chosen tactics for the treatment of stroke is the prevention of deadly complications, such as pneumonia, bedsores, etc.
In the treatment of ischemic stroke, great importance is attached to aminophylline, since it not only reduces the severity of cerebral edema, but also positively affects the hemodynamics of the brain. The positive effect of aminophylline is that it only briefly dilates the vessels of the brain, affecting mainly the vessels as a vasoconstrictor factor. Its action in this case is directed mainly to unaffected vascular pools, from which blood can move to the ischemic zone. When using vasodilators, it can lead to the “steal” phenomenon, i.e., there is an increase in cerebral ischemia in the affected area. The drug must be administered very slowly, it is used in the form of a 2.4% solution of 10 ml intravenously. A solution of aminophylline is used with 10 ml of a 40% glucose solution or isotonic sodium chloride solution. The appointment of the drug can be repeated after 1-2 hours, and then applied 1-2 times a day for the first 10 days. The effectiveness of aminophylline is associated primarily with the period that has passed after the stroke, there is an excellent effect if the drug was administered in the first minutes or hours after the onset of the stroke. The patient's speech and movement are restored by the end of the injection. Vasodilators are used only when angiospasms play a pathogenetic role. In this case, it is possible to prescribe no-shpy, nicotinic acid, papaverine, xavina, complamin.
Currently, the method of hemodilution is widely used for the treatment of ischemic stroke; for this, polyglucin is administered intravenously by drip or reopoliglyukin in a volume of 800-1200 ml. This method improves microcirculation and collateral circulation in the infarction area, as well as reduces the activity of the blood coagulation system.
When carrying out intensive therapy, the provision of normal water-salt metabolism is taken into account. This requires monitoring the moisture content of the skin and tongue, skin turgor and blood counts. The latter include: the level of hematocrit and electrolytes in blood serum. If violations are found, they need to be corrected. The fluid is limited and control is exercised over the rational use of diuretics, since their irrational use causes dehydration of the body, which contributes to an increase in blood clotting and a decrease in blood pressure. At the same time, excessive fluid administration during infusion therapy can lead to an increase in cerebral edema. Important are the control of the level of glycemia and the maintenance of normo-glycemia. This fact may contribute to a change in therapy in patients with diabetes mellitus. In this category of patients, a temporary transition to insulin and an increase or decrease in its dose are resorted to.
Since it has been proven that ischemic stroke can occur against the background of an increase in the coagulating properties of the blood and a decrease in the activity of its fibrinolytic system, anticoagulants and antiaggregants are widely used in therapy.
If the diagnosis of ischemic stroke is made reliably and there are no contraindications from the side of the kidneys, liver, peptic ulcer of the stomach and duodenum, there are no malignant tumors, and the blood pressure numbers are below 200/100 mm Hg. Art., anticoagulants are used. They are prescribed 1-2 days after a stroke under strict control of the parameters of the blood coagulation system, i.e. coagulograms, thromboelastograms. If blockage of cerebral vessels by an embolus or thrombus is detected, then they are combined with fibrinolytic drugs.
Anticoagulant therapy begins with heparin, which is a direct-acting anticoagulant. Assign heparin at a dose of 5000-10000 IU intravenously, intramuscularly or subcutaneously 4 times a day. Therapy with the drug is carried out under the mandatory control of blood coagulation parameters for 3-5 days. In advance, 1-2 days before its cancellation, anticoagulants of indirect action, such as phenylin, neodicumarine, dicoumarin, are included in the therapy. Therapy with this group of drugs is carried out for a long time, for 1–3 months, sometimes longer, under strict control of the coagulogram, thromboelastogram and prothrombin index, the latter should not decrease by less than 40–50%. The bleeding time during therapy with these drugs should increase by 1.5–2 times. Thrombolytic therapy includes the use of fibrinolysin in combination with heparin. Treatment begins in the first hours or days after the onset of the disease with the appointment of fibrinolysin at a dose of 20,000-30,000 IU intravenously. The drug is dissolved beforehand in 250–300 ml of isotonic sodium chloride solution with the addition of 10,000 IU of heparin. The mixture is prescribed first 1 time per day, and then every 6 hours. Heparin is administered intramuscularly at 5000-10,000 IU. Treatment with fibrinolysin continues for 2–3 days, and then anticoagulant therapy is continued according to the method proposed above. Contraindications to the appointment of heparin are the following conditions: blood pressure above 180 mm Hg. Art., a significant decrease in blood pressure, epileptic seizures, coma, severe liver disease, peptic ulcer of the stomach and duodenum, chronic renal failure.
It was revealed that in young and middle-aged patients with severe signs of atherosclerosis or a combination of atherosclerosis with hypertension, pentoxifylline is more effective, which does not have a pronounced effect on the blood coagulation system, but positively affects its rheological properties.
For elderly patients without significant signs of pathology of the cardiovascular system, it is advisable to prescribe xanthinol nicotinate, parmidine, indomethacin. If the patient has a pronounced tachycardia, a persistent increase in blood pressure, then this is an indication for the appointment of anaprilin.
In the case of rapid withdrawal of antiplatelet agents in patients, a withdrawal syndrome occurs, which is characterized by a sharp increase in the rheological properties of the blood and a deterioration in the general condition of the patient. Given this fact, it is necessary to strictly observe the scheme for reducing the dose of drugs.
