What is the best fluid for cerebral infarction?

Cerebral infarction is a relatively dangerous disease with a higher incidence rate among middle-aged and elderly people. If the condition of a cerebral infarction patient is serious and he or she does not receive timely care when the disease occurs, it will threaten the person's life safety. Cerebral infarction is divided into different types according to different symptoms, including acute cerebral infarction and cerebral edema. Different types of cerebral infarction require different treatment methods!

1. Treatment principles for acute cerebral infarction

① Comprehensive treatment and individualized treatment: At different times during the development of the disease, targeted comprehensive treatment and individualized treatment measures are taken for different conditions and causes. ② Actively improve and restore blood supply to the ischemic area, promote cerebral microcirculation, block and terminate the pathological process of cerebral infarction.

③Prevent and treat ischemic cerebral edema.

④ Brain cell protection treatment should be used early in the acute phase, and comprehensive measures can be taken to protect the brain tissue in the penumbra surrounding the ischemia to avoid worsening of the disease.

⑤ Strengthen nursing care and prevention of complications, eliminate pathogenic factors, and prevent recurrence of cerebral infarction.

⑥ Actively carry out early and standardized rehabilitation treatment to reduce the disability rate.

⑦ Others: It is best not to use glucose liquid within 12 hours after onset of the disease. Hydroxyethyl starch (706 generation plasma) or Ringer's solution plus adenosine triphosphate (ATP), coenzyme A and vitamin C can be used to avoid using high-sugar liquids in the acute phase to aggravate acidosis and brain damage.

2. General treatment in the acute phase

During the acute phase, you should rest in bed as much as possible and strengthen the care of your skin, oral cavity, respiratory tract, and urination and defecation. Pay attention to the balance of water and electrolytes. If the patient is still unable to eat on his own 48 to 72 hours after onset, he should be given nasogastric liquid diet to ensure nutritional supply. The patient's daily care, diet, and treatment of other complications should be given priority. In addition, most patients, their relatives and friends, and some medical staff expect better medicines to help patients recover soon, while neglecting other aspects of treatment, such as the patient's diet. Since some patients with cerebral infarction cannot take care of themselves and even have difficulty swallowing during the acute phase, if they are not given proper nutrition, energy metabolism problems will quickly arise. At this time, even if the treatment medication is good, it is difficult to achieve good treatment results.

3. Treatment of cerebral edema

(1) Mannitol: 20% mannitol hypertonic solution is commonly used in clinical practice. Mannitol is one of the most commonly used and effective dehydrating agents. When the cerebral infarction is large or accompanied by bleeding, there is often brain edema around the lesion. In recent years, it has been found that mannitol also has a strong free radical scavenging effect. Depending on the condition of the patient, 125-250 ml of 20% mannitol is selected and quickly injected intravenously once every 6-8 hours. The speed of intravenous drip should be fast, and intravenous push injection is best. It is required to inject 250 ml of 20% mannitol within 15-30 minutes. If it is too slow, it will not have the effect of reducing intracranial pressure. The dosage of mannitol should not be too large, generally controlled below 1000ml/d. For elderly patients or patients with poor renal function, it should be controlled below 750ml/d and administered in 4 to 6 doses. Generally, the dosage should be reduced after 3 to 5 days of application, and the appropriate usage time is 7 to 10 days. In recent years, most scholars believe that, in addition to being used to rescue brain herniation, rapid small-dose infusion (125 ml) can achieve similar effects as a single large-dose infusion. During the use of mannitol, the patient's renal function changes should be closely monitored, and attention should be paid to monitoring changes in water and electrolytes.

(2) 10% glycerol fructose: It can produce pharmacological effects through hypertonic dehydration. It can also utilize the energy generated by glycerol metabolism and enter the brain metabolism process to improve local metabolism. Through the above effects, it can reduce intracranial pressure and intraocular pressure, eliminate cerebral edema, increase cerebral blood volume and cerebral oxygen consumption, and improve brain metabolism.

Dosage: Generally, 250-500 ml of 10% fructose (glycerol fructose) is slowly infused. The peak time of reducing intracranial pressure of glycerol fructose injection occurs later than that of mannitol. Therefore, in the case of acute intracranial hypertension such as brain hernia, mannitol is recommended to be used first. However, the duration of blood pressure reduction of glycerol fructose is about 2 hours longer than that of mannitol.