Cerebrovascular accident is the cause of disability, so it is important to examine the patient at different times after vascular accident, and timely treatment of ischemic stroke, drugs can eliminate the motor and speech disorder. Character providing first and subsequent medical care depends on the cause of stroke.
First aid
If the time of acute cerebrovascular passed over 3 hours and the patient is prescribed such preparations:
- Aspirin 1 mg / kg 1 time a day;
- Trental 5 ml / drip and 0.9% solution of sodium chloride (250 ml);
- Tserakson 1000 mg / drip with 200 ml of saline solution;
- Aktovegin 20 ml / in №15;
- diuretic drugs: Mannitol 0.5-1.5 g / kg / in;
- gidroksetilirovannogo starch solution (Refortan Influkol or 500 ml / h).
Medicaments eliminate cerebral edema and reduce intracranial pressure.
In the first hours after the disaster vascular prescribe drugs for ischemic stroke:
- rr clonidine with 10 ml saline / v or v / m;
- Pentamine 0.5 ml of a 5% solution w / w or w / o;
- Diazepam 4 ml 10 ml solution of sodium chloride in / in;
- vomiting - rr Cerucalum 5 mg / ml, 2 ml / v saline.
neuroprotection
Drugs given to the patient for treatment after ischemic stroke, protect brain cells from death, inhibit biochemical reactions in the ischemic focus.
For the treatment used neuroprotective:
- calcium channel blockers;
- GABA antagonists and leukocytes;
- trace elements (Mg).
The patient is prescribed such medicines:
- uric acid (antioxidant);
- piracetam;
- Albumen;
- Magnesium sulfate;
- Tserakson.
Possess neuroprotective following medications:
- inosine;
- nicotinamide;
- Riboflavin;
- cytoflavin;
- Reamberin;
- Meksidol.
Among secrete neuroprotective drugs affecting the cerebral peptidergic complexes.
This group of medications include:
- Cere;
- semaks;
- Cortexin.
Rehabilitation of patients undergoing vascular events, held with drugs that inhibit the oxidation of lipids. The doctor prescribes the patient Thioctacid, Valium, Oktolipen.
For the treatment in the first day after the stroke using preparations which are antagonists of glutamate receptors:
- memantine;
- Memantal.
Secondary neuroprotection carried through 6 hours after stroke. It lasts 7 days.
The fight against thrombosis
To prevent the formation of thrombi using fibrinolytics - effective drugs for ischemic cerebral stroke. The patient perform the procedure using the drug Micardis (rtPA). For intravenous administered 0.9 mg rtPA (90 mg).
For on / in the prescribers Urokinase Medac. The drug is administered at a dose of 30 mg. If there is a main cerebral artery occlusion due to thrombus blockage, the patient is injected intravenously antiaggregant Abciximab (0.125 .mu.g / kg / min for 12 hours).
Heparin is employed only for washing the catheter 500 JV / h. After stent placement prescribed Clopidogrel 75 mg per day, aspirin 100 mg per day.
For early secondary prevention of ischemic attacks using Heparin. The drug used for the treatment of conditions such as:
- coagulopathy;
- dissection of the cerebral vessels;
- intracranial stenosis.
The patient is administered in / 5,000 or 10,000 units of the medicament.
For treatment used low molecular weight heparin fractions:
- fraxiparine;
- Fragmin.
During the recovery period the patient is taking aspirin at a dose of 100-300 mg per day. The drug is not used in the first hours after the thrombotic treatment.
As secondary prevention prescribed antiplatelet agents:
- Plavix - 75 mg per day;
- Dipyridamole-Retard - 200 mg 2 times a day;
- Agrenoks.
pressure and normalization of the heart
On the first day of cerebral circulation blood pressure increases to 140/90 mm Hg. Art. In the acute phase of ischemic stroke is accompanied by an increase in systolic blood pressure to 200 mm Hg. Art, diastolic -. 120 mm Hg. Art.
As used antihypertensive medicaments:
- beta-blockers;
- diuretics;
- ACE inhibitors;
- calcium antagonists.
Perindopril is administered in a dose of 4 mg per day.
To quickly lower blood pressure patient is recommended:
- Captopril orally 6.25 -12.5 mg;
- Lebetalol (5-20 mg);
- Clonidine tablets (0.075-0.3 mg);
- sodium nitroprusside / in (0.3-0.5 g / kg in 1 min.).
In the acute phase of stroke used Urapidil (Ebrantil). The drug is administered in an amount of 12.5-25 mg. The drug is administered in / in for 5 minutes. The maximum number of 25-100 mg of the drug.