In ischemic stroke of the brain, the appointment of Cavinton is preferable. In some cases, this drug can impair venous outflow from the cranial cavity, it should not be used in combination with heparin. With a brain stem infarction, it is better to prescribe cinnarizine. In some cases, acetylsalicylic acid can be used, which affects only the platelet link of hemostasis.
Acetylsalicylic acid in this case is used at a dose of 80-130 mg / day, the most commonly used is the appointment of small doses of 80-325 mg / day, since this reduces the risk of complications from the gastrointestinal tract and inhibition of prostacyclins of the vascular wall, which have antithrombotic action. In order to reduce the irritating effect of acetylsalicylic acid on the gastric mucosa, a form that does not dissolve in the stomach is used.
Curantyl is used at a dose of 75 mg 3 times a day. According to the results of studies of the combined use of acetylsalicylic acid and chimes, the effectiveness of this combination for the prevention of stroke in patients with transient ischemic attacks in the anamnesis of the disease has been proven, the risk of recurrent stroke is also reduced, the risk of developing deep vein thrombosis and arterial occlusion in patients with vascular pathology is also reduced. . One of the main characteristics of the drug is the possibility of using it in patients of different ages without laboratory control of the blood count.
The drug ticlopidine is usually prescribed at a dose of 250 mg 2 times a day under the strict control of a complete blood count. A blood test is taken for control every 2 weeks during the first three months of treatment due to the risk of developing leukopenia.
Clopidrogel is prescribed at a dose of 75 mg/day and has much fewer side effects than acetylsalicylic acid and ticlopidine.
An important role in the treatment of ischemic stroke is played by metabolic therapy with the appointment of barbiturates-antihypoxants, which inhibit brain metabolism, peripheral dilatation of intact vessels and vasogenic cerebral edema, which leads to redistribution of blood to the area of local ischemia. The drugs in question are indicated mainly for patients with psychomotor agitation, the presence of convulsive readiness on the EEG, and paroxysmal changes in muscle tone. The most commonly used thiopental - sodium or hexenal, phenobarbital. It has been proven that sodium oxybutyrate, or GHB, has a pronounced antihypoxic property, which differs from barbiturates in the ability to maintain oxidative processes in the brain at a sufficiently high level. Therapy with barbiturates and GHB is carried out under strict control of blood pressure, electrocardiography and echoencephalography.
Means of metabolic therapy include drugs of the nootropic group, which increase the resistance of the brain to hypoxia by stimulating cerebral metabolism and secondary enhancement of blood circulation, and also prevent premature death of viable neurons near the stroke site (ischemic penumbra area). These drugs include piracetam, pyriditol and aminalon. The appointment of drugs of the nootropic group is advisable in the acute period in patients with mild cerebral symptoms and disorders of consciousness, as well as in all patients in the recovery period of the disease.
Cerebrolysin must be prescribed in large doses - 20-50 ml / day. This dose is administered 1 or 2 times, diluted in 100-200 ml of physiological saline, intravenously drip for 60-90 minutes, a course of 10-15 days.
Piracetam is prescribed at 4-12 mg/day intravenously drip-but, a course of 10-15 days, and then the dose is reduced to 3.6-4.8 g/day. Such a dose can be prescribed to the patient and from the beginning of treatment.
As drugs with an antioxidant effect, emoxipine at a dose of 300-600 mg intravenously, as well as naloxone at a dose of 20 mg intravenously, can be prescribed (the drug must be administered slowly over 6 hours).
It is allowed to carry out therapy not only with one drug, but also with their combination. The course of treatment is 1.5–2 months. Along with these drugs, glutamate and aspartate are prescribed. It is also recommended to use sublingual glycine at a dose of 1-2 mg per day in the first 5 days of a stroke.
Surgical treatment of ischemic stroke should be carried out in the presence of pathology of the main vessels, including the carotid and vertebral arteries. Surgical treatment itself may consist of brain surgery in the area of the focus of ischemic stroke and surgery on the main vessels, as a result of the defeat of which a heart attack arose and formed. There are no clearly formulated physiological justifications for surgical treatment. Given this fact, brain surgery for ischemic stroke is performed very rarely. Most often, surgical intervention is performed on the carotid and vertebral arteries, the brachiocephalic trunk, subclavian, and much less frequently on the middle cerebral arteries. Indications for surgical tactics of treatment on the carotid arteries are stenosis of the internal carotid artery, which is accompanied by transient circulatory disorders, persistent, but at the same time not severe neurological symptoms, symptoms of chronic cerebral ischemia; pathological tortuosity of the carotid arteries with impaired cerebral circulation; bilateral occlusive process in the carotid arteries. Indications for the behavior of surgery on the vertebral arteries are their atherosclerotic occlusion or stenosis, abnormal discharge and compression in cervical osteochondrosis.
Immediately after the acute period of a stroke, a long and intense period of rehabilitation follows, during which partially or completely lost functions are restored. Vascular surgeons in our country successfully carry out all types of surgical interventions on the carotid and vertebral arteries. A favorable outcome of the disease is guaranteed by the correct approach to the indications, the technique of surgical intervention and the correct management of the postoperative period. In this case, the likelihood of developing life-threatening complications is minimized. It has been proven that timely surgical intervention reliably prevents the occurrence of repeated and primary strokes, and also improves the recovery of functions lost as a result of a stroke.
