Core Tip: diabetic cerebrovascular disease is a group of diabetic complications of cerebral vascular department, the cause of death from diabetes point of view, the major causes of death in patients with diabetes complications, including death due to cerebrovascular disease accounts for about 10%.
Diabetes, cerebrovascular disease is diabetes, a group of the Ministry of cerebral vascular complications of diabetes cause of death from the point of view, the major causes of death in patients with diabetes complications, including death due to cerebrovascular disease accounts for about 10%. Currently, diabetes, high medical costs, China's annual cost of treatment in patients with diabetes, up to 250 billion yuan, of which 70% for the treatment of chronic complications. Then recovering from diabetes, cerebrovascular disease treatment, what does?
Treatment of a cerebrovascular disease of diabetes: glycemic control
As mentioned earlier, high blood sugar to accelerate the process of atherosclerosis, the blood glucose control in the normal or near normal range, will effectively prevent the recurrence of cerebrovascular disease. When the acute phase of cerebrovascular disease is high blood sugar using insulin therapy corrects glucose toxicity, then, most patients with type 2 diabetes can still switch to diet and oral medication. There are several oral drugs: insulin secretion agents: sulfonylureas and nateglinide, including drugs. Mainly to stimulate islet b cells secrete insulin, increased insulin levels; biguanide drugs: mainly inhibit liver glucose production, but also may delay intestinal absorption of glucose and enhanced insulin sensitivity. a-glucosidase inhibitors: slow intestinal absorption of starch and fructose, lower postprandial blood glucose. Glitazones drugs: an insulin sensitizer, can be enhanced by reducing insulin resistance and insulin action. Choose hypoglycemic drugs should note the following: obesity, side effects, allergic reactions, age and other health conditions such as kidney disease, liver disease can affect the drug of choice; combination therapy should adopt a different mechanism of action of hypoglycemic drugs; oral hypoglycemic drugs in combination therapy still can not effectively control high blood sugar, insulin and hypoglycemic agents should be used in combination therapy or insulin therapy alone.
Diabetes treatment of cerebrovascular disease II: blood pressure control
After the acute phase, without stenosis, blood pressure should be controlled in the normal range. U.S. JNC7 that: the age of 50 years of age, compared with diastolic blood pressure, the systolic blood pressure greater than 140mmHg is more important cardiovascular disease (CVD) risk factors. When blood pressure is 175/115mmHg that exists when the risk of CVD, blood pressure for each additional 20/10mmHg, CVD risk would be doubled. General control of blood pressure can be used calcium antagonists, ACEI, ARB, diuretics, etc.
Diabetes treatment of cerebrovascular disease III: Anticoagulation
The efficacy of aspirin in secondary prevention in doubt. 2006 AHA / ACC secondary prevention guidelines state that: atherosclerotic disease, without contraindications, indefinitely aspirin 75-162mg / d. Recommend the best long-term use of aspirin dose 75-150mg, enabling patients to get the maximum benefit while minimizing the side-effects. It is noteworthy that, in the secondary prevention of stroke, ESPRIT experiments confirmed that combined aspirin and dipyridamole is superior to aspirin alone. Not recommended in patients with coronary heart disease, dipyridamole, because conventional doses of oral dipyridamole in patients with stable angina can increase exercise-induced myocardial infarction. Meanwhile, ESC guidelines state that there are contraindications to aspirin in patients using clopidogrel instead of aspirin for secondary prevention.
