2020-05-07
腦(nao)(nao)(nao)血(xue)(xue)管病(中(zhong)(zhong)(zhong)(zhong)醫(yi)稱為(wei)中(zhong)(zhong)(zhong)(zhong)風(feng))是(shi)危(wei)害人類健康的(de)(de)(de)三大(da)殺手之一。中(zhong)(zhong)(zhong)(zhong)風(feng)一旦發(fa)(fa)(fa)病,再(zai)發(fa)(fa)(fa)率(lv)很高。統計結果顯示(shi),大(da)約(yue)25%腦(nao)(nao)(nao)血(xue)(xue)管病幸存者(zhe)在2年(nian)內再(zai)發(fa)(fa)(fa),而5年(nian)內有大(da)約(yue)40%患(huan)者(zhe)再(zai)次復發(fa)(fa)(fa),其中(zhong)(zhong)(zhong)(zhong)65%為(wei)缺(que)血(xue)(xue)性(xing)腦(nao)(nao)(nao)中(zhong)(zhong)(zhong)(zhong)風(feng)。原發(fa)(fa)(fa)卒(zu)中(zhong)(zhong)(zhong)(zhong)后,再(zai)次卒(zu)中(zhong)(zhong)(zhong)(zhong)的(de)(de)(de)危(wei)險性(xing)與一般(ban)人群相比升高9倍,再(zai)次中(zhong)(zhong)(zhong)(zhong)風(feng)的(de)(de)(de)患(huan)者(zhe)預后更差(cha),70%-80%常導(dao)致(zhi)(zhi)嚴重的(de)(de)(de)致(zhi)(zhi)殘或死(si)亡。近三十(shi)年(nian)來,中(zhong)(zhong)(zhong)(zhong)風(feng)的(de)(de)(de)一級(ji)預防(fang)(控制(zhi)危(wei)險因(yin)素(su),防(fang)止中(zhong)(zhong)(zhong)(zhong)風(feng)發(fa)(fa)(fa)生)取(qu)得了令人矚(zhu)目(mu)(mu)的(de)(de)(de)成(cheng)效,其發(fa)(fa)(fa)病率(lv)呈逐年(nian)降低(di)趨勢。中(zhong)(zhong)(zhong)(zhong)風(feng)的(de)(de)(de)二(er)級(ji)預防(fang)是(shi)對已發(fa)(fa)(fa)生過(guo)中(zhong)(zhong)(zhong)(zhong)風(feng)的(de)(de)(de)患(huan)者(zhe)采用各種(zhong)相關措施預防(fang)其再(zai)發(fa)(fa)(fa)。再(zai)次復發(fa)(fa)(fa)往往是(shi)多因(yin)素(su)交叉作(zuo)用導(dao)致(zhi)(zhi)。流行病學(xue)資(zi)料顯示(shi),首次發(fa)(fa)(fa)作(zuo)為(wei)腦(nao)(nao)(nao)血(xue)(xue)栓(shuan)(shuan)形(xing)成(cheng)者(zhe)再(zai)次發(fa)(fa)(fa)作(zuo)多仍為(wei)血(xue)(xue)栓(shuan)(shuan)形(xing)成(cheng),而腦(nao)(nao)(nao)栓(shuan)(shuan)塞(sai)約(yue)38%轉變為(wei)其它類型如(ru)血(xue)(xue)栓(shuan)(shuan)形(xing)成(cheng),腔隙性(xing)梗死(si)超過(guo)半數再(zai)發(fa)(fa)(fa)為(wei)腦(nao)(nao)(nao)血(xue)(xue)栓(shuan)(shuan)形(xing)成(cheng)。(一)目(mu)(mu)前針對腦(nao)(nao)(nao)血(xue)(xue)管病的(de)(de)(de)二(er)級(ji)預防(fang)的(de)(de)(de)醫(yi)療(liao)措施,國(guo)內外大(da)致(zhi)(zhi)有以下(xia)幾(ji)方面
1. 管(guan)(guan)理(li)血(xue)(xue)(xue)(xue)壓(ya)2. 控制血(xue)(xue)(xue)(xue)脂、血(xue)(xue)(xue)(xue)糖3. 抗血(xue)(xue)(xue)(xue)小板治(zhi)療(liao)4. 抗凝治(zhi)療(liao)5.降低增(zeng)高的血(xue)(xue)(xue)(xue)漿半胱氨酸水(shui)平(ping)6. 腦(nao)(nao)血(xue)(xue)(xue)(xue)管(guan)(guan)血(xue)(xue)(xue)(xue)液(ye)動(dong)力學和血(xue)(xue)(xue)(xue)液(ye)流變學監測7. 手(shou)術(shu)治(zhi)療(liao)(1)頸動(dong)脈內膜切除(chu)術(shu)(Carotid endarterectomy,CEA)(2)顱內-顱外血(xue)(xue)(xue)(xue)管(guan)(guan)搭橋術(shu)8. 神經(jing)科介入治(zhi)療(liao)(二)預防腦(nao)(nao)血(xue)(xue)(xue)(xue)管(guan)(guan)病再發(fa)(fa)(fa)(fa)的衛生宣教。預防腦(nao)(nao)血(xue)(xue)(xue)(xue)管(guan)(guan)病再發(fa)(fa)(fa)(fa)應(ying)注意以(yi)下幾點:(1) 警(jing)惕復發(fa)(fa)(fa)(fa)的早期(qi)癥(zheng)狀(zhuang)(zhuang),腦(nao)(nao)血(xue)(xue)(xue)(xue)管(guan)(guan)病癥(zheng)狀(zhuang)(zhuang)緩解后,若又出現頭痛(tong)、頭暈、說話不(bu)(bu)清、手(shou)指活動(dong)不(bu)(bu)靈(ling)、偏側肢(zhi)體麻木等癥(zheng)狀(zhuang)(zhuang)。(2) 消除(chu)復發(fa)(fa)(fa)(fa)的內在(zai)病理(li)因素。特別(bie)是高血(xue)(xue)(xue)(xue)壓(ya)。(3) 避免復發(fa)(fa)(fa)(fa)的誘發(fa)(fa)(fa)(fa)因素,如(ru)情(qing)緒激動(dong)、過(guo)度用(yong)力勞累、氣候(hou)變化、煙酒刺激等。(4) 建立合理(li)的飲食(shi)習(xi)慣,注意飲食(shi)的營養結構,科學合理(li)的安排(pai)飲食(shi)。食(shi)量應(ying)適(shi)當,不(bu)(bu)可過(guo)飽和過(guo)饑。戒除(chu)煙酒等不(bu)(bu)良嗜(shi)好。(5) 在(zai)腦(nao)(nao)出血(xue)(xue)(xue)(xue)的康復期(qi),使用(yong)活化腦(nao)(nao)細胞、改善腦(nao)(nao)代謝、循環的藥物(wu)宜在(zai)醫生的指導下進(jin)行。(6) 結合自身情(qing)況(kuang),開(kai)展適(shi)當體育(yu)鍛煉,增(zeng)強體質,提高抗病能力。