Acute treatment
In the treatment of acute phase, thrombolysis should be carried out within the golden time window of 4.5 hours to reduce brain metabolism, control brain edema, protect brain cells and save ischemic penumbra. Acute treatment is mainly as follows:
Oxygen inhalation and ventilation support to correct hypoxia;
ECG monitoring and timely treatment of heart disease;
Actively carry out thrombolysis (within the golden time window of 4.5 hours) and/or embolectomy to achieve the purpose of vascular recanalization;
Antiplatelet and anticoagulant therapy;
Actively control infection and prevent or correct high fever, control blood pressure and blood sugar, and attach importance to nutritional support.
In addition, when cerebral thrombosis occurs in a large area, surgical decompression should be performed as soon as possible after doctors carefully evaluate and clarify the indications, which can reduce the mortality and disability rate.
general treatment
Keep the respiratory tract unobstructed and stay in bed quietly;
Turn over regularly, pat the back and suck sputum, pay attention to the position of limbs and the handling of defecation to prevent bedsore, pneumonia, constipation and urinary tract infection, and pay attention to the balance of nutrition, water and electrolyte of patients;
If it is vasculitis such as rheumatism, leptospirosis and syphilis, it should be treated with anti-rheumatism and penicillin respectively;
Actively treat primary diseases: formulate feasible prevention and treatment measures for primary diseases (such as hypertension, diabetes, coronary heart disease, etc.). ) prevent recurrence. For example, actively treat heart diseases such as coronary heart disease and correct arrhythmia.
medicine
Drugs are used for thrombolysis, anticoagulation, antiplatelet and anti-brain edema, so as to ensure the blood circulation and microcirculation of patients' bodies, prevent the recurrence of thrombosis and protect nerve cells. Patients can be treated with the following drugs under the guidance of a doctor.
Intravenous thrombolytic drugs
Recombinant tissue plasminogen activator (RTPA): Application within 3 hours can effectively improve the cure rate. There is a risk of intracranial hemorrhage.
Urokinase: It can effectively inhibit thrombosis, but it will increase the risk of bleeding.
Antiplatelet drugs
Aspirin: It can reduce the mortality and disability rate and reduce the recurrence rate.
Clopidogrel: Combined with aspirin can reduce the risk of recurrence.
Both drugs increase the risk of bleeding.
anticoagulant
Heparin: It can reduce the recurrence rate.
Agatraban: Thrombosis can be inhibited by inhibiting thrombin.
These two drugs also increase the risk of bleeding.
Fibrinolytic drugs
Defibrase: It can improve nerve function and reduce the recurrence rate, but it will increase the risk of intracranial and extracranial bleeding.
Batroxobin: It can reduce the mortality and disability rate, but it is easy to cause bleeding.
Drugs for controlling blood lipid
Statins: can improve the prognosis and prevent recurrence, but occasionally rhabdomyolysis occurs, leading to renal failure.
Drugs for improving microcirculation
Butylphthalide: It can improve the circulation and neurological deficit in ischemic areas, and its serious risk has not been monitored.
Human urinary kininogenase can improve cerebral arterial circulation.
Surgical therapy
Emergency endovascular surgery
Considering some influencing factors, according to the location of thrombus, some patients can treat cerebral thrombosis by treatment in blocked blood vessels.
Ventricular decompression and drainage
Ventricular decompression and drainage is the operation of inserting puncture needle or drainage tube with core into ventricle to drain cerebrospinal fluid, thus reducing intracranial pressure. For patients with severe intracranial hypertension, the condition is still aggravated after active drug treatment, especially those with reduced consciousness level, decompression can be considered. This operation can reduce the mortality and disability rate and improve the self-care rate of patients.