Diabetes, cerebrovascular disease treatment IV: Rehabilitation
Cerebrovascular disease morbidity is extremely high, early system rehabilitation, can make 50-70% of patients activities of daily living (ADL) self-care ability. Early rehabilitation, and prevent disuse muscle atrophy disuse syndrome generation, effectively prevent limb contractures, as well as non-paralyzed side to prevent or reduce muscle atrophy. Also to some extent relieve the patient's anxiety, reduce the production of orthostatic hypotension, and effectively prevent or reduce lung and urinary tract infections, osteoporosis, pressure sores and other complications, shorter hospital stay. Within 30d after the onset of rehabilitation are early, but as early as possible for as well. Infarction patients after onset 2 ~ 3d, the incidence of cerebral hemorrhage patients can start after 4 ~ 5d rehabilitation, depending on the severity of illness of patients to make decisions. After admission the patient severity, is associated with disturbance of consciousness or coma, the clinical type of stroke, cardiovascular conditions such as the right to determine the start time of the decision is particularly important rehabilitation. Hemorrhagic stroke within the dynamic head CT in the 48h observation of whether to expand hemorrhage, cerebral infarction should be taken to have recurrent or progressive stroke. 14d cardiac infarction within 10% to 20% may have recurrent, fatal cerebral infarction may be related with severe large vessel occlusion, infarction, or terminal area watershed infarction may be associated with a high degree of carotid artery stenosis or occlusion caused by perfusion down under the. These situations can MRA, 3D-CT, DSA, CT, MRI and other modern means of inspection to help determine the assessment. Early rehabilitation, including sitting, standing, standing, walking or even the way anti-spastic and non-paralyzed side of the upper and lower extremity muscle strength enhancement training. Depending on the patient to choose, step by step. Initially the patient fatigue, usually 2 times a day, 30min each time within the training time, and gradually extend the training time, and must pay attention to management of the patient's blood pressure and heart rate, especially orthostatic hypotension can be caused by reduced blood supply to the brain aggravate the disease or recurrence. When the blood pressure or systolic blood pressure rose to more than 4kPa 24kPa, the training should be terminated, and given symptomatic treatment. Psychotherapy is also important. To conduct psychological counseling, if necessary, need to use fashion antidepressant and anxiety medication.
Diabetes, cerebrovascular disease treatment five: correct hyperlipidemia
PARCLE study included 4713 stroke within 1-6 months, TIA patients were randomly divided into atorvastatin and placebo groups, follow-up of 4.9 years, found that atorvastatin group was significantly lower than the placebo group, LDL blood , compared with the placebo group, a significant reduction in endpoint events (stroke and major coronary events) the incidence of confirmed atorvastatin significantly reduces stroke risk. Thus correcting hyperlipidemia on stroke recurrence are very important. The mechanism of statins stabilize plaque and reduce LDL, lower CRP, to reduce plaque inflammation and other effects.
Diabetes, cerebrovascular disease treatment six: diet, prevent obesity
Diet therapy should be individualized as possible. Based on the patient's age, gender, standard weight, actual weight, with or without complications, and physical activity conditions. First, the development of total calories (according to standard weight, rather than actual body weight basis) :20-25 card at rest / day / kg body weight. Light manual labor (mental) :25-30 cards / day / kg body weight. Moderate physical :30-35 cards / day / kg body weight. Heavy manual work: 40 cards / day / kg body weight. Heat distribution :25-30% fat, 55-65% carbohydrates, 15% protein, three meals a day may be assigned to 1 / 5 2 / 5, 2 / 5 or 1 / 3, 1 / 3, 1 / 3. The body mass index (BMI) control 25/kg/M2 below. Quit smoking, limit alcohol consumption.
Diabetes, cerebrovascular disease treatment VII: Treatment of hyperhomocysteinemia
The study found that elevated homocysteine each 5mmol / L, the equivalent of cholesterol 20mg / L due to the risk of cardiovascular disease, the incidence of myocardial infarction 3.4 times higher than the normal range. Therefore, determination of blood Hcy in North America are becoming as ubiquitous as cholesterol clinical indicators. High homocysteine has been identified as an independent cerebrovascular risk factor. Large sample epidemiological studies have shown that light, medium and high homocysteine was markedly increased risk of cerebrovascular disease. Most patients with type 2 diabetes control blood Hcy concentrations higher than normal, and with fasting blood glucose, HbA1C and duration of diabetes-related. High homocysteine in patients with clinical use VitB6, VitB12 treatment and folic acid supplement, usually in a few weeks can be reduced to normal. Normal dosage folic acid 5mg, VitB625mg, VitB12 250mg / d, or B12 alone VitB6 invalid, but the combination or folic acid is effective. 650mg / d is the minimum effective dose of folic acid, vitamin therapy can reduce carotid artery plaque, the treatment of patients should be lifelong. Although the experiments that the vitamin intervention to prevent stroke after stroke to reduce total Hcy levels does not improve the prognosis, but the researchers also noted that "baseline Hcy levels and prognosis of sustained and between different levels of contact." Therefore recommend the use of vitamin intervention.