Patients with impaired consciousness or mental disorders need special adequate treatment. This category of patients needs adequate nutrition, control of the vital functions of the pelvic organs, care for the skin, eyes and oral cavity. It is advisable to use beds with a hydromassage mattress and side rails for such patients in order to avoid falling of such a patient. Nutrition in the first days is provided by intravenous administration of special nutrient solutions, and in the following days it is advisable to carry out nutrition through a nasogastric tube. The nutrition of patients who are conscious and with a normal swallowing act begins with liquid food, and then they switch to receiving food in a semi-liquid and regular form. In the absence of the possibility of normal swallowing, the patient is fed through a probe. If the act of swallowing is not restored 1-2 weeks after the stroke, then it is necessary to resolve the issue of applying a gastrostomy to further feed the patient through it. In order to prevent constipation and straining the patient during defecation, which is especially important for subarachnoid hemorrhage, patients are prescribed laxatives. If constipation nevertheless develops, then a cleansing enema is prescribed, but at least 1 time per day with sufficient nutrition. If there is urinary retention, then, if necessary, a permanent urethral catheter is installed. For the prevention of bedsores, in addition to turning the patient over, it is necessary to ensure the dryness of the skin, to change the bed and underwear of the patient in a timely manner, straighten the folds and prevent urinary and fecal incontinence. In case of redness and maceration of the skin, it is treated with a 2–5% solution of potassium permanganate or sea buckthorn oil or solcoseryl ointment. If pressure sores become infected, they are treated with antiseptic solutions.
Often a stroke occurs against the background of concomitant pathology, such as arteritis, hematological diseases. The presence of this pathology aggravates the course of a stroke and, accordingly, requires special treatment.
In infectious arteritis, therapy is determined by the underlying disease. If a non-infectious nature of arteritis is detected in a patient, corticosteroids are prescribed, for example, prednisone at a dose of 1 mg / kg / day, it is used either as an independent therapy or in combination with cytostatics. If a patient is diagnosed with polycythemia, then blood volume should be reduced by phlebotomy in order to maintain a hematocrit of 40-45%. In the case of concomitant thrombocytosis, myelosuppressants are used, such as radioactive phosphorus, etc. If the patient has thrombocytopenic purpura, plasmapheresis, administration of fresh frozen plasma and corticosteroids are indicated, for example, prednisolone is prescribed at a dose of 1–2 mg / kg / day. Repeated RBC transfusions are indicated for patients with sickle cell anemia. When severe dysproteinemia is detected in blood tests, plasmapheresis is an effective method of treatment. In patients with antiphospholipid syndrome, anticoagulants and antiplatelet agents are used, plasmapheresis and prednisolone at a dose of 1–1.5 mg / kg / day are possible, if repeated ischemic attacks are diagnosed in a patient, then cytostatics are used. If leukemia is diagnosed, then it is advisable for the patient to prescribe cytostatic drugs, and bone marrow transplantation is also indicated. In the treatment of patients with disseminated intravascular coagulation, sodium heparin is used, as in the treatment of the underlying disease. Sometimes ischemic strokes develop in young women. In this case, they are advised to stop taking oral contraceptives, and alternative methods of contraception are prescribed.
In case of stenosis of the internal carotid artery after an acute period of stroke, the expediency of carotid endarterectomy is discussed. This method of treatment is prescribed for its pronounced narrowing by 70–99% of the diameter in patients who have undergone a transient ischemic attack. In some cases, it is performed with a moderate narrowing of 30-69% of the diameter of the internal carotid artery. This is an indication in patients who have had a minor stroke, or with moderate neurological deficits after a stroke. Also, when choosing the tactics of treating patients with atherosclerosis of the precerebral and cerebral vessels, the prevalence of the lesion, the severity of the pathology, and the presence of concomitant pathology are taken into account.
One of the most frequent and severe complications of a stroke is movement disorders. Restoration of impaired movements occurs within a maximum of 2–3 months from the moment a stroke patient enters the hospital. Recovery continues throughout the year, the most important being the first six months of treatment. Even in patients with lost the ability to move independently, there is a restoration of functions. Patients with a lack of the ability to move independently due to hemiplegia can also fully restore their abilities. In the case of adequate physiotherapy, most of these patients begin to move around on their own, at least as early as 3-6 months after the onset of the disease.
When the patient is in the hospital, therapeutic exercises, massage, classes with a speech therapist, etc. are carried out.
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Cardiologist
Higher education:
Cardiologist
Saratov State Medical University. IN AND. Razumovsky (SSMU, media)
Level of education - Specialist
Additional education:
"Emergency Cardiology"
1990 - Ryazan Medical Institute named after Academician I.P. Pavlova
The duration of how long a patient will need to undergo treatment in a hospital setting, after a situation where a stroke has occurred, directly depends on the severity and subsequent dynamics of the disease. It makes little sense to keep in the hospital ward after a stroke for too long, since everyone determines the first hours and days, as well as how much the patient's condition then consolidated. If the situation is stabilized and there is no need to put a dropper, then the patient can already be discharged in a few weeks. Therefore, everything will depend on the condition of the person and what plan he had a stroke.
