For the prevention and treatment of acute ischemic stroke complications in the acute phase, see expert guidance!

The time division of the acute phase of stroke is not uniform, and generally refers to within 2 weeks after the onset (within 1 week for light type and within 1 month for severe type)
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The "Guiding Standards for the Diagnosis and Treatment of Acute Ischemic Stroke in China" mainly introduces the emergency treatment system, pre-hospital treatment, acute diagnosis and treatment, prevention and treatment of acute complications and other conditions, as well as early rehabilitation and secondary prevention Related content, regarding the prevention and treatment of acute ischemic stroke complications and other situations, the article mainly proposes the following recommendations
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01 and cerebral edema and increased intracranial pressure caused by factors ① avoid treatment of increased intracranial pressure, head and neck, such as excessive distortion, excitement, force, fever, epilepsy, not smooth airway, cough, constipation
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②It is recommended to raise the head position for patients with increased intracranial pressure and bedridden cerebral infarction, usually raising the head of the bed>30°
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③Mannitol and hypertonic saline can significantly reduce cerebral edema, lower intracranial pressure, and reduce the risk of cerebral hernia.
The type of drug, the treatment dose and the number of administrations can be selected according to the specific conditions of the patient
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If necessary, glycerol fructose or furosemide can also be used
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④For patients with malignant middle cerebral artery infarction and severe intracranial pressure increase within 48 hours of onset and under 60 years of age, the condition is still aggravated by active drug treatment, especially for patients with lowered level of consciousness, please consult neurosurgery to consider whether to reduce it.
Compression surgery and surgical treatment can reduce the mortality rate, reduce the disability rate, and increase the self-care rate
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Surgical decompression in patients over 60 years of age can reduce death and severe disability, but the ability to live independently has not been significantly improved
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Therefore, we should be more cautious, and we can choose whether to operate or not according to the patient's age and the patient's/family's values ​​for this possible outcome
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⑤ For patients with large-area cerebellar infarction that compresses the brainstem, please consult a neurosurgery consultation for assistance
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⑥Because of the lack of effective evidence and the potential risk of increased infectious complications, the use of glucocorticoids (conventional or high-dose) for the treatment of cerebral edema and increased intracranial pressure caused by ischemic stroke is not recommended
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⑦It is not recommended to use barbiturates when ischemic cerebral edema occurs, and the effectiveness and safety of hypothermia in the treatment of severe ischemic stroke should be further studied
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02 Hemorrhagic transformation after cerebral infarction ①Symptomatic hemorrhagic transformation: stop antithrombotic (antiplatelet, anticoagulation) therapy and other bleeding-causing drugs; ②Reversing drugs can be selected according to the cause of the bleeding, but the pros and cons should be weighed and the side effects of the drugs should be weighed; ③ Timing of resumption of anticoagulation and antiplatelet therapy: For patients who need antithrombotic therapy, antithrombotic therapy can be started 10 days to several weeks after symptomatic hemorrhage turns into a stable condition, and the pros and cons should be weighed; the risk of recurrence of thrombosis is relatively low Or those with poor general conditions can use antiplatelet drugs instead of anticoagulant drugs
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03 Epilepsy ① Preventive use of anti-epileptic drugs is not recommended; ② Long-term use of anti-epileptic drugs is not recommended after one isolated seizure or acute seizure control; ③ Epilepsy that recurs 2 to 3 months after stroke is recommended Conventional epilepsy is treated with long-term medication; ④ Status epilepticus after stroke is recommended to be treated according to the principles of status epilepticus treatment
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04 Pneumonia ①Early evaluate and deal with dysphagia and aspiration problems, and special attention should be paid to preventing pneumonia in patients with impaired consciousness; ②Patients with fever suspected of pneumonia should be given anti-infective treatment, but preventive use of anti-infective drugs is not recommended
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05 Urinary dysfunction and urinary tract infection ① Those with urinary dysfunction should be evaluated and recovered early; ② Those with urinary incontinence should try to avoid indwelling a urinary tube and use the potty or potty regularly; ③ Those with urinary retention should measure the residual urine in the bladder, which can be Cooperate with physical massage, acupuncture and other methods to promote the recovery of urinary function.
Intermittent catheterization or indwelling catheterization can be used when necessary; ④ People with urinary tract infection decide anti-infective treatment based on the condition, but preventive use of antibiotics is not recommended
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06 Deep vein thrombosis and pulmonary embolism ① Encourage patients to move as soon as possible and raise the lower limbs; try to avoid intravenous infusion of the lower limbs (especially on the paralyzed side)
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② Anticoagulation therapy does not significantly improve neurological function and reduce mortality, but increases the risk of bleeding.
Routine use of preventive anticoagulation therapy (subcutaneous injection of low molecular weight heparin or unfractionated heparin) in bedridden patients is not recommended
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③For those who have developed DVT and pulmonary embolism without contraindications, low molecular weight heparin or unfractionated heparin can be given, and those with anticoagulation contraindications can be given aspirin treatment
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④Compression therapy (alternating compression device) and drugs (antiplatelet drugs and fluid replacement therapy) can be combined to prevent DVT.
Routine compression therapy alone is not recommended; but for ischemic stroke patients with antithrombotic contraindications, it is recommended alone Application of compression therapy to prevent DVT and pulmonary embolism
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⑤For patients with DVT or pulmonary embolism without contraindications for anticoagulation and thrombolysis, heparin anticoagulation is recommended first, and patients with proximal DVT or pulmonary embolism without relief of symptoms can be given thrombolytic therapy
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07 Pressure ulcers ① Turn over regularly for people with paralysis to prevent skin pressure; maintain good skin hygiene and maintain adequate nutrition
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②Patients who are prone to pressure ulcers are advised to use specific mattresses, wheelchair cushions and seats until they recover their mobility
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08 Nutritional support ① Before the patient starts eating, use a drinking water test to evaluate the swallowing function; ② Pay attention to nutritional support after the onset, and those with dysphagia in the acute stage should receive enteral nutrition support within 7 days of the onset; ③ Those who cannot recover from the dysphagia within a short period of time A nasogastric tube can be placed early to eat, and for those who cannot recover from dysphagia for a long time, a gastrostomy can be used to eat
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09 Post-stroke Affective Disorders ①The patient's mental state should be assessed, and attention should be paid to post-stroke anxiety and depression symptoms.
If necessary, psychologists should assist in diagnosis and treatment; ②Patients with post-stroke anxiety and depression symptoms should be treated accordingly
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10 Cognitive impairment after stroke should pay attention to the assessment of the cognitive function of patients after stroke, according to the patient's condition, select appropriate evaluation tools and time for screening and evaluation, combined with the results of screening and evaluation for comprehensive intervention
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The above content is extracted from: Medical Administration and Hospital Administration.
Chinese Guidelines for the Prevention and Treatment of Stroke (2021 Edition)-11.
Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke.
2021-8-31.