Encyclopedia of Family Medicine

Chapter 41 Prevention of Common Diseases (2)
Precautions during exercise include: ① Stop exercising immediately when angina pectoris is caused; ② Heart rate after exercise should be no more than 20 beats/min than before exercise, and return to pre-exercise heart rate within 10 minutes of rest; ③ Occurrence during or after exercise If you have arrhythmia, you should stop exercising immediately; ([-]) you should stop exercising if you experience shortness of breath or dizziness during exercise;

Arrange work and life reasonably.Life should be regular, maintain an optimistic and happy mood, avoid overwork and emotional agitation, pay attention to the balance between work and rest, and ensure adequate sleep.

Promote non-smoking.The substances that cause cardiovascular disease in tobacco are mainly nicotine and carbon monoxide.They enter the human blood through the respiratory tract, which can cause organ hypoxia and promote arteriosclerosis.The more cigarettes you smoke, the more serious coronary heart disease.The longer the smoking age, the younger the age of starting smoking, the deeper the inhalation of tobacco mist into the respiratory tract, the greater the risk of coronary heart disease and the higher the mortality rate.Therefore, non-smokers must not be infected with this bad habit, and those who have smoked should quit as soon as possible.It should be emphasized that passive smokers also suffer.The so-called passive smoking means that people who do not smoke are forced to inhale smoky air and damage their health when people around them smoke.Therefore, smokers should not regard smoking as a personal matter, but should abide by social ethics and not smoke in public places.

Treat related diseases.Actively treat diseases related to coronary heart disease and remove risk factors, such as high blood pressure, obesity, hyperlipidemia, gout, diabetes, etc.

For those who have been diagnosed with coronary heart disease, active treatment can prevent the progression of the disease, and even promote the regression of atherosclerotic plaque.Commonly used drugs are: vasodilators, lipid-lowering drugs, antiplatelet drugs.

3.Prevention of Hypertension

Blood pressure is the pressure that blood exerts on the walls of blood vessels as it flows through them. .

凡成人收缩压达到或超过21．3kPa（160mmHg）和（或）舒张压达到或超过12．7kPa（95mmHg），即可确诊为高血压。收缩压在18．7~21．3kPa（140~160mmHg）和（或）舒张压在12~12．7kPa（90~95mmHg）者，称为临界高血压。对临界高血压，若加强预防，半数左右可转化为正常。

Hypertension can be further divided into primary hypertension (ie hypertension) and secondary hypertension (also known as symptomatic hypertension).The former refers to a cardiovascular disease whose etiology is not yet clear, but with hypertension as the main clinical manifestation, accounting for more than 90% of all hypertensive patients.The latter is hypertension caused by some specific organic causes, such as adrenal tumors, kidney diseases, etc., which are less than 10%.

Hypertension can cause damage to the heart, brain, kidney and peripheral arteries, and promote the occurrence of arteriosclerosis.Hypertension is still one of the most important pathogenic factors of stroke and coronary heart disease, and causes increasing senile dementia and uremia.However, hypertension often has no symptoms or mild symptoms in the early stage, and it progresses quietly in the long course of the disease. It is often not discovered until serious or fatal complications occur, but it is too late.It is not an exaggeration for scientists to call it a "quiet killer".

(1) The pathogenic factors of hypertension

Hypertension is caused by the interaction of genetic factors and environmental factors.The following factors have been identified.

family history.Hypertension has a more obvious familial tendency.In three different families in which both parents have hypertension, one of the parents suffers from hypertension, and the parents have no hypertension, the prevalence rates of hypertension in children are 45%, 28% and 3%, respectively, suggesting that the disease related to genetic factors.

age. The prevalence increases significantly after the age of 40.It shows that the physiological changes in the body caused by aging or the long-term influence of external factors have a certain relationship with the occurrence of hypertension.

gender.There is little difference in the average prevalence between the sexes, but female patients are generally milder and more common after menopause.

occupation and environment.Occupations with mental stress and less physical activity, and environments that chronically stimulate vision and hearing can promote blood pressure.People who like recreational and sports activities (such as sports, calligraphy, flower planting, stamp collection, etc.) are less likely to suffer from high blood pressure.