Diabetes, cerebrovascular disease is diabetes, a group of the Ministry of cerebral vascular complications of diabetes cause of death from the point of view, the major causes of death in patients with diabetes complications, including death due to cerebrovascular disease accounts for about 10%. Currently, diabetes, high medical costs, China's annual cost of treatment in patients with diabetes, up to 250 billion yuan, of which 70% for the treatment of chronic complications. Then recovering from diabetes, cerebrovascular disease treatment, what does?
Treatment of a cerebrovascular disease of diabetes: glycemic control
As mentioned earlier, high blood sugar to accelerate the process of atherosclerosis, the blood glucose control in the normal or near normal range, will effectively prevent the recurrence of cerebrovascular disease. When the acute phase of cerebrovascular disease is high blood sugar using insulin therapy corrects glucose toxicity, then, most patients with type 2 diabetes can still switch to diet and oral medication. There are several oral drugs: insulin secretion agents: sulfonylureas and nateglinide, including drugs. Mainly to stimulate islet b cells secrete insulin, increased insulin levels; biguanide drugs: mainly inhibit liver glucose production, but also may delay intestinal absorption of glucose and enhanced insulin sensitivity. a-glucosidase inhibitors: slow intestinal absorption of starch and fructose, lower postprandial blood glucose. Glitazones drugs: an insulin sensitizer, can be enhanced by reducing insulin resistance and insulin action. Choose hypoglycemic drugs should note the following: obesity, side effects, allergic reactions, age and other health conditions such as kidney disease, liver disease can affect the drug of choice; combination therapy should adopt a different mechanism of action of hypoglycemic drugs; oral hypoglycemic drugs in combination therapy still can not effectively control high blood sugar, insulin and hypoglycemic agents should be used in combination therapy or insulin therapy alone.
Diabetes treatment of cerebrovascular disease II: blood pressure control
After the acute phase, without stenosis, blood pressure should be controlled in the normal range. U.S. JNC7 that: the age of 50 years of age, compared with diastolic blood pressure, the systolic blood pressure greater than 140mmHg is more important cardiovascular disease (CVD) risk factors. When blood pressure is 175/115mmHg that exists when the risk of CVD, blood pressure for each additional 20/10mmHg, CVD risk would be doubled. General control of blood pressure can be used calcium antagonists, ACEI, ARB, diuretics, etc.
Diabetes treatment of cerebrovascular disease III: Anticoagulation
The efficacy of aspirin in secondary prevention in doubt. 2006 AHA / ACC secondary prevention guidelines state that: atherosclerotic disease, without contraindications, indefinitely aspirin 75-162mg / d. Recommend the best long-term use of aspirin dose 75-150mg, enabling patients to get the maximum benefit while minimizing the side-effects. It is noteworthy that, in the secondary prevention of stroke, ESPRIT experiments confirmed that combined aspirin and dipyridamole is superior to aspirin alone. Not recommended in patients with coronary heart disease, dipyridamole, because conventional doses of oral dipyridamole in patients with stable angina can increase exercise-induced myocardial infarction. Meanwhile, ESC guidelines state that there are contraindications to aspirin in patients using clopidogrel instead of aspirin for secondary prevention.
