To treat cerebral thrombosis, comprehensive therapy should be taken according to specific conditions. Mainly include: (1) thrombolytic therapy; (2) Anticoagulation therapy; (3) Dilution therapy; (4) treatment of detumescence therapy; (5) Properly raise blood pressure and improve cardiac output; (6) calcium channel blockers; (7) free radical scavenger; (8) brain metabolism activating agent; (9) cerebrovascular dilators; (1) oxygen therapy; (11) dealing with nervous visceral syndrome; (12) Chinese medicine: (13) acupuncture treatment; (14) surgical treatment.
After the patients with cerebral thrombosis were hospitalized in the acute stage, their condition was stable and improved to some extent, most of them went home to continue treatment and rehabilitation training. At this time, home care is very important. If the nursing is good, the patient's condition can continue to change for the better and the order can be prolonged. On the contrary, it can aggravate the condition and cause various complications, sometimes even endangering the patient's life. Therefore, in order to make patients recover as soon as possible, attention should be paid to family care.
(1) Pay attention to personal hygiene: wipe your body regularly, help patients change clothes and pants, and dry the bedding. Maintain oral hygiene. When hemiplegic patients can't brush their teeth by themselves, they can scrub their mouths with sterilized gauze dipped in warm water, or wipe all parts of their mouths with cotton swabs and cotton balls dipped in warm salt water once a day, morning and evening.
(2) Pay attention to the prevention of bedsores: Hemiplegic patients who stay in bed for a long time, and keep a certain fixed position or posture for a long time, the blood circulation of the compressed parts of their bodies, such as the lower back and waist skin and soft tissues, is blocked, malnutrition and poor resistance, resulting in local skin redness, ulceration, erosion and ulcers, and finally bedsores are formed. In severe cases, the ulcer will expand and deepen, and then the whole body will be infected, which can cause septicemia and endanger life. In order to prevent bedsore, we should pay attention to changing the posture of bed rest and turn over the patient once every 2-3 hours. The mattress should be kept flat, dry and clean, and cleaned in time after defecation to keep the skin dry and hygienic. If the local skin starts to turn red, you can rub it with 5% alcohol and gently massage it in a circular way. You can also use moxa stick moxibustion locally to make the skin slightly warm. If bedsore has formed, it should be treated according to each stage of bedsore under the guidance of a doctor.
(3) Pay attention to prevent lung infection: Hemiplegic bedridden patients have poor resistance and are prone to lung infection. Therefore, we should be especially careful to avoid catching cold and prevent colds. Otherwise, sputum is not easy to cough up after upper respiratory tract infection, and it is easy to spread to lower respiratory tract and cause lung infection.
(4) Pay attention to the treatment of defecation: Some hemiplegic patients are incontinent. If it is not cleaned in time, it will easily cause urinary system infection. Therefore, we must pay attention to changing the pad cloth frequently and keep it clean locally. If there is redness around the anus or skin, it can be washed and dried with warm water and coated with zinc oxide paste to protect the skin. If you have constipation, you should relax your bowels in time, and you can use kaisailu or soap enema. Increasing cellulose intake in diet can prevent dry stool to some extent. Chinese traditional medicine senna leaves soaked in water instead of tea, which has good laxative function, so try it.
(5) Pay attention to nutrition: A considerable number of hemiplegic patients are undernourished or malnourished because they can't take care of themselves and may have dysphagia. Therefore, special attention should be paid to strengthening nutrition in home care to ensure the supply of protein, vitamins, cellulose and electrolytes for patients. Patients with dysphagia who have not fully recovered can eat some soft food. If necessary, insist on nasal feeding. If conditions permit, please consult a nutritionist. To help determine the best way to supply nutrition, such as intravenous nutrition or oral nutrition, to ensure that patients get the nutrition they need during the rehabilitation period.