Dietary sodium and potassium content.Population surveys found that those with a daily salt intake of more than 10 grams in their diet had a high prevalence of hypertension, but potassium salt had the opposite effect.Therefore, the diet should be light, eat more fresh vegetables and fruits rich in potassium, and reasonably reduce salt intake or eat low-sodium salt.

weight.People who are overweight are more likely to have high blood pressure.The blood pressure of obese patients can be reduced correspondingly after weight loss.

diabetes.The incidence of hypertension is higher in diabetic patients.

Tobacco and alcohol.The prevalence of hypertension is higher among smokers.Nicotine in the smoke can cause peripheral blood vessels to constrict, lower the temperature of the distal extremities, and increase blood pressure.A small amount of alcohol has little effect on blood pressure, but excessive drinking can increase body weight and increase blood pressure through water and sodium retention in the body.

other.Those with elevated blood lipids and elevated uric acid also have a higher prevalence of hypertension.also.The disease is also associated with excessive intake of certain trace elements (such as cadmium).

(2) Prevention of hypertension

① Open-minded, optimistic spirit, pay attention to the balance between work and rest, and actively participate in cultural and sports activities. Mental workers should insist on doing certain physical activities, which is conducive to maintaining the normal function of the higher nerve center.

② Eat a low-fat, low-salt diet to avoid obesity.

③ Carry out mass disease prevention and treatment work, and conduct collective health examinations; regular follow-up and observation of people who have a family history of hypertension and who have a record of increased blood pressure is conducive to early detection and early treatment of the disease.

④ It is recommended to include blood pressure measurement as a routine examination during diagnosis, which will help to find asymptomatic early hypertensive patients and provide them with opportunities for early treatment.

⑤ People who have suffered from hypertension should understand that this disease is a chronic disease that can be controlled and requires long-term patient and active treatment.Possible causes of high blood pressure should be looked for and measures taken to eliminate them.In daily life, we must not only overcome pessimism, but also avoid the wrong view that blood pressure is somewhat high and it does not matter if it is cured.In addition, we should pay attention to the combination of work and rest, ensure enough sleep, participate in work within our ability, physical labor and various forms of physical exercise, and arrange a good diet with the help of medical staff.

It is important to point out that hypertension may be a lifelong disease, so patients should monitor their blood pressure regularly.Blood pressure should be measured not less than once a week, and the drug and amount should be adjusted in time according to the measured blood pressure. Do not use the drug by feeling or stop the drug at will to avoid accidents (high or low blood pressure).

Prevention of cerebrovascular disease

Cerebrovascular disease is a group of diseases that seriously endanger the health of middle-aged and elderly people. It is called stroke or sudden stroke in traditional Chinese medicine and cerebrovascular accident in western medicine.The onset of cerebrovascular disease is acute, often leading to coma, half body, and even life-threatening.The incidence of the disease in middle-aged and elderly people is as high as 100/10, and the fatality rate is 25% to 50%. More than half of the survivors have residual disabilities or develop dementia.Although stroke mainly occurs in middle-aged and elderly people, many preventive measures should be started at a young age.

(1) Causes of stroke

The pathogenic factors of cerebral sudden onset mainly include the following three aspects: one is that cerebral arteriosclerosis narrows the lumen of blood vessels, resulting in insufficient blood supply and infarction; When the blood flow is slow or the blood viscosity increases, thrombosis is prone to occur.Stroke has certain family genetic factors.Therefore, people with a family history of sudden onset should pay special attention to prevention.

Hypertension is closely related to stroke, about 70% of stroke patients have hypertension, and almost 100% of stroke patients suffer from hypertension.Therefore, hypertensive patients must take various measures to control their blood pressure within a safe range, that is, the systolic blood pressure does not exceed 21kPa (160mmHg) and the diastolic blood pressure does not exceed 13kPa (100mmHg).

