13 tricks to "perfect" stroke prevention!

*Only for medical professionals to read and reference About stroke, a disease with a high incidence, high disability rate, high fatality rate, and high recurrence rate, how to effectively prevent it? 1 Face up to stroke, preventable and curable! In China, stroke is a kind of disease with high incidence, high disability rate, high fatality rate and high recurrence rate, which brings a heavy burden to patients, families and society
.

But in fact, stroke is preventable and treatable, and many patients miss the best time for treatment due to pre-hospital delays
.

The results of a study published online in the Lancet Neurology sub-journal showed that 90.
2% of the stroke burden could be avoided by controlling risk factors, and stroke is a highly preventable disease! The study analyzed stroke information in the large database of the Global Burden of Disease (GBD) and found that 74% of the stroke burden was caused by behavioral risk factors, while 72% was caused by metabolic risk factors
.

In addition, the most striking finding of the study is that 29.
2% of stroke-related disability globally is associated with air pollution, including both environmental and household air pollution
.

Of course, the biggest risk factor for stroke is hypertension, which is associated with 64% of the stroke burden
.

2 Which risk factors are controllable? Note: The picture shows the proportion of stroke burden caused by risk factors.
It can be seen that China has significantly exceeded 90%
.

That is to say, more than 90% of strokes in China are caused by controllable factors and can be avoided
.

The study listed 17 modifiable risk factors for stroke, including: • Environmental PM2.
5 pollution, household solid fuel combustion pollution, lead exposure; • High sodium diet, high intake of sugary sweetened beverages, fruit low intake, low vegetable intake, low whole grain intake, alcohol; • low physical activity; • smoking, secondhand smoke; • high BMI, high fasting blood sugar, high systolic blood pressure (SBP), high cholesterol, Low glomerular filtration rate (GFR)
.

313 strokes to prevent stroke 1.
Control blood pressure: normal blood pressure is below 140/90mmHg, and diabetic patients are maintained below 130/80mmHg
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2.
Physical exercise: At least 30 minutes of exercise every day
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3.
Weight control: waist-to-hip ratio is less than 0.
9 for men and less than 0.
8 for women
.

4.
Regulate blood lipids: LDL is controlled at 2.
6mmol/L, combined with diabetes, coronary heart disease, metabolic syndrome, and smoker LDL<2.
07mmol/L
.

5.
Quit smoking 6.
Reasonable diet: control salt intake, no more than 6g per day, and reduce the intake of saturated fatty acids
.

7.
Treatment of heart disease: control the heart rhythm and heart rate, and treat the primary disease of the heart
.

8.
Psychological intervention and drug treatment to relieve depression
.

9.
Control blood sugar: fasting is controlled below 6.
0mmol/L, postprandial blood sugar is controlled below 10.
0mmol/L, and glycosylated hemoglobin is below 7.
0%
.

10.
Limit alcohol consumption: men drink less than 1 bottle of beer or 4 taels of red wine and 1 tael of white wine a day, and women drink half of it
.

11.
Women avoid oral contraceptives and postmenopausal estrogen replacement therapy
.

12.
Oral administration of vitamin B6, vitamin B12 and folic acid in patients with hyperhomocysteinemia
.

13.
Antithrombotic drugs: including the antiplatelet drug aspirin and the anticoagulant drug warfarin, the specific choices are as follows: ↓① For female patients aged 45 years and above, those with low risk of cerebral hemorrhage and good gastrointestinal tolerance are recommended to take low doses Aspirin, but its effect is very limited; men may consider low-dose aspirin for primary prevention of myocardial infarction; but it does not reduce the risk of ischemic stroke
.

② For patients with non-valvular atrial fibrillation, if they are younger than 65 years old and have no vascular risk factors, it is recommended to take aspirin
.

③ For patients with non-valvular atrial fibrillation, if they are 65-75 years old and have no vascular risk factors, it is recommended to take aspirin or oral anticoagulants (INR 2.
0-3.
0) unless contraindicated
.

④ For patients with non-valvular atrial fibrillation, if they are older than 75 years old, or although they are younger than 75 years old, but have risk factors such as hypertension, left ventricular dysfunction, diabetes, etc.
, oral anticoagulants are recommended (INR 2.
0-3.
0)
.

⑤ If patients with atrial fibrillation cannot accept oral anticoagulants, it is recommended to take aspirin
.

⑥ For patients with atrial fibrillation, if there is a mechanical prosthetic valve, long-term anticoagulation is recommended
.

The INR target value varies with the type of prosthetic valve, but it cannot be lower than 2~3
.

⑦ In patients with asymptomatic internal carotid artery stenosis of more than 50%, it is recommended to take low-dose aspirin to reduce the risk of vascular events
.

4 Strategies for the prevention and treatment of stroke complications If some complications after stroke are not dealt with in time, they can often lead to aggravation of the disease or even death, and also affect the recovery of neurological function in the future.
Therefore, the prevention and treatment of stroke complications is extremely important.

.

1.
Frequent active and passive leg exercises in tight compression stockings or inflatable support socks
.

2.
Frequently turn bedridden patients over, paying special attention to the compressed parts
.

3.
Passively move limbs at risk of contracture and place them in a suitable resting position, using a splint if necessary
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4.
Ensure fluid intake and nutrition, including assessing whether the patient has dysphagia and providing necessary nutritional support
.

5.
After exclusion of contraindications, subcutaneous injection of low-dose heparin (5000U) every 12 hours, or an equivalent amount of low-molecular-weight heparin or sulfonate mucopolysaccharide to prevent deep vein thrombosis and pulmonary embolism
.

6.
Encourage walking as soon as possible under close supervision (starting with normal vital signs)
.

7.
Maximize lung function (eg, stop smoking, deep breathing exercises, breathing therapy, prevent aspiration in patients with dysphagia)
.

8.
Early detection and treatment of infections, especially pneumonia, urinary tract infections and skin infections
.

9.
Manage urinary bladder-related problems in bedridden patients, and try not to use indwelling catheters
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10.
Promote the modification of risk factors (eg smoking cessation, weight loss and healthy eating)
.

11.
Early rehabilitation (such as active and passive exercise, joint range of motion exercise)
.

12.
Discuss with the patient residual function, prognosis, and ways to make up for missing function in patient-acceptable language
.

13.
Encourage maximum independence through rehabilitation
.

14.
Encourage patients and their families to contact a stroke support group for social and psychological support
.

Reference [1] Chen Haozhu, Lin Guowei, Wang Jiyao
.

Practical Internal Medicine 14th Edition [2] Robert S.
Porter, MD MSD Manual 19th Edition [3] DOI: http://dx.
doi.
org/10.
1016/S1474-4422(16)30073 -4[4] http://