First, the treatment principle of cerebral thrombosis
(1) Limit fat intake. It is necessary to reduce the total fat, increase polyunsaturated fatty acids and reduce animal fat in daily diet, so that the P/S ratio can reach above 1.8, so as to reduce the synthesis of endogenous cholesterol in the liver. When cooking, vegetable oil, such as soybean oil, peanut oil and corn oil, is used instead of animal oil, and the dosage is 25 grams per person per day, preferably within 75 grams per month. To limit the cholesterol in food, each person should be within 3 mg per day, that is, you can eat 3 egg yolks per week.
(2) control the total heat. If the intake of total fat is controlled in the diet, the blood lipid will drop, and the weight of obese or overweight patients will also drop. It is best to reach or maintain the ideal weight, which is beneficial to the physiological function of all internal organs.
(3) appropriately increase protein. As the amount of fat in the diet decreases, it is necessary to appropriately increase the protein. It can be provided by lean meat and skinless poultry, and fish can be used more, especially marine fish. Eating a certain amount of bean products every day, such as tofu and dried beans, is beneficial to reducing blood cholesterol and blood viscosity.
(4) restrict the intake of refined sugar and sugary sweets, including snacks, sweets and drinks. With the development of beverage industry, all kinds of sugary drinks are increasing. After drinking more sugary drinks locally, the sugar in the body will be converted into fat and accumulated in the body, which will still increase the weight, blood sugar, blood lipid and blood viscosity, which is extremely unfavorable to the recovery of cerebral thrombosis, so the application of drinks should also be controlled. For example, when patients with cerebral thrombosis suffer from diabetes and apply hypoglycemic drugs to produce hypoglycemia, they can drink drinks properly to prevent the blood sugar from falling further. When the transient hypoglycemia is relieved, don't drink sweet drinks again.
Now many manufacturers produce health drinks, among which low-sugar drinks are the main ones. Replacing sucrose with some sweeteners has been welcomed by people and satisfied the requirements and taste of people who like sweets. Common sweeteners include aspartame, stevioside and so on. Its sweetness is dozens of times that of sucrose, its dosage is small, it does not produce heat, is non-toxic, is not absorbed in the body, and can be excreted from the kidney with urine. Many animal experiments have proved that aspartame is not carcinogenic. Can be placed in solution and pastry making.
(5) Some patients with cerebral thrombosis are complicated with hypertension, so the amount of salt should be small, and a low-salt diet should be adopted, with 3 grams of salt per day, and salt can be added after cooking and mixed well.
(6) Pay attention to cooking methods. If you put salt into cooking, the cooked food is still very weak and difficult to eat. In order to increase appetite, you can add some vinegar, tomato sauce and sesame sauce when cooking. Vinegar can not only flavor, but also accelerate the dissolution of fat and promote digestion and absorption. Sesame sauce has high calcium content, which can be supplemented by regular consumption. Calcium ions can increase the compactness of vascular endothelium and prevent cerebral hemorrhage.
(7) Patients with cerebral thrombosis should always drink water, especially in the morning and evening. Drinking water in the morning can dilute the gastrointestinal tract. After water enters the blood, it is excreted in the form of sweat and urine with activities. The activity at night is small, and the biggest advantage of drinking water before sleep is that it can dilute the blood and prevent thromboembolism.
Second, the choice of food for cerebral thrombosis
(1) Foods with dietary fiber and vitamin C should be added, including coarse grains, vegetables and fruits. Some foods such as onion, garlic, mushrooms, fungus, kelp, hawthorn, seaweed, light tea, konjac and other foods have lipid-lowering effects.
(2) Usually, light, soft food rich in dietary fiber should be eaten, and cooking methods such as steaming, boiling, stewing, boiling, stir-frying, stir-frying and warm mixing should be adopted, but frying, frying, frying in oil and baking are not suitable.
Rehabilitation of cerebral thrombosis
(1) Keep calm?
For light patients, they can lie flat with their heads about 3 degrees high. No matter what means of transportation is adopted, they should be sent to the nearby municipal hospital within 1-2 hours as far as possible, so as to avoid the delay of transferring to a small hospital because there is no corresponding inspection equipment. It is best to call 12 ambulance for critically ill patients. When waiting for the bus, if the patient has symptoms such as disturbance of consciousness and vomiting, he can turn his head sideways to prevent vomit from being inhaled into the lungs by mistake. ?