On the timing and stages of stroke treatment in hospital
At the moment, stroke has become a fairly common disease. On average, 3-4 people have seizures per 1000 people. Most of the cases are patients suffering from ischemic stroke, others are people with a hemorrhagic type of the disease. All relatives are always interested in the question of how much time the victim needs to spend in intensive care and in the hospital so that the condition is completely stabilized.
How many people stay in the hospital after a stroke occurs will depend on how each stage of the disease proceeds. Namely:
- Period before hospitalization;
- Undergoing treatment in intensive care, as well as in the intensive care unit;
- Hospitalization in a general ward.
How long a patient will have to stay in the hospital after a stroke is regulated by the Ministry of Health based on established treatment standards.
Standard situations and with complications
On average, the duration of a person's stay in the hospital after a stroke should be 21 days. This is provided that there are no failures of body systems that fall under the category of vitally critical. For 30 days, leave those who have been identified violations of a serious level.
When the established 30 days are still too short for the condition of the person being treated, a Medical and Social Expertise is scheduled to consider how to continue treatment and whether an individual rehabilitation course is necessary. Doctors try to prevent a person from spending too much time in the intensive care unit with complications - for up to 3 weeks, the situation is usually already stabilized.
During this period, the patient's vital signs are checked and predictions are made. Most often, violations and complications occur due to inadequate functioning of the brain. When an ischemic stroke occurs and paralyzes an arm or leg, but at the same time a person can serve himself, speech is not impaired - doctors consider 2 weeks in the hospital to be a sufficient period.
What you need to understand after graduation
Treatment after a stroke should be carried out comprehensively. It is usually set up like this:
- The patient takes prescribed medications that improve blood circulation, as well as eliminate spasms and swelling;
- Electrical stimulation is underway;
- Training in physical therapy is carried out;
- Massage sessions are scheduled.
It is important that a person understands that after the end of a hospital stay caused by a stroke, a number of treatment measures will be required and everything does not end with discharge from the hospital. At home, you will need to continue to do physical education, carefully monitor the pressure and your regimen. Alcohol and smoking will be strictly contraindicated. You need to move as much as possible, it is best to take walks in the fresh air.
What determines the duration of hospitalization
All patients who have signs of ischemia affecting the brain or a stroke in a hemorrhagic format are necessarily placed in the hospital for hospitalization. The terms for which the patient will be determined in the department will depend primarily on the following factors:
- The size and localization of the lesion point - in the case of a massive stroke, the length of stay in hospital will be significantly longer;
- How severe are the clinical symptoms;
- Is the patient in depressed consciousness - when the patient is in a coma, it will be impossible to transfer him to the general ward, it will be possible to discharge him from the intensive care unit only if the changes in his condition are positive;
- In what state are the key and vital functions of the body;
- Whether constant monitoring is required and whether there is a risk of a recurrence of a stroke;
- Whether or not the patient has serious comorbidities.
Treatment in intensive care will be aimed at eliminating all violations in vital functions. It will be differentiated, basic or undifferentiated, depending on which plan the violation occurred.
When and when does rehabilitation start?
After an ischemic stroke has occurred, rehabilitation will be required, starting on day 4-5. But already from the first hours, as the patient arrives at the hospital, he will need passive-type gymnastics. This is not even so much gymnastic exercises as giving the body a certain position in which the condition will stabilize and improve.
To do this, the patient's arms and legs are laid out correctly, the body is placed in a special way. To do this, use rollers or pillows, seating the patient in a semi-sitting state. Once in about 2 hours, the position of the body will change. Already on the 4-5th day, the patient should begin to turn over to the side position. It is impossible to stay in one position for too long, so as not to cause congestive phenomena, pneumonia or bedsores.
Gradually, the patient should be taught the most basic movements so that the brain has memories of how to control the body. The development and consolidation of motor stereotypes will help speed up the recovery process much faster.
Is it possible for relatives to stay in the hospital during the rehabilitation process?
It will be a great support for the patient if one of the relatives is in the ward as often as possible. In this way, the relatives themselves have the opportunity to learn how to care for the patient before he is discharged, in order to alleviate possible difficulties later. After being discharged home, relatives should dress the patient, feed, give medicines and perform joint exercises necessary for recovery.
It is important to know many things, such as the fact that you should start putting on a shirt from the hand that has suffered, and take it off from a healthy one. Even after a hospital stay, you will need to communicate with a person in a constant mode, in a very calm and patient tone. The most intensive recovery of the patient occurs in the first 3-4 months after the stroke occurred.
The frequency of the course of treatment
Often, the patient's relatives believe that the course for treatment is prescribed very large and frequent. But this is due to the specifics of the patient's recovery process. Everything happens in the first few months. At the same time, everything must be done to reduce the risk of recurrence of a stroke.
The initial course is prescribed to be taken immediately when a stroke occurs. The next course is carried out in 2-3 weeks. After that, you will need to take about 3-4 more courses during the first 6-8 months. After this, a break of 2-3 months is made and the course of treatment is repeated. Favorable time for rehabilitation should be used in the most effective way.