Diabetes, cerebrovascular disease treatment IV: Rehabilitation
Cerebrovascular disease morbidity is extremely high, early system rehabilitation, can make 50-70% of patients activities of daily living (ADL) self-care ability. Early rehabilitation, and prevent disuse muscle atrophy disuse syndrome generation, effectively prevent limb contractures, as well as non-paralyzed side to prevent or reduce muscle atrophy. Also to some extent relieve the patient's anxiety, reduce the production of orthostatic hypotension, and effectively prevent or reduce lung and urinary tract infections, osteoporosis, pressure sores and other complications, shorter hospital stay. Within 30d after the onset of rehabilitation are early, but as early as possible for as well. Infarction patients after onset 2 ~ 3d, the incidence of cerebral hemorrhage patients can start after 4 ~ 5d rehabilitation, depending on the severity of illness of patients to make decisions. After admission the patient severity, is associated with disturbance of consciousness or coma, the clinical type of stroke, cardiovascular conditions such as the right to determine the start time of the decision is particularly important rehabilitation. Hemorrhagic stroke within the dynamic head CT in the 48h observation of whether to expand hemorrhage, cerebral infarction should be taken to have recurrent or progressive stroke. 14d cardiac infarction within 10% to 20% may have recurrent, fatal cerebral infarction may be related with severe large vessel occlusion, infarction, or terminal area watershed infarction may be associated with a high degree of carotid artery stenosis or occlusion caused by perfusion down under the. These situations can MRA, 3D-CT, DSA, CT, MRI and other modern means of inspection to help determine the assessment. Early rehabilitation, including sitting, standing, standing, walking or even the way anti-spastic and non-paralyzed side of the upper and lower extremity muscle strength enhancement training. Depending on the patient to choose, step by step. Initially the patient fatigue, usually 2 times a day, 30min each time within the training time, and gradually extend the training time, and must pay attention to management of the patient's blood pressure and heart rate, especially orthostatic hypotension can be caused by reduced blood supply to the brain aggravate the disease or recurrence. When the blood pressure or systolic blood pressure rose to more than 4kPa 24kPa, the training should be terminated, and given symptomatic treatment. Psychotherapy is also important. To conduct psychological counseling, if necessary, need to use fashion antidepressant and anxiety medication.
Diabetes, cerebrovascular disease treatment five: correct hyperlipidemia
PARCLE study included 4713 stroke within 1-6 months, TIA patients were randomly divided into atorvastatin and placebo groups, follow-up of 4.9 years, found that atorvastatin group was significantly lower than the placebo group, LDL blood , compared with the placebo group, a significant reduction in endpoint events (stroke and major coronary events) the incidence of confirmed atorvastatin significantly reduces stroke risk. Thus correcting hyperlipidemia on stroke recurrence are very important. The mechanism of statins stabilize plaque and reduce LDL, lower CRP, to reduce plaque inflammation and other effects.
Diabetes, cerebrovascular disease treatment six: diet, prevent obesity
Diet therapy should be individualized as possible. Based on the patient's age, gender, standard weight, actual weight, with or without complications, and physical activity conditions. First, the development of total calories (according to standard weight, rather than actual body weight basis) :20-25 card at rest / day / kg body weight. Light manual labor (mental) :25-30 cards / day / kg body weight. Moderate physical :30-35 cards / day / kg body weight. Heavy manual work: 40 cards / day / kg body weight. Heat distribution :25-30% fat, 55-65% carbohydrates, 15% protein, three meals a day may be assigned to 1 / 5 2 / 5, 2 / 5 or 1 / 3, 1 / 3, 1 / 3. The body mass index (BMI) control 25/kg/M2 below. Quit smoking, limit alcohol consumption.
Diabetes, cerebrovascular disease treatment VII: Treatment of hyperhomocysteinemia
The study found that elevated homocysteine each 5mmol / L, the equivalent of cholesterol 20mg / L due to the risk of cardiovascular disease, the incidence of myocardial infarction 3.4 times higher than the normal range. Therefore, determination of blood Hcy in North America are becoming as ubiquitous as cholesterol clinical indicators. High homocysteine has been identified as an independent cerebrovascular risk factor. Large sample epidemiological studies have shown that light, medium and high homocysteine was markedly increased risk of cerebrovascular disease. Most patients with type 2 diabetes control blood Hcy concentrations higher than normal, and with fasting blood glucose, HbA1C and duration of diabetes-related. High homocysteine in patients with clinical use VitB6, VitB12 treatment and folic acid supplement, usually in a few weeks can be reduced to normal. Normal dosage folic acid 5mg, VitB625mg, VitB12 250mg / d, or B12 alone VitB6 invalid, but the combination or folic acid is effective. 650mg / d is the minimum effective dose of folic acid, vitamin therapy can reduce carotid artery plaque, the treatment of patients should be lifelong. Although the experiments that the vitamin intervention to prevent stroke after stroke to reduce total Hcy levels does not improve the prognosis, but the researchers also noted that "baseline Hcy levels and prognosis of sustained and between different levels of contact." Therefore recommend the use of vitamin intervention.
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