Cerebral hemorrhage refers to non-traumatic brain parenchymal hemorrhage. When blood pressure rises sharply, cerebral artery disease is accompanied by hypertension rupture, which is called hypertensive cerebral hemorrhage.
treat cordially
First, the principle of treatment, reduce intracranial pressure, control brain edema, prevent the formation of cerebral hernia, reduce elevated blood pressure and prevent further bleeding.
Second, conventional treatment (1) general treatment; (1) Keep quiet, stay in bed absolutely, and rescue on the spot. It is not suitable for long-distance transportation and excessive movement, so as not to aggravate bleeding; ② Keep the respiratory tract unobstructed and suck away oral secretions or vomit at any time.
Proper oxygen supply and intermittent inhalation are appropriate;
③ Maintain the balance between nutrition and water and electrolyte.
(2) control brain edema and reduce intracranial pressure;
(3) Controlling hypertension and lowering the elevated blood pressure are important measures to prevent further bleeding, but it is not advisable to lower the blood pressure too low to prevent insufficient blood supply. Generally maintained at 20.0 ~ 21.312.0 ~13.3 kpa (150 ~160/90 ~100 mmhg).
(4) Hemostatic drugs and coagulant drugs have no effect on cerebral hemorrhage, but they can still be used if there is gastrointestinal bleeding or coagulation disorder;
(5) Prevention and treatment of complications. Severe patients should pay special attention to basic nursing, change posture regularly, pay attention to dry and clean skin, prevent bedsore and lung infection, maintain functional position of paralyzed limbs, massage and passive exercise to prevent joint contracture;
Third, surgical treatment.
The combination of Chinese medicine, acupuncture and massage therapy has certain effect on treatment and rehabilitation.
prevent
Patients with hypertension should control their blood pressure under the guidance of a doctor, so as to avoid drastic changes, full meals, strenuous activities, forced defecation, sexual intercourse and other factors that may induce blood pressure to rise. If you have severe headache or neck pain, dyskinesia, dizziness or syncope, nosebleeds, blurred vision, etc. It may be a precursor to cerebral hemorrhage, so you should go to the hospital for examination in time.
The dosage and usage of the above drugs should be in accordance with the doctor's advice.
When blood pressure rises sharply, cerebral artery disease is accompanied by hypertension rupture, which is called hypertensive cerebral hemorrhage.
What about sudden cerebral hemorrhage?
Cerebral hemorrhage is a frequently-occurring disease in middle-aged and elderly people. It is bleeding caused by the sudden increase of blood pressure, which leads to the rupture of microvessels in the brain. At the bleeding focus, blood can directly compress the brain tissue, causing brain edema around it, and then secondary brain displacement and brain hernia.
The typical manifestations of cerebral hemorrhage are: sudden numbness, weakness or paralysis of one limb, when the patient often falls unguarded, or the items in his hand suddenly fall to the ground; At the same time, patients will also have crooked mouth, drooling, vague language or aphasia, and some will also have headache, vomiting, blurred vision, disturbance of consciousness, incontinence and so on. After the patient's cerebral hemorrhage, the family members should carry out emergency rescue.
1. Stay calm and lie flat immediately. Don't rush to send the patient to the hospital, lest it shake the road. You can tilt your head to one side to prevent sputum and vomit from being sucked into the trachea.
2. Quickly loosen the patient's collar and belt, keep indoor air circulation, keep warm when it is cold, and pay attention to cooling when it is hot.
3. If the patient is unconscious and snores strongly, it means that the base of his tongue has dropped. You can wrap the patient's tongue with a handkerchief or gauze and gently pull it out.
4. The patient's head can be covered with a cold towel, because the blood vessels contract when they are cold, which can reduce the amount of bleeding.
5. Patients with incontinence should be treated on the spot, and the patient's body should not be moved at will to prevent the cerebral hemorrhage from aggravating.
6. On the way to the hospital, the patient's condition is stable, and the vehicle runs as smoothly as possible to reduce bumps and vibrations; At the same time, raise the patient's head slightly, keep an angle of 20 degrees with the ground, and pay attention to the changes of the condition at any time.
Cerebral infarction and cerebral hemorrhage
* First of all, you need to stay in bed, have an optimistic and cheerful attitude, have full confidence in the recovery of the disease, cooperate closely with us, actively treat and recover as soon as possible.
* Some patients will have one or two hands and feet unable to move, weak, or temporarily unable to speak, which may have a certain impact on later life. You should have a correct understanding of your illness, as long as you control the medicine as soon as possible, and carry out various functional exercises and language rehabilitation training (such as counting, looking at pictures and talking, etc.). ), and perseverance, has a positive effect on the rehabilitation of paralyzed hands and feet and language function.