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In recent years, stroke has become an increasingly common pathology among people of different sexes and ages, every 4 patients out of 1000 are prone to cerebral catastrophe. 80% of all registered cases are ischemic brain lesions, the remaining 20% are a hemorrhagic type of stroke. It is almost impossible to predict the crisis of the disease and its peak (the hemorrhage itself), just as it is difficult to answer the question of how many days the patient will be in intensive care after a stroke.
The nature of the pathology is unique for each individual patient, and there are no people whose recovery period would be the same. Therefore, the number of days spent in the hospital depends on several factors, which will be discussed further. In general, the therapy of a stroke condition consists of three periods - this is the pre-hospital stage, the patient's stay in the intensive care unit (reanimation unit) and therapy in the general ward.
Being in intensive care
How long patients who have survived a cerebral hemorrhage lie in the hospital is the question most often asked to the doctor by the patient's relatives. The question is logical, because no one, including the patient himself, imagined that an attack of ischemia would overtake at the very moment, and relatives are not allowed into the intensive care unit. The general standards of care suggest a three-week course of therapy in a hospital for those patients who do not experience loss or serious impairment of vital functions after a stroke, and a 30-day course of treatment for patients with serious impairment.
These terms are approved by the Ministry of Health, but in cases requiring longer treatment, an examination is carried out, during which it may be decided that the patient needs an individual rehabilitation program.
In the intensive care unit, the patient is kept, as a rule, no longer than 21 days. This period is allotted for better control of doctors over the patient's condition and for the prevention of dangerous consequences that may arise due to disturbances in the functioning of the brain.
Every patient who has had an ischemic or hemorrhagic stroke is supposed to be in the intensive care unit, and the duration of treatment depends on several criteria:
- the size of the lesion and its location in the brain tissue (with extensive therapy, the process takes longer);
- severity of clinical manifestations of pathology;
- whether there is depression of consciousness in the patient or a state of coma - in this case, the patient with a stroke will be in the intensive care unit until signs of positive dynamics appear;
- dysfunction of vital organs and systems of the body - breathing, swallowing and others;
- high probability of recurrence of hemorrhage, which involves additional monitoring of the patient's condition;
- serious comorbidities that can adversely affect the general condition of a patient with a stroke.
Based on these factors, we can say that the time spent by the patient after surgery in the intensive care unit is an individual indicator that is not the same for everyone.
Course of therapy in the intensive care unit
Intensive therapy of a stroke condition involves the elimination of primary dysfunctions of the vital systems of the body, the treatment itself is divided into two stages.
The first stage is the basic treatment, it consists of the following activities:
- elimination of violations of the respiratory system, if any;
- correction of hemodynamics;
- fight against fever, psychomotor disorders and swelling of the brain;
- and caring for him.
This is followed by a stage of differentiated therapy, its course depends on the type of stroke. In the hemorrhagic form of the lesion, doctors set themselves the task of removing the swelling of the brain and adjusting the level of pressure, arterial and intracranial. Also at this stage, the possibility of surgical intervention is assessed - it is most often performed after 2 days spent in the intensive care unit.
If the patient has experienced an ischemic stroke, the main emphasis in therapy is on restoring full blood circulation in the brain, improving metabolism and removing signs of hypoxia (oxygen starvation of the brain tissue).
It is difficult to make any forecast on which day the patient will be transferred to the general ward and how long the treatment may take. In young patients, compensatory abilities are much higher than in older people, so they usually recover faster. The more extensive the lesion in the brain structures was, the longer and more difficult the rehabilitation process will be.
Coma
Loss of consciousness during cerebral hemorrhage is observed only in 10% of all cases of pathology. In whom is the patient 
flows into the fulminant stratification of a deep vessel of the brain, with such a development of events, even a qualified doctor cannot predict the duration of therapy. A patient who has fallen into a coma should receive prompt resuscitation assistance and be constantly monitored for changes in the state during resuscitation procedures.
Diagnostics and correction of the condition is carried out as follows:
- control over vital signs is provided by equipment connected to the patient - it monitors the pulse and blood pressure;
- in a state of coma, the patient is forced to lie down around the clock, which requires the use of anti-decubitus mattresses and turning the patient over every few hours;
- the feeding of a comatose patient is carried out through a probe, the food includes fruit juices and mixtures, clinical nutrition - everything must be ground and warmed up before feeding.
If the doctor assesses the patient's condition as serious, he may be put into an artificial coma, which is necessary for urgent brain surgery.
Recovery from a coma is the struggle of the body with the consequences of a stroke, in which intensive care is regarded as auxiliary. If the patient gets better, his sight, hearing, speech and intelligible thinking return to him - the recovery period will pass much faster.
At this stage, the patient receives not only the vital provision of the main functions (breathing, feeding), but also the prevention of immobilization. For this, verticalizers, devices for developing the muscles of the arms and legs are used, and measures are taken to prevent joint atrophy.
Being in a general ward
The following facts become the criteria for transferring a patient to the general department:
- lack of jumps in pressure and pulse during an hour of continuous monitoring;
- spontaneous breathing, without the support of a ventilator;
- the return of consciousness to the patient, his ability to perceive and understand speech well, to contact the doctor;
- exclusion of rebleeding.
Only in the presence of the above criteria and positive changes in the dynamics of treatment, the doctor can decide to transfer the patient to the general department. Rehabilitation in a hospital is carried out in the department of neurology, treatment includes medication, and with the patient's preserved motor activity, the first recovery exercises.