Obesity, smoking, hyperlipidemia and diabetes are all factors related to hypertension and arteriosclerosis, and are also related to the occurrence of sudden cerebral infarction. Attention should be paid to prevention and treatment.

Emotional agitation can easily cause blood pressure to rise, which is often the cause of cerebral hemorrhage.Therefore, patients with hypertension and cerebral arteriosclerosis should pay attention to adjusting emotions, strengthening self-cultivation, and controlling mental tension and excitement.
(2) Premonition of brain burst - "small burst"

Stroke can often come on suddenly, but if you observe carefully, you can still find some signs, such as transient speech impairment, limb movement failure, dizziness, double vision, etc., which is called transient ischemic attack in medicine.It comes on suddenly, and the symptoms usually only last for a few minutes or hours, and they can disappear by themselves within 24 hours without leaving traces.About 1/3 of patients with minor strokes will develop cerebral thrombosis in the future, and patients should go to the hospital for systematic examination in time to strengthen prevention.

About 20% of patients who have suffered a stroke can relapse within a few years after recovery. Of course, prevention should be strengthened for these people.Headache, dizziness, heaviness of the limbs, and numbness are not necessarily signs of a sudden brain attack, but if these symptoms occur, you should go to the hospital for examination in time.

(3) Prevention of stroke

Cause prevention.Hypertension and atherosclerosis are the main causes of cerebral palsy, so the occurrence and development of these two diseases should be actively prevented first.Hypertensive patients should measure their blood pressure frequently to keep the blood pressure within a safe range; for those with low blood pressure, the blood flow is slow, which is easy to induce cerebral thrombosis. Therefore, it is necessary to appropriately increase blood pressure and take some Chinese and Western medicines that promote blood circulation and remove blood stasis, such as Shengmai Powder , aspirin, dipyridamole and sodium alginate diester, etc., the dose is the same as the treatment of coronary heart disease.

Reasonable arrangement of life.The daily life of middle-aged and elderly people should develop certain laws and habits to avoid overwork.At the same time, it is also necessary to do some appropriate physical activities, such as walking every day, playing Tai Chi, doing health exercises and body massage, etc., in order to facilitate blood circulation, consume excessive calories, and lose weight properly.The amount of exercise should be increased gradually and gradually, and strenuous exercise should be avoided.

Adjust your emotions.Keep a happy and stable mood, and avoid being too worried, impatient, anxious, and angry, so as to avoid a sudden increase in blood pressure caused by emotional agitation and lead to stroke.Middle-aged and elderly people can learn calligraphy and painting, plant flowers and plants, read newspapers, listen to music, watch relaxing and pleasant TV programs and other healthy and beneficial activities to cultivate their sentiments.

Moderate diet and alcohol and tobacco.Cerebrovascular sclerosis is related to diet and smoking.Excessive consumption of fat, sweet and thick-flavored products will make people obese, increase blood lipids, and aggravate arteriosclerosis.Middle-aged and elderly people should develop good eating habits, moderate their diets, and avoid overeating.Eat more fresh vegetables and fruits, and have a light meal.Smoking is a risk factor in sudden cerebral infarction and should be quit.After excessive drinking, the heart beats faster and blood pressure rises, which can easily cause cerebral hemorrhage.Middle-aged and elderly people, especially those with high blood pressure, need to pay special attention to alcohol consumption.

Treat the primary disease.Actively treat diseases such as high blood pressure and arteriosclerosis under the guidance of a doctor.

Group prevention and group governance.Where conditions permit, the community shall conduct regular neurological examinations for middle-aged and elderly people.Those who are prone to stroke risk should be registered, frequently reviewed, and preventive medicines should be given.