* Diet should be rich in protein, vitamins and fats, such as fish, bean products, grains and soybeans. Avoid spicy and greasy food (such as strong tea, coffee, fried food), eat more fruits and vegetables, and keep the stool unobstructed. If you have facial paralysis, you can input semi-liquid materials such as milk paste and porridge. When eating, you need to deliver food to the healthy side (where there is no facial paralysis), and the delivery speed should be slow to avoid choking and suffocation. If the condition is critical and swallowing is difficult, the doctor will insert a gastric tube and give nasal feeding liquid to ensure nutritional supply.
* Patients are not sensitive to hot and cold stimuli due to illness, so remind their families not to use heating devices such as hot water bottles to help keep warm in cold weather. Otherwise, it will cause serious consequences such as burns.
* Physical activity is not suitable for patients with urinary incontinence. Pay attention to protecting the skin, clean the perianal perineal skin after defecation, keep it dry, and apply talcum powder appropriately. Every two hours, the nurse will turn over and pat the patient's back to avoid long-term compression and necrosis of the paralyzed limb skin and bedsore.
* Within 1~2 weeks after onset, when the condition is basically stable, functional exercise of the affected limb can be carried out as soon as possible, three times a day, ranging from 10~20 times each time. Massage and passive activities can prevent joint adhesion and muscle atrophy. You can increase the number of exercises in the future to help yourself recover as soon as possible.
Exercise method:
* At the beginning, take a deep breath and do simple active exercise, focusing on the extension of hemiplegic hands and feet: shoulder abduction, upper limb extension and lower limb bending.
* Use pillows and wooden frames to maintain the functional position of limbs during exercise, so as to prevent the upper limbs from buckling and foot drop.
* You can gradually increase the practice of sitting, standing and walking, walk with a correct gait and go up and down the stairs. Pay attention to strengthen protection to prevent accidents such as falling.
* After the initial recovery of upper limb activity function, focus on climbing the wall, grasping things, holding walnuts and other exercises to strengthen self-care ability: eating, grooming, dressing and undressing.
* The situation has further improved, and labor therapy such as writing, knitting and gardening can be carried out.
How to communicate with aphasia patients?
1). Use short and clear sentences when you speak, and speak a little slower than usual.
2) Encourage conversation, don't force it, ask simple and direct questions, and let patients answer "yes" or "no".
3) For people with serious communication problems, you can express your opinions by gestures and facial expressions, and you can also encourage patients to communicate by gestures.
4) Every time you talk to the patient, you should give him enough time to think and organize what he said.
5) Talk to him with familiar names and terms.
What is cerebral hemorrhage? In medical terms, it is to rule out traumatic cerebral hemorrhage, in which hypertension is the most common cause. If someone suddenly has severe headache, dizziness with nausea and vomiting, hands and feet are inactive or suddenly unable to speak, unconsciousness, incontinence and high blood pressure, it may be cerebral hemorrhage.
health education
1. Patients need a quiet and comfortable environment, especially within 2 weeks of onset. They should minimize visits, keep calm and stable emotions, and avoid all kinds of negative emotional influences.
2. Stay in bed for 2 weeks absolutely, and turn your head gently from side to side. Avoid excessive movement or raising your head. Turn your limbs slightly in bed every 2 hours. Don't be too nervous. Urinating must be carried out in bed, and you can't get out of bed to relieve yourself, so as to avoid another bleeding accident.
3. Some patients will have symptoms of restlessness. We will take protective measures for such patients, such as restraining straps and bed guards, to prevent patients from pulling out infusion tubes or stomach tubes and falling off the bed. Maybe some family members can't bear it, and we understand their feelings. Once the patient's condition is stable and he is no longer agitated, we will immediately remove the restraints on the body, but the bed stall needs constant intensive care, especially for patients with air cushion beds, to prevent them from falling off the bed. I hope everyone will cooperate.
4. There will be different degrees of headache in the course of the disease, such as head swelling pain, needle prick pain and severe pain. This is the most common symptom. We will give reasonable treatment. With the improvement of the disease, the headache will gradually disappear, so you don't have to be overly nervous. You should learn to divert your attention. If you still feel unbearable pain during the treatment, please let us know in time so that the doctor can take more effective treatment measures.
5. Elderly patients have a high degree of cardiovascular and cerebrovascular aging and brittleness, and seasonal changes are easy to induce diseases. Long-term bed rest is easy to cause lung infection, and sputum is not easy to cough up. Drugs can eliminate phlegm, strengthen turning over and patting the back, make phlegm disperse and cough up, and reduce lung infection. If you can't expectorate, you should take sputum suction measures, hoping to cooperate.