For secondary prevention of high blood pressure and prevent the development of cardiovascular disease patients recommend the following products:
- acetylsalicylic acid 75-300 mg / day;
- Ticlopidine 500 mg / day;
- Dipyridamole 400 mg / day of aspirin (50 mg / day).
For the prevention of recurrent stroke is used:
- indapamide;
- perindopril;
- nitrendipine;
- eprosartan;
- Teveten.
- Digidralazin;
- Metoprolol.
When stroke for maximum effect, the patient is prescribed:
- diuretic or a calcium antagonist and a beta-blocker;
- Amlodipine and an ACE inhibitor.
Patients suffering from heart failure, recommend medications such as:
- diltiazem;
- nimodipine;
- isradipine;
- Adalat retard;
- Izoptin retard;
- Amlodipine.
In acute left ventricular failure designate such groups of medicines, as:
- opioids;
- nitrates;
- catecholamines;
- cardiac glycosides.
To eliminate the attack acute coronary insufficiency Fentanyl is administered 1-2 ml of 0.005% solution and droperidol (4.2 ml of 0.25% solution), in / slow. When intense pain accompanied by a feeling of fear in the patient / slow injected 1 mm 2% morphine hydrochloride solution. To eliminate the nervous strain administered 2 ml of 0.5% solution seduksen. For symptomatic treatment using such agents as:
- drugs that enhance metabolism in the heart muscle;
- Antiplatelet agents;
- valerian tablets;
- Fenazepam 0.5 mg 3 times per day;
- Elenium 0.001 grams 3 times per day.
The patient is prescribed:
- sustak;
- Trinitrolong;
- Nitromaz;
- tsitramon;
- nitrosorbid;
- Kordanum.
Maintaining a healthy cholesterol level
Preparations for the treatment of ischemic cerebral stroke reduce the level of lipids in the blood of the patient. Anticholesterol agents used for the treatment of stroke, are divided into two main groups: statins, fibrates. The doctor recommends that the lipoic acid and omega-3.
The patient is prescribed medication such as:
- rosuvastatin;
- atorvastatin;
- simvastatin;
- fluvastatin;
- Lovastatin.
To restore the cerebral circulation and reduce cholesterol apply the following medications:
- Crestor;
- Merten;
- Roxer;
- Tavastor;
- Lipitor;
- Torvakard;
- lipitor;
- Zocor;
- Vasilip;
- Simgal;
- Simla;
- Lescol Forte;
- Cardiostatin 20 mg.
Prescribe medicines, the doctor takes into account the following factors:
- the patient's age;
- floor;
- body weight;
- bad habits;
- accompanying illnesses.
In the acute phase of ischemic stroke, statins increase the patient's chances for rehabilitation, reduce the risk of recurrent acute disorders of cerebral circulation.
Reduce blood cholesterol drugs such as:
- bile acid sequestrants;
- inhibitors of cholesterol absorption in the intestine.
other medications
To carry out the medical treatment of ischemia used drugs such as:
- Aminophylline (19 ml of 2.4% solution);
- hypertonic glucose solution (in the absence of a patient of diabetes);
- sodium chloride;
- magnesium sulfate.
In the absence of renal pathology Merkuzal used, Novurit.
The patient is prescribed a mixture containing Chlorpromazine, antihistamines (diphenhydramine), Novocaine. In some cases, hydrocortisone, prednisone can be used.
Tablets from stroke reduced brain edema, inside the patient takes glycerol (1 mg per 1 kg body weight) Mannitol. To eliminate hyperthermia administered 2-3 ml of 50% solution in Analgin / m.
In order to reduce blood pressure is often used neuroplegic means:
- Chlorpromazine (5 ml of 0.5% solution);
- Benzogeksony (1 ml of 2% solution).
For i / v infusion administered:
- 0.9% solution of sodium chloride, 250 ml;
- 5% solution of glucose to 250 mL;
- 2.5% p-p chlorpromazine 1-2 ml;
- 1% p-p diphenhydramine 1-2 ml.
To improve the blood supply to ischemic areas of the brain used vasodilators1-3 ml of 2% solution of papaverine hydrochloride / v with 10% glucose, Instenon 1-2 ml / m stugeron 1 tablet 2 times per day.
To improve microcirculation in / or administered drugs Poliglyukin Reopologlyukin of 800-1200 mg per day. Therapy is 7 days.
With the weakening of the heart muscle injected 0.5-1.0 ml 0.06% solution Korglikon 0.25-0.5 ml or 0.005% ra-ra strofantina with glucose.
Prevention of ischemic stroke is the proper treatment of hypertension.
In addition to drug treatment in patients recommend the observance of work and rest, elimination of congestion, walking outdoors.