After completing the full course of treatment (in the general ward this is a three-week period), the patient is sent home to continue outpatient therapy. Working patients are required to be issued a sick leave, and the period of sick leave depends on the level of brain damage and the disorders that have arisen as a result of a stroke. So, after a small stroke, the patient will be able to start work after 3 months, after a moderate hemorrhage - after 4 months (while in the hospital he stays for 30 days).
Severe cases of hemorrhage, with a long recovery period, require a medical and social examination, which will establish the need to extend the sick leave after 3-4 months of outpatient treatment. Patients who underwent emergency surgery, after an aneurysm rupture, are in the hospital for at least 60 days, after which they are issued a sick leave for 4 months, with the right to extend without undergoing an examination (if there are prerequisites for a relapse of the pathology).
As you can see, the terms of recovery and stay in the hospital are individual for each person. Only the attending physician can give a prognosis for successful rehabilitation, and therefore questions about the dynamics of treatment, the patient's condition and possible recommendations should be asked to a specialist treating a particular patient.
Stroke is one of the most common pathologies of the cardiovascular system, its frequency of occurrence is more than 2 times higher than the diagnosis of myocardial infarction. Every year, about 6 million people are admitted to hospitals with this diagnosis.
The risk of stroke increases in old age, after 55 years, but, unfortunately, there is a tendency to rejuvenate the pathology and often people who have not reached 40 years of age hear such a diagnosis.
The disease is characterized by an acute violation of blood circulation in the brain, which is accompanied by the death of nerve cells and the occurrence of problems with certain functions of the body.
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Hemorrhagic stroke
Depending on the cause of the disease, it is divided into two types:
- hemorrhagic;
- ischemic.
A hemorrhagic stroke occurs when a blood vessel in the brain ruptures and a hemorrhage occurs in its cavity. This type of stroke accounts for about 10-15% of all diagnosed cases.
There are many reasons for the manifestation of pathology, the main ones are:
- hypertension (high blood pressure);
- amyloid angiopathy;
- vasculitis;
- aneurysms (thin places in the walls of blood vessels capable of breaking through);
- thrombophilia, etc.
Along with various pathological processes that can cause a stroke, hypertension accounts for close to 70% of all cases, 20% is accompanied by arterial aneurysms, and only the remaining 10% occur due to a number of other changes.
Hemorrhagic stroke has two types of hemorrhage:
- intracerebral, in this case, blood from the vessels enters the surrounding tissues, the blood supply to the brain is disturbed, and, accordingly, its cells cease to function in full;
- subaranchoidal hemorrhage, this type consists in the penetration of blood between the skull and the surface of the brain, its main cause is the rupture of the aneurysm.
The main symptoms of pathology are:
- Strong headache;
- nausea accompanied by vomiting;
- dizziness up to loss of consciousness.
Focal manifestations depend on the location of the hematoma that has arisen, most often there are violations:
- memory;
- limb sensitivity;
- speech;
- mental disorders.
Ischemic stroke
This type of pathology occurs as a result of clogging of a blood vessel by a thrombus, which causes ischemia (insufficient blood flow in the brain). Violation of blood flow leads to an instant lack of oxygen and irreversible processes in the brain cells begin to occur within minutes.
The ischemic type is diagnosed in most cases, in percentage terms it occurs in 85-90%.
Ischemic stroke also has its own types:
The main causes of the pathological process are:
- atherosclerotic and atherothrombotic stenoses;
- cardiogenic embolism;
- arterial embolism;
- stratification of the walls of the arteries;
- less often scars and inflammatory processes in the vessels.
Prehospital stage of treatment
The danger of a stroke lies in the lightning-fast damage to the vital functions of the body and without timely medical care, the patient can become disabled, and even death is not ruled out. For this reason, pre-hospital treatment is an important step in saving a patient's life.
Attention! The further life of the patient depends on the speed and effectiveness of first aid.
Steps to take before the ambulance arrives:
- place the patient in a horizontal position, on his back, while making sure that the head remains without unnecessary movements;
- release a person from restrictive clothing, especially the collar of a shirt and a belt on trousers;
- ensure the maximum flow of fresh air into the room;
- if the patient vomits, gently turn his head to one side so that the vomit does not enter the respiratory tract;
- measure the pressure, if it is elevated, give the patient a medicine to reduce it, when there is none at hand, lower the legs into a basin of hot water.
Upon the arrival of the medical team, the first thing they do is to transport the patient as quickly as possible to the hospital, to the intensive care unit or intensive care unit. During transport, it is important to prevent the patient from oscillating and causing shocks, for example when driving.
All patients must be hospitalized, there are no official contraindications for this, but there are medical and social restrictions that the doctor can rely on:
- deep coma;
- previously expressed mental changes with repeated hemorrhage;
- terminal stage of cancer.
There are no other restrictions regarding age or late treatment after the onset of the first clinical symptoms!
The main goal of the pre-hospital stage is to stabilize the impaired vital functions of the body until the moment of arrival at the medical facility.
These functions include:
- restoration and maintenance of breathing;
- correction of intracranial pressure;
- maximum reduction of swelling of the brain;
- maintenance of glucose metabolism.