6. Long-term bed rest, skin pressure for more than 2 hours, prone to bedsore, should strengthen the turn. Massage the pressed part to keep the skin clean and dry. Limbs are placed in functional positions to prevent deformity.
7. Diet: nutritious, low-fat, light and soft foods, such as eggs and bean products. People who have difficulty eating can tilt their heads to one side, feed slowly, avoid talking, and prevent coughing and suffocation.
8. Keep the stool unobstructed, eat more bananas and honey, drink more water, strengthen moderate turning, massage the abdomen and reduce constipation. Patients who do not defecate for several days or have poor defecation can use laxatives to induce defecation. It is forbidden to hold your breath and forcibly defecate to prevent cerebral hemorrhage again.
9. During the recovery period, raise the bedside 10~ 15○ according to the doctor's advice, and then gradually raise it to the semi-recumbent position according to the degree of tolerance and adaptation, ranging from 30 minutes to1~ 2 hours every day.
10. Hypertension is a common cause of this disease. Taking antihypertensive drugs should be quantified on time, and the dosage should not be increased or decreased at will to prevent the sudden rise and fall of blood pressure and aggravate the condition.
1 1. Follow-up regularly after discharge, monitor blood pressure and blood lipids, and take appropriate physical activities, such as walking and Tai Ji Chuan.
Diet of patients with cerebral hemorrhage
Besides medication, a reasonable diet is also important for rehabilitation.
If the stroke patients are in stable condition, but have different degrees of disturbance of consciousness and dysphagia, they should adopt nasal feeding diet, and infuse digestible juicy diet, such as thick rice soup, soybean milk, milk, fresh vegetable juice and fruit juice, or infuse 1000-2000ml mixed milk for 5-6 times, and the infused food should not be overheated or cooled to 37℃-39℃. The raw materials for making mixed milk are 600 ml of fresh milk, 350 ml of concentrated rice soup, 2 eggs, 50 g of sugar, 0/0 g of sesame oil/kloc-0, and 3 g of salt. The preparation method is divided into three steps: (1) break the washed eggs, put them in a clean container, add sugar, salt and oil, and stir them evenly with chopsticks; (2) 600 ml of fresh milk and 350 ml of rice soup are mixed and boiled; (3) Pour the prepared egg liquid into the cooked milk-rice soup, and stir with chopsticks while pouring to obtain 1000 ml mixed milk. This 1000 ml mixed milk contains 40 grams of egg white, 40 grams of fat, 0/20 grams of sugar and 4 184 kilojoules (1000 kilocalories). If the patient is complicated with diabetes, no sugar is added.
If stroke patients are conscious, but sometimes they choke when eating, they should be given a pasty diet, including steamed egg soup, thick porridge with minced meat and vegetables, rotten noodles with minced meat and vegetables, lotus root starch washed with milk and fruit pulp, or mashed food with a masher and served to the patients.
Stroke patients don't have dysphagia in the recovery period, so they should adopt a light, less greasy and digestible soft and balanced diet.
The first is animal fat, such as lard, butter, cream and so on. And foods with high cholesterol content, such as egg yolk, roe, animal viscera, fat meat, etc. , should be limited, because the saturated fatty acids contained in these foods can significantly increase the blood cholesterol concentration and promote arteriosclerosis; Vegetable oils can be used, such as soybean oil, tea oil, sesame oil, peanut oil, etc. Because the unsaturated fat contained in it can promote cholesterol excretion and convert it into bile acid, so as to reduce the blood cholesterol content and delay and relieve arteriosclerosis.
Secondly, there should be proper protein in the diet, and we should always eat some egg whites, lean meat, fish and various beans and bean products to supply the body with ammonia and acid. Generally, drink a cup of milk and a cup of yogurt every day, because milk contains milk factor and orotic acid, which can inhibit the synthesis of cholesterol in the body and reduce the content of blood lipid and cholesterol. When drinking milk, you can remove the skin. Beans contain sterols, which can also promote cholesterol excretion.
Third, eat more fresh vegetables and fruits, because they contain vitamin C, potassium and magnesium. Vitamin C can lower cholesterol, enhance the density of blood vessels and prevent bleeding. Potassium and magnesium have protective effects on etiology and tube.
Fourth, you can eat more foods rich in iodine, such as kelp, seaweed and shrimp. Iodine can reduce the deposition of cholesterol on the arterial wall and prevent arteriosclerosis.