Cancer prevention
1.Carcinogenic Factors and Preventive Measures
Among all carcinogenic factors, diet, lifestyle and environment play a crucial role. The corresponding anti-cancer measures include:
diet. ①No partial eclipse, no overeating; ②Don’t eat moldy food; ③Eat less smoked salt marinated and over-salted and hard food; ④Eat more fresh vegetables and fruits; ⑤Control fat intake; ⑥Try to avoid food carcinogen.

lifestyle. ①Do not smoke; ②Restrict drinking; ③Don’t be addicted to smoking and drinking at the same time; ④Keep your mind comfortable and avoid worrying and overwork; ⑤Strengthen physical exercise and pay attention to personal hygiene; Hormones be careful.

surroundings. ①Take protective measures to reduce or control exposure to known chemical carcinogens; ②Try to improve the environment; ③Do not use dangerous or carcinogenic chemicals as much as possible.

Known chemical carcinogens are as follows:

Those with obvious carcinogenic effects: 4-aminobiphenyl, arsenic and arsenic compounds, asbestos, benzene, benzidine, ethyl ketone-naphthylamine, methyl ketone-methyl ketone ether, chromium and certain chromium compounds, di-naphthalene Amines, kerosene, tar, allyl chloride.

Carcinogenic potential: acrylonitrile, phenylpyrene, beryllium and beryllium compounds, diethyl sulfate, dimethyl sulfate, nickel and some nickel compounds.

有致癌可能但证据尚不充分的：金胺（工业用）、三氯甲苯、镉和镉化合物、四氯化碳、氯酚、滴滴涕、氯二甲基甲酰胺、麦氯醇、直接黑38（工业纯）、直接蓝6（工业纯）、直接棕95（工业纯）、二溴乙烯、环氧乙烷、亚乙基硫脲、甲醛（气体）、肼、苯氧基乙酸除草剂、多氯联苯、2、4、6-三氯酚等。

If you need to be exposed to the above carcinogens or other suspected carcinogens at work, you should take the following measures:

① Wear protective clothing according to labor insurance requirements, although they are generally not as comfortable as ordinary clothes;
② Such as prolonged exposure to carcinogens.A face covering or mask should be worn;
③ Separate the work clothes from the usual clothes;

④ Before putting on and taking off work clothes, use a vacuum cleaner to vacuum or wash the work and clean;

⑤ It is best to take a shower before leaving the workplace;
⑥ Accept the supervision of the labor protection department;

⑦Regular physical examination.

2.Taking Precancerous Lesions Seriously

Certain lesions, which are not cancer or even tumors themselves, have the risk of turning into cancer. Such lesions are collectively referred to as precancerous lesions.The vast majority of cancers have precancerous lesions, but only a very small number of precancerous lesions turn into cancers, because precancerous lesions can return to normal or stop their development after appropriate treatment or nutritional intervention.Common precancerous lesions are as follows:

Leukoplakia.Occurs on the mucous membrane at the junction of the skin and the mucous mold, such as the lips, tongue, oral cavity, female vulva, and male glans.At the beginning of the lesion, tiny punctate, smooth blue-white spots or stripes can be seen on the mucosa, which touch each other to form glossy and hypertrophic white spots.The shape is indeterminate, the size is different, and it is hard and rough to the touch.Sometimes the edge is surrounded by pigmentation, and some patients can still see mucosal peeling fissures and ulcers. They are sensitive to heat and irritating food, may have painful congestion and bleeding points, and the white spots of the vulva or glans may have severe itching.

Leukoplakia has a long course and develops slowly.To the occurrence of cancer, the white spots can be seen to become rough and form papillary hairs.

The main reasons for leukoplakia are long-term repeated stimulation, such as smoking, gingival friction, poor local hygiene, and some are due to chronic infection and malnutrition.Therefore, patients should quit smoking and alcohol, correct dentures, keep the skin clean, and pay attention to nutrition.Those with chronic infection should be actively treated.Leukoplakia can be treated by freezing, laser, and electrocoagulation.

