The early mortality rate of cerebral hemorrhage is very high, about half of the patients die within a few days of onset, and most of the survivors have different degrees of sequelae. The prognosis of cerebral hemorrhage is related to the location, amount, times of bleeding, general condition and complications. Mild cerebral hemorrhage, external capsule hemorrhage and cerebral lobe hemorrhage have good prognosis. After treatment, hemiplegia can recover obviously, and some patients can return to work through functional exercise. The prognosis of internal capsule, ventricle and pons hemorrhage is poor, more than those who died of cerebral hernia hours or days after onset. Most people who are in a coma for more than 1 week die of complications or sequelae.
The reference conditions for judging the prognosis of cerebral hemorrhage are:
(1) The older you are, the worse your prognosis is. The mortality rate under 60 years old is about 30%, and the mortality rate over 70 years old can be as high as 70%.
(2) The longer the history of hypertension, the higher the blood pressure and the worse the prognosis. When the blood pressure is above 26.6/ 16 kPa (200/ 120 mm Hg), the mortality rate is 30.07%.
(3) The more acute and severe the onset, the higher or lower the blood pressure at onset, and the worse the prognosis.
(4) The deeper and longer the coma, the worse the prognosis. 94% people who are in a deep coma die. Patients with post-illness disturbance of consciousness or gradual improvement of disturbance of consciousness have a better prognosis. The longer the sleepiness, the worse the prognosis.
(5) The faster the disease progresses, the earlier the symptoms of intracranial hypertension appear, the more serious the symptoms, and the worse the prognosis. The mortality rate of patients with optic papilla edema is 59%, and the earlier the optic papilla edema appears, the higher the mortality rate. 100% patients died within 3 hours after onset. Within 48 hours, 50% died. When the lumbar puncture pressure is above 200 mm Hg, the mortality rate is 64.5%.
(6) Patients with large amount of bleeding have poor prognosis. Patients with hematoma formation and obvious displacement of midline structure have poor prognosis. Lumbar puncture with colorless and transparent cerebrospinal fluid has a good prognosis.
(7) Relationship between neurological signs and mortality: The mortality rate of patients with unequal pupils on both sides is 64%, the mortality rate of those with unresponsive pupils to light is 88%, and the mortality rate of those without corneal reflex is 92%. Most of the people who have strabismus or floating eyes with separated eyeballs, or have rigidity of brain removed or rigidity of brain removed die. Patients with complete hemiplegia or quadriplegia and hypotonia have poor prognosis.
(8) The relationship between vital signs and mortality: the mortality rate above 38℃ is 765,438 0%, the mortality rate above 65,438 000 beats/min is 75%, and the mortality rate above 30 breaths/min is 76%.
(9) The author suffers from epilepsy and has a poor prognosis. Because it will aggravate brain edema or cerebral hemorrhage.
(10) The prognosis of patients with visceral dysfunction is poor. The common situation is gastrointestinal bleeding, and the mortality rate is as high as 80%.
(1 1) Patients with metabolic disorders, such as acidosis and electrolyte disorders, have poor prognosis.
(12) has symptoms of hypothalamic damage, such as increased peripheral leukocytes, decreased eosinophils in blood, and poor prognosis when fasting blood glucose exceeds 200 mg.
(13) The prognosis of patients with progressive EEG changes is poor.
(14) Recurrent authors with poor prognosis.
(15) The worse the effect of dehydration, the worse the prognosis.
Family nursing care of patients with cerebral hemorrhage
1, psychological nursing
Patients often have emotional reactions such as depression, depression, irritability, irritability, pessimism and disappointment. Therefore, family members should be psychologically considerate of patients, talk with them more, comfort and encourage them, create a good family atmosphere, patiently explain their illness, eliminate their doubts and pessimism, make them understand their illness, and establish and consolidate their confidence and determination in functional rehabilitation training.
2. Prevention of complications
(1) Help the patient turn over and pat the back 4-6 times a day regularly, each time for about 10 minutes. Once the patient is found to have yellow phlegm, fever, shortness of breath and blue lips, he should seek medical treatment immediately.
(2) Encourage patients to drink more water to clean the urinary tract. And pay attention to the cleanliness of perineum to prevent cross infection. If urine turbidity and fever are found, it is a sign of urinary tract infection and should be treated as soon as possible.
(3) Most paralyzed patients have constipation, and some may cause cerebral hemorrhage to happen again because of forced defecation. Therefore, we should pay attention to the diet structure, give patients a low-fat, high-protein and high-energy diet and fruits and vegetables containing crude fiber, and give them enough water. Regularly defecate the toilet, and use laxatives and enemas when necessary.
(4) Patients are paralyzed in bed, and bedsores are prone to occur at bony protrusions such as occipital tuberosity, scapula, buttocks, sacrococcygeal region and heel. Use a soft pillow or sea cushion to protect the bone protuberance, turn over every 2~3 hours, avoid procrastination, keep the bed dry and clean, take warm baths and massage regularly, improve local blood circulation and local nutritional status.
(5) Massage the limbs 10~ 15 minutes every day to promote venous blood return and prevent deep venous thrombosis. Once unexplained fever and lower limb swelling and pain are found, they should be diagnosed and treated quickly.
3, keep the function bit
Maintaining the functional position of paralyzed limbs is the premise to ensure the smooth recovery of limb functions. When lying on your back or side, look up 15~30 degrees. The knee joint of the lower limb is slightly flexed, the foot and calf are kept at 90 degrees, and the toes are upward. The forearm of the upper limb is in a semi-flexion state, holding a cloth roll or a round object.
4. Functional exercise
Functional exercise 3~4 times a day, and the number of times is gradually increasing. With the recovery of the body, patients should be encouraged to exercise, get out of bed in time, and prevent falling and stepping on the air. At the same time, acupuncture, physical therapy and massage are combined to speed up recovery.
(1) upper limb function exercise: the nursing staff stood on the affected side of the patient and held the wrist of the affected side with one hand; The other hand is placed slightly above the elbow joint to make the affected limb stretch and rotate up and down, left and right; The nurse holds the wrist of the affected limb with one hand and moves each finger with the other hand.
(2) Functional exercise of lower limbs. The nurse holds the ankle joint of the affected limb with one hand and the knee joint slightly lower than the affected limb with the other hand, so that the hip and knee joint can stretch, bend, rotate inside and outside, adduction and abduction. The nurse holds the arch of the affected limb with one hand and does tiptoe exercises with the other.
5. Exercise in daily life
The ultimate goal of home care is to help patients take care of themselves. Gradually train patients to eat, dress, wash, go to the toilet and some outdoor activities, from full care to assistance until they take care of themselves.