Emergency diagnostics in a hospital setting
Of the diagnostic measures, computed tomography is urgently performed, Dopplerography is possible to assess the speed of blood flow through the vessels and identify the degree of stenosis.
In parallel with the started treatment, additional studies are carried out:
- complete blood count with obligatory platelet count;
- laboratory test for blood glucose levels;
- chest x-ray;
- biochemical blood test with the determination of the level of urea and creatinine.
Depending on the type of stroke, angiography may be additionally prescribed to determine the size of the hematoma and the exact location of its localization for further surgical intervention, as well as arteriography.
intensive care phase
Treatment in intensive care usually takes place within the first three weeks. During this period, the main activities are aimed at preventing various somatic complications as a result of insufficient functioning of the brain.
Main activities:
- maintaining an adequate supply of oxygen;
- blood pressure control;
- correction of the cardiovascular system;
- control of homeostasis and swallowing function (with dysphagia, a probe is installed);
- monitoring the normal functioning of the bladder and gastrointestinal tract;
- limb massage.
If the patient is in an extremely serious condition, he is turned from side to side every two hours, the skin is wiped with camphor alcohol at least twice a day. The cavity of the mouth and nose is washed with chamomile infusion at least four times a day, and liquid is also introduced into the body at the rate of thirty milliliters per kilogram of body weight.
Medical, basic therapy includes:
- The supply of an oxygen-carbohydrate mixture through the nose;
- Installation of an air vent and elimination of possible retraction of the tongue;
- For high blood pressure, inpatient stroke medications should include: eufillin, clonidine, magnesia;
- If the pressure is low, appoint: mezaton, strophanthin, ephedrine. If these drugs are ineffective, the course of treatment is changed to taking dopamine in parallel with coricosteroid drugs, for example, prednisolone or cordcamine;
- To protect brain activity, apply: cerebrolysin, piracetam, macrodent and vitamin B6;
- To eliminate cerebral edema, appoint: glycerol, lasix, furosemide (diuretics are prescribed with extreme caution, strictly on prescription). Seduxen and corticosteroids (dexon) to protect the brain membrane.
Differentiated treatment of stroke in a hospital
Such measures of therapy are used in parallel with the basic treatment, but depend on the type of stroke. An individual approach is important here, since ischemic and hemorrhagic strokes have different causes, course features, and one type of treatment for each of them is not suitable.
For hemorrhagic stroke:
With this type of pathology, they often resort to surgical intervention, the purpose of which is to remove the hematoma. But it is not possible to perform the operation for all persons, but only for young and middle-aged people with lateral forms of hematomas.
Indications for surgical intervention, as a rule, are:
- compression by a hematoma of the brain;
- lack of proper result from conservative treatment;
- negative impact of hematoma on cerebral blood flow;
- danger of breakthrough of the center of hemorrhage.
Prices for stroke treatment in a hospital directly depend on the complexity of the pathological process and the type of therapy required.
What to do after discharge?
The recovery period after a stroke upon arrival home is quite long and painstaking.
There are three options for continuing the rehabilitation period, it all depends on the financial capacity of the patient's family and the general condition of the patient:
| home recovery | This method requires a certain psychological attitude from all family members, so the arrangement of their lives will be forced to change dramatically. It is desirable for the patient to allocate a separate room, but it should not look like a ward from a medical institution. It should be filled with light, fresh air and contain emotions, for example, photographs of loved ones of the patient, favorite paintings or flowers. In a word, the room should be cozy and comfortable. In addition to comfort, patients require daily care, which should include:
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| Rehabilitation center |
According to doctors, a rehabilitation center is considered the best way out in this situation, since the patient is constantly under the supervision of qualified specialists and with the help of psycho-emotional support from them and their relatives, the patient recovers faster. The main condition for successful rehabilitation in this case is the right choice of clinic. Read customer reviews, talk to families whose relatives are being treated there, learn about the medical staff and the general atmosphere in the institution. The resulting overall picture will help you make the right choice in favor of a particular institution. |
| Combined method |
This method consists in a short-term, but such a necessary placement for the patient in a rehabilitation center, followed by the continuation of restorative therapy at home. This option will help relatives learn the basic principles of care and recovery procedures for the patient and further use them at home. |
Remember that a stroke is not a sentence, and with timely treatment, further adequate rehabilitation and faith in a speedy recovery, the patient will definitely recover. The main task for all family members is to help him in this and believe in a positive result.
Stroke is a violation of cerebral circulation, which is accompanied by the appearance of neurological symptoms.
Causes of a stroke
To understand the causes of stroke, you should know that there are two types of stroke: ischemic and hemorrhagic. They differ both in origin and in the method of treatment.
Ischemic stroke occurs due to the formation of a blood clot or clot, which clogs the arteries of the brain and disrupts the processes of blood supply.
Hemorrhagic stroke appears due to a rupture of a cerebral vessel, as a result of which blood accumulates in neighboring tissues. The blood formed in large quantities exerts high pressure on the brain tissues, as a result of which their work is disrupted.