Fifth, the daily amount of salt should be kept below 6 grams, because salt contains a lot of sodium ions, which can increase blood volume and heart burden, increase blood viscosity, and thus raise blood pressure, which is not good for stroke patients.
Sixth, avoid alcohol, strong tea, coffee, spicy spices and other foods that stimulate the nervous system. In addition, eating less chicken soup and broth is beneficial to protect the cardiovascular and cerebrovascular systems and the nervous system, and overeating is also necessary.
Stroke patients at home can generally choose the following supplementary diet prescription: 1. 6 grams of auricularia auricula, soaked in water, with vegetables or steamed. It can reduce blood lipid, prevent thrombosis and prevent platelet aggregation. 2. Five celery roots and 10 red dates, decocted in water and eaten in jujube soup, can reduce blood cholesterol. 3. Eat fresh hawthorn or soak it in boiling water, add some honey, and let it cool to make tea. If stroke complicated with diabetes, honey should not be added. 4. Eating raw garlic or onion 10- 15g can reduce blood lipid, enhance fibrin activity and prevent arteriosclerosis. 5. The vinegar of stroke patients after meals is 5- 10 ml, which has the effect of softening blood vessels.
Sequelae of cerebral hemorrhage-There are tips for rehabilitation.
Some patients with cerebral hemorrhage have saved their lives after treatment, but they have left the sequelae of hemiplegia, especially the patients' hands, which are always like fists. Our family has a unique skill since ancient times. By pressing the base of the patient's nail, the hand can be extended. If you press it once a day, after seven or eight times, it is not a problem to stretch freely even if you can't return to the original level.
The specific method is: the performer presses the nail root of the affected side of the patient with his thumb nails. The requirement is that it must be pressed on the nail root, not on the nail meat. After finding the position, with a gentle force, the patient's finger will stretch out on its own at that time, and the time should not exceed 30 seconds. Might as well add some. Both the performer and the patient read "the meridians are unblocked and the cerebral vessels are unblocked". The pressing sequence is as follows: first press the nail roots of the middle finger and thumb (fingers extend outward when forced), then press the index finger and the nameless nail roots, and finally press the nail roots repeatedly with the small nail roots, and press them back and forth for * * * three times. (Sun Hongde, Changling County, Jilin Province)
After acute cerebral hemorrhage, we should pay attention to the following problems:
(l) Psychological care: In the acute stage, the attention of family members and patients is focused on saving lives, while in the rehabilitation stage, they are often anxious to restore their functions and ask them to take care of themselves quickly or even go to work. There are many people who need new drugs and new treatments; Some patients are pessimistic, disappointed and depressed. Therefore, patients should be encouraged to establish confidence in overcoming the disease, be physically disabled and determined; We should treat our diseases and functions realistically and strive for a good prognosis. We should cooperate with medical staff and families to overcome the disease. "If you come, you will be safe." Otherwise, if you are eager to get well, you will be impatient, but it will be bad.
(2) Pay attention to rational drug use: Because patients often suffer from several diseases or symptoms at the same time, doctors have prescribed a variety of drugs, so relatives and friends or family members should not add more drugs themselves. Excessive and disorderly medication may have side effects on the stomach, liver, kidney or hematopoietic system, which will not only accelerate recovery, but also lead to other problems.
(3) preventing the recurrence of stroke; It is meaningful to prevent recurrence in recovery period. Because stroke can suddenly recur, the more attacks, the worse the prognosis and the higher the mortality. In order to prevent recurrence, attention should be paid to stabilizing blood pressure, eating properly, and whether there are cardiopulmonary complications.
(4) Do a good job in family rehabilitation: the rehabilitation period is generally spent at home, and family members should know how to do a good job in family rehabilitation. During this period, drugs are no longer the main treatment.
(5) Pay attention to rehabilitation nursing, including psychological nursing and basic nursing, to ensure the basic needs of patients; Do a good job in special care, depending on the specific patient and condition, such as nasal feeding tube, urinary tube, bedsore care.
(6) Ensure proper nutrition and intake: Because stroke patients are often accompanied by aphasia, they can't express their wishes correctly, or they have difficulty coughing and swallowing, so they can't ensure eating. Intake is often insufficient or excessive, and their families should pay enough attention to it. Need to set a recipe, set a fixed amount, supply at a fixed time, and feed through a nasal tube if necessary.
(7) Smooth defecation: constipation and excessive defecation can induce hemorrhagic cerebral embolism in the middle of the year. In order to keep the stool unobstructed, defecate regularly and eat celery, carrots and fruits properly. Drugs can be used when necessary, such as boiling water for diarrhea, Maren Runchang pills, fruit guide and so on.