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50 cases of massive cerebral infarction in the Treatment of

Not acute onset. Disturbance of consciousness: 47 cases of people's homes have different levels of consciousness, including drowsiness l3 cases, lethargy in 8 cases, moderate coma l7 cases, light coma in 9 cases. Other manifestations: nausea and vomiting have l9 cases, paralysis 4l cases, 36 cases of partial body sensory disturbances, aphasia l8 cases, seizures in 9 cases, 46 cases of urinary incontinence, hemianopia in 7 cases, ranging from large bilateral pupil l5 cases, 9 cases of restlessness Bilateral pathological reflex (+) 42 cases of meningeal irritation sign (+) 11 cases,[link widoczny dla zalogowanych], blood glucose levels> 6.9mmol/L25 cases of fundus by ophthalmoscopy have 38 cases of atherosclerosis, T> 38.4 ~ C16 cases with stress ulcer and gastrointestinal bleeding in 9 cases. 1.4 imaging (head CT or MRI examination): The patients are in line with more than one lobe infarction,[link widoczny dla zalogowanych], the largest cross-sectional diameter of 5cm or more diagnostic criteria for massive cerebral infarction. Parts: the left side in 29 cases, the right 2l cases, 9 cases of cerebral hemisphere,[link widoczny dla zalogowanych], frontal,[link widoczny dla zalogowanych], temporal, parietal l2 cases, top, temporal, occipital ll cases, the amount of parietal lobe in 5 cases, top, l3 cases of occipital lobe, temporal Ye l4 cases, 7 cases of occipital lobe, parietal lobe in 3 cases, 6 cases of basal ganglia. L9 cases combined lateral pressure,[link widoczny dla zalogowanych], midline shift in 19 cases, ipsilateral sulci shallow side of the cistern away. 7 cases were complicated by hemorrhagic infarction. 1.5 Treatment and prognosis of medical treatment patients were 5O. Acute phase of the condition of patients, illness duration 6h and <24h, and the exclusion of contraindications were given lower fiber enzyme treatment, while giving the dehydration and restore brain cell function, blood circulation, correcting water, electrolyte imbalance and other treatment; with thrombolytic contraindications are given dehydration reduce intracranial pressure, blood circulation, anti-platelet therapy, cerebral protection agent, to maintain water and electrolyte balance, nutritional support, control blood pressure, head cooling and other symptomatic and supportive treatment, and actively given to prevent complications and early rehabilitation. Dehydration therapy alone or in combination, including mannitol, glycerol and fructose, furosemide, since the protein. 2 results of 8 patients died, 42 patients survived, 2 patients in persistent vegetative state, the other survivors have varying degrees of mental retardation and limb movement disorder, aphasia in 13 cases, 8 cases of mental disorders. 3 Discussion of massive cerebral infarction with severe acute infarction, mainly due to the brain's main arteries, such as the middle cerebral artery, internal carotid artery occlusion causing cerebral infarction and cerebral infarction affect two or more leaves, the largest cross-sectional diameter of more than 5cm infarction , with a high morbidity or mortality; this group of patients the average age of 61.4 years, age, high, and most associated with hypertension, hyperlipidemia, hyperglycemia, coronary heart disease, 9 patients had a history of stroke . Massive cerebral infarction because infarction location, size and scope of different, and so would not affect the surrounding brain tissue arising from the different clinical symptoms and signs. Important part of infarction, infarct area is large, l more severe clinical symptoms. The main cause is hypertension, atherosclerosis of cerebral thrombosis, cardiac embolism, hyperlipidemia, diabetes and so on. Activities of large cerebral infarction patients than state onset, the incidence of more acute, and most had disturbance of consciousness, signs of significant positioning can be accompanied by headache, nausea, vomiting, increased intracranial pressure performance, and it will be difficult identification of intracerebral hemorrhage, and early CT signs are often not typical, 4 ~ 6h after onset can still be formed after the brain edema and mass effect. Therefore, early identification of large cerebral infarction to cerebral ischemia, edema and necrosis of the evidence, combined with a comprehensive analysis of imaging in order to make the correct diagnosis early. Treatment of the disease mainly to reduce intracranial pressure, cerebral edema leading to brain herniation as the direct cause of the formation of a variety of dehydrating agent and in combination is better. Head cooling helps reduce cerebral metabolic rate, control of oxygen free radicals, thereby reducing mortality. Incidence in a large area of infarction within 6h to consider thrombolytic therapy, but poor efficacy (thrombolytic therapy in this group 6 patients, 3 died), still need to make further efforts. On the surgical treatment of large cerebral infarction, most scholars believe that once the indications for surgery as soon as possible ... decompression surgery to reduce morbidity and mortality in patients. In addition. Can still be through the use of oxygen free radical scavengers, calcium antagonistic agent, metabolism, blood circulation, comprehensive application of brain cell activation agent to improve brain function, and nutritional support, correct pH, water, electrolyte imbalance, adjustment blood pressure, control blood sugar, reduce blood fat, early rehabilitation therapy and other symptomatic treatment also help to reduce morbidity and mortality.
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