In medicine, there are many reasons for the development of such a terrible disease as a stroke. Among them are:
- high blood pressure - constant drops in blood pressure disrupt the elasticity of blood vessels and lead to their ruptures,
- frequent arrhythmias - interruptions in heart rate can lead to the formation of blood clots that disrupt blood circulation in the brain,
- exceeding the permissible level of cholesterol in the blood - high cholesterol contributes to the formation of plaques that block blood vessels and lead to the development of a stroke,
- high blood sugar causes fragility and fragility of the walls of blood vessels, resulting in an increased likelihood of their rupture,
- the formation of aneurysms in the vessels of the brain,
- poor blood clotting leads to the formation of clots in the vessels,
- overweight,
- alcohol consumption,
- smoking.
The most common causes of stroke are thrombosis, internal bleeding in the brain.
Thus, the main cause of stroke is damage to nerve cells that are located in the brain and are responsible for all functions of the human body.
Stroke Symptoms
In most cases, the symptoms that occur in patients with a stroke are:
- movement disorders. Weakness or awkwardness of movement, lack of coordination,
- speech disorders,
- sensory disturbances
- behavioral and cognitive dysfunctions. Difficulty dressing, combing hair, brushing teeth,
- memory disorders,
- severe headache, vomiting,
- increased breathing,
- disturbance of consciousness.
Stroke and its treatment
Treatment of a patient during a stroke should be carried out in the neurology department, which will ensure accurate diagnosis of stroke and intensive treatment, reduce mortality and disability among patients.
AT stroke treatment there are two main areas:
- treatment of the consequences of a stroke,
- prevention of recurrent stroke.
Movement disorders can be attributed to the most common consequences of a stroke. The patient's motor activity is restored within about two to three months from the moment of a stroke and can last for a year.
Therapeutic exercises should be carried out in the first days after the diagnosis of a stroke, if there are no contraindications to physical activity. To reduce pain before gymnastics, you can use anesthetic ointments or compresses.
If a patient has problems with speech after a stroke, you should contact a speech therapist. The patient must be in constant contact with people, listen to the radio, TV.
big role in stroke treatment plays its prevention. The risk of a recurrence of a stroke exists in the presence of arterial hypertension, arrhythmia, pathology of the heart valves, heart failure, and diabetes mellitus. Preventive measures for recurrent stroke should begin as early as possible and last for less than 4 years.
In addition, maintaining a healthy lifestyle is of great importance. It is recommended to reduce the consumption of foods containing a large amount of cholesterol, to increase the amount of fresh vegetables and fruits in the diet.
Rehabilitation course stroke treatment includes therapeutic gymnastics, training on simulators, massage, physiotherapy, stimulation treatment.
Consequences of a stroke
Various conditions that begin to manifest after a stroke depend on the location of the pathology, its size, and with a hemorrhage in the brain, the resulting consequences depend on the size of the hematoma, and how much it compresses the surrounding tissues and organs.
Possible consequences of a stroke:
- movement disorders that lead to paralysis. Motor functions are actively restored after a stroke in the first three months. Great importance in this process belongs to therapeutic exercises. Also important is the desire and desire of the patient to perform the prescribed set of exercises.
- speech disorders can persist for a long time. To eliminate such violations, constant classes with a speech therapist, speech training are necessary.
- mental disorders, which are most often manifested by depression. The development of depressive conditions is caused by the severity of the disease, the loss of many opportunities for self-service. Possible manifestations of aggression, anxiety. If the violations do not recover on their own, it is possible to take medications.
- memory impairment, sometimes even loss of memory. In most cases, memory is restored, but this requires regular training.
- violations in the coordination of movements, which manifest themselves differently depending on the affected area. A good result for restoring coordination of movements is observed when taking medications.
Rehabilitation after a stroke
It is possible to eliminate the consequences of a stroke only by performing a series of measures for proper rehabilitation. Among them are the following procedures:
- light massage of the upper and lower extremities,
- physical therapy, which will help restore the patient's motor activity,
- special exercises for the development of fine motor skills of the hands,
- water massage, water procedures that stimulate muscle tension.
Competent performance of all medical procedures aimed at the rehabilitation of the patient, leads to the fact that the patient can return to an independent life. As a rule, the rehabilitation period takes about 3 years.
Stroke prevention
Strict adherence to doctor's prescriptions, as well as maintaining a healthy lifestyle will help you avoid the development of a stroke. If you have had a stroke, then in order to avoid recurring cases, you should follow these recommendations:
- control your blood pressure. By lowering your blood pressure, you reduce your risk of another stroke.
- you should reconsider your diet and exclude foods rich in cholesterol and fats. This will reduce the formation of plaques on the walls of blood vessels. If you cannot eliminate these foods from your diet on your own, you need to see a doctor who will prescribe you special drugs that will lower your blood cholesterol levels.
- give up smoking. The very process of smoking or the presence of smokers in the environment leads to the appearance of a stroke.
- to treat diabetes with medication, if present, and to constantly monitor blood sugar levels. This will significantly reduce the risk of stroke.
- reduce excess weight, which contributes to the causes of stroke.
- Eat a diet rich in fresh fruits and vegetables.
- do physical exercises. Regular exercise lowers blood pressure, lowers blood cholesterol levels, reduces body weight, and improves the condition of your blood vessels. This greatly reduces the risk of developing the disease.
- reduce the amount of alcohol consumed. Since alcohol increases blood pressure, which is the main cause of stroke.