Senile keratotic lameness.Also known as solar keratosis.More common in the elderly, a small number of middle-aged patients.

The lesions initially appear as round or irregular rashes that are flat or slightly raised.Adhesive brownish-yellow or black crusts on the surface.If it is forcibly removed, the surface of the underlying tissue will be rough, moist, red, and easy to bleed.By the time the skin breaks into ulcers, it has mostly evolved into squamous cell carcinoma, a process that takes more than 10 years.

Early lesions can be expected to improve after avoiding light exposure and frictional stimulation.Treatment is often rubbed with para-aminobenzoic acid, once a day.Surgical excision, laser or cryotherapy can also be used.

Breast hyperplasia.The probability of breast hyperplasia turning into breast cancer is only 1% to 2%, so there is no need to be nervous, just pay attention to breast self-examination, and ask a doctor for examination if necessary.

Breast adenofibroma.Malignant changes occurred in less than 1%.Adolescent patients can be closely observed, and if it occurs in women over 35 years old, surgical resection can be performed as appropriate.

Esophageal epithelial hyperplasia.There are mild hyperplasia and severe hyperplasia.The former will not become cancerous, and there is no need for regular review.The cancerous rate of severe hyperplasia is about 25% to 30%, and it takes about 5 to 10 years to transform into cancer.The causes of esophageal epithelial hyperplasia include smoking, drinking, rough diet, eating too fast, eating moldy food for a long time, esophageal inflammation, etc. Therefore, patients should try to avoid these factors.Patients with severe hyperplasia need to be closely observed and go to the hospital for regular checkups.Vitamin B2 and retinoic acid have certain therapeutic value for this disease and can be used under the guidance of a doctor.

Atrophic gastritis.There are two types, A type and B type. Type A mostly occurs in the body of the stomach, is diffuse, and the disease is severe. The function of gastric acid secretion decreases or disappears. Patients often suffer from pernicious anemia due to gastric mucosal atrophy.However, type A atrophic gastritis rarely develops into gastric cancer. Type B mostly occurs in the gastric antrum, and there is also severe mucosal damage in the gastric body. Type B atrophic gastritis is prone to malignant transformation into gastric cancer, and intestinal metaplasia or atypical hyperplasia often precedes canceration. The identification of type A and type B atrophic gastritis can be resolved by measuring gastric acid, serum gastrin, parietal cell antibodies and intrinsic factor antibodies.Prevention is active treatment, stop smoking, and regular review. The process of type B atrophic gastritis turning into cancer can last for more than 10 years.

Intestinal metaplasia.It refers to the replacement of gastric mucosa by intestinal epithelium. Due to the widespread application of fiberoptic gastroscope, the detection rate of intestinal metaplasia tends to increase, and it often occurs at the same time as atrophic gastritis.Its significance and prevention methods are the same as those of atrophic gastritis.

Chronic Obstructive Pulmonary Disease.Including chronic bronchitis, emphysema, bronchiectasis and other diseases.Because they all have chronic inflammation for a long time.Mucosal epithelial cells proliferate under inflammatory stimuli, and a small number of them can transform from severe hyperplasia to carcinoma.Patients with chronic obstructive pulmonary disease have a 3 to 5 times higher risk of developing lung cancer than normal people.Prevention is to stop smoking, control chronic infections, and regularly review chest X-rays.

Cervical erosion.Cervical erosion inevitably has epithelial dysplasia.When dysplasia reaches a certain level, it will undergo qualitative change and become cancer.For women with cervical erosion, the incidence rate of cervical cancer is 4-4 times higher than that of women with smooth cervix, and the more serious the degree of erosion, the higher the incidence rate of cervical cancer.

Cervical erosion is more common in women with poor local hygiene, frequent sexual disorder, early marriage, and prolificacy. The most common cases are 30 to 40 years old, while cervical cancer is more common in the elderly over 60 years old, so as long as appropriate measures are taken, Make regular inspections, prevention is not difficult.

(End of this chapter)