First aid, treatment, and rehabilitation: a comprehensive fight against stroke

Editor’s Note:

As the "three major killers" threatening the health of our country's people, coronary heart disease, stroke and lung cancer have always been the main targets of medical experts. In recent years, more and more new technologies and new concepts have been applied to the diagnosis and treatment of these diseases, helping doctors to extend the life of more patients and improve the quality of life. To this end, People's Daily Online and the Population Culture Development Center of the National Health Commission have launched a series of video reports to introduce disease knowledge and cutting-edge technologies in the medical field, and look forward to future medical trends.

Stroke, commonly known as stroke. According to the definition of the World Health Organization, stroke refers to damage to cerebral blood vessels and focal (or overall) brain tissue caused by various reasons, causing clinical symptoms for more than 24 hours or death. It has the characteristics of high morbidity, disability rate, recurrence rate and mortality rate. It is the number one cause of death among Chinese residents. According to statistics from the World Health Organization, one in every six people in the world may suffer from stroke, one person dies from stroke every six seconds, and one person is permanently disabled by stroke every six seconds.

Stroke and the disability it causes have placed a huge burden on patients, families and society. At present, what innovative technologies and methods are available for stroke disability reduction and precision treatment? Around this topic, experts including Lu Jie, deputy director of Xuanwu Hospital Affiliated to Capital Medical University, Jiao Liqun, deputy director of the Department of Neurosurgery of Xuanwu Hospital Affiliated to Capital Medical University, Ma Qingfeng, director of the Emergency Department of Xuanwu Hospital Affiliated to Capital Medical University, and Ji Ruijun, chief physician of the Department of Vascular Neurology of Beijing Tiantan Hospital Affiliated to Capital Medical University, explained to the majority of netizens.

Shorten the "DNT time" to rescue stroke patients faster

Normal brain tissue may undergo irreversible changes after 3 hours of ischemia, and ischemic brain cells may become necrotic after 6 hours. All patients suspected of having a stroke should go to a qualified hospital as soon as possible after the onset of the disease to strive for a good treatment opportunity.

High disability rate due to stroke

Faster and more accurate is the gold standard for doctors to rescue stroke patients. The period from the onset of the patient's admission to the hospital to the medication is called "DNT time", which is a matter of life and death for the patient. Therefore, shortening the "DNT time" has become the core goal of stroke treatment.

In order to shorten the "DNT time", the hospital developed a stroke emergency green channel APP

To achieve this goal, Xuanwu Hospital Affiliated to Capital Medical University developed a stroke emergency green channel APP. "The doctor on the car can push the patient information to the hospital to be treated through the APP. The staff of the hospital to be treated will receive the alarm through the APP, and then they can see the pre-hospital patient's score and basic information and make corresponding preparations. If during this process, it is considered that the patient may need intervention, the interventional doctor can also prepare in advance. The specialist team of the stroke green channel accompanies the patient throughout the process of evaluation, examination and doctor-patient communication from receiving the patient to thrombolysis or thrombectomy. Through process optimization, the DNT time has been shortened from more than 60 minutes to a median of 27 minutes in 2019." Ma Qingfeng introduced.

AI-assisted technology improves doctors’ diagnostic accuracy

In this race against time, quick and accurate diagnosis can enable patients to receive better treatment.

Since 2016, under the guidance of the National Health Commission, national stroke prevention and control work and stroke center construction work have been carried out in succession, and a dense stroke treatment network has gradually taken shape.

In every stroke center, medical imaging equipment, as an extension of the doctor's eyes, can help doctors find the infarction site more quickly and accurately. Lu Jie introduced that CT tomography was used at first, which took a long time, but now spiral CT scanning can complete the whole brain scan in one or two seconds. Magnetic resonance imaging is also very fast and can be completed in 5 minutes.

"Although the scanning time is short, the entire post-processing process takes one hour for one patient." Lu Jie said that now that artificial intelligence has been developed, it can be completed in 4-5 minutes, and the doctor can make some corrections to form a final report.

AI-assisted diagnosis technology improves doctors’ diagnosis speed and accuracy

As AI-assisted diagnosis technology is gradually applied to clinical diagnosis, the locations of vascular blockage and cerebral ischemia can be directly marked, greatly improving the doctor's diagnosis speed and accuracy, and preparing for the next step of treatment.

"There are several ways to treat stroke now." Jiao Liqun introduced that one is to use drug thrombolysis in the acute phase, which is to inject some drugs into the vein. These drugs can dissolve the blood clots. Another is to use mechanical methods to remove the blood clots in a very short time in the case of acute stroke, which is intravascular treatment.

Jiao Liqun believes that in the future it may be possible to use methods such as CT, MRI or imaging to clearly determine whether a patient needs active treatment and what the results will be after treatment.

Wearable devices help patients with functional disabilities recover

With the advancement of medical technology, more stroke patients have been able to survive. However, the disability rate of stroke is still as high as 60%-70%, and many patients may lose their ability to speak or even move.

Nowadays, brain-computer interfaces are gradually being applied to stroke rehabilitation. When volunteers wear the acquisition device for receiving EEG signals, they only need to imagine what they are going to say next in their brains. These devices can analyze the weak EEG signals of different frequencies in the brain, thereby controlling the computer to display the words in the volunteers' minds on the computer screen.

Using brain-computer interface to help patients with dysarthria and aphasia recover

"Different types of brain-computer interfaces target different functional disorders." Ji Ruijun introduced that the most important brain-computer interface based on visual evoked potentials helps patients with dysarthria and aphasia to replace their language. The brain-computer interface based on motor imagery is aimed at improving patients' motor dysfunction.

Preventing serious diseases before they happen and preventing the threshold from moving forward have become important parts of stroke prevention and treatment. "Based on the previous cohort study of the population, we have established a prediction model for carotid artery stenosis." Ji Ruijun introduced that this model uses an online evaluation model. As long as the prediction factors are input, the model can effectively and highly identify the risk factors and accurately screen out those who may have carotid artery stenosis through the automatic algorithm in the background, and screen out high-risk patients and groups for cerebrovascular disease.