(2) prepare enough cash or checks as far as possible?
in order to avoid the delay of treatment due to lack of funds after arriving at the hospital. ?
family members cooperate with doctors in the hospital?
(a) to assist in nursing?
Most patients with cerebral thrombosis are obese, and some of them are also complicated with diabetes. Now they have hemiplegia and local neurotrophic disorder. If they are pressed for a long time, their skin will break down and form "bedsores". Once it happens, it may aggravate cerebrovascular disease due to infection and fever, and in severe cases, it may also cause sepsis and cause death. Therefore, family members should pay attention to turning over and patting the back regularly, scrubbing the skin with warm water, and gently massaging the crushed parts, especially the parts with prominent bones, such as the spine and sacrococcygeal region. The frequency of turning over is generally about 2 hours. If skin ulceration is found, it should be reported to the medical staff in time for early treatment. Patients with incontinence should change diapers frequently, clean them with warm water after each defecation, dry them and apply talcum powder. ?
(2) diet problems?
Some patients have dysphagia after illness, which is caused by muscle paralysis in charge of swallowing.
The patient coughs when eating, especially when drinking water, and even the food is ejected from the nose and mouth. At this time, we should pay attention not to force the patient to eat water or medicine. For light patients, they can eat sticky food, such as thick porridge and soft rice. Boil and chop vegetables, minced meat and other non-staple foods and mix them in the rice to avoid too thin and dry food, which is easy to swallow. If there are no contraindications for oral drugs, they can be ground and mixed in food. Severe patients need nasal feeding diet, that is, insert a hose into the stomach through the nostril and inject rice soup, milk, vegetable juice and other foods into the stomach with a syringe to ensure adequate nutrition. Oral drugs can also be injected from the stomach tube. Note that the injected food and drugs must not have large particles, so as not to block the stomach tube. Nasal feeding diet is a necessary means to ensure treatment at a certain stage, which is directly related to the success or failure of patient rescue. Some patients and their families are unwilling to accept the gastric tube, which is very dangerous for patients to swallow reluctantly. If food is inhaled into the respiratory tract by mistake, it will cause lung infection and aspiration pneumonia. In severe cases, people may die of suffocation. ?
(3) pay attention to the changes of the condition and report the abnormal situation to the medical staff in time?
Patients with cerebral thrombosis have relatively slow onset, mild symptoms at onset, and most of them will not have conscious disturbance. However, the condition may gradually worsen within a few hours or days. Although the medical staff has taken active measures to treat it, sometimes it can't stop the disease from progressing. If the blocked blood vessels are large, the area of brain tissue necrosis is large, and the brain edema is obvious, the patient may gradually become drowsy, that is, he can wake up instead of falling asleep immediately. Severe cases can enter a coma. Family members should pay attention to observe whether the paralyzed limb strength of the patient gradually becomes smaller or even completely unable to move. What's your mental state? If the patient is found to be sleepy and listless, the medical staff should be informed immediately. At the same time, for critically ill patients, it is necessary to record the amount of water intake and urine intake every day for the doctor's reference. ?
(4) early help patients to move their paralyzed limbs and promote rehabilitation?
On the second day after onset, if the patient's condition is stable, he can start to do passive limb movements, that is, help the paralyzed limb to stretch and flex. This is conducive to promoting blood circulation of paralyzed limbs, preventing deep vein thrombosis, promoting muscle strength and joint mobility, and preventing limb contracture and deformation. When inactive, the paralyzed limb of the patient should be placed in an antispasmodic position, that is, when lying on the back, the upper limb of the affected side is placed on a pillow to make it slightly abduction and external rotation, the elbow joint is slightly flexed, and the wrist joint is slightly extended back, holding a cylindrical object of appropriate size, such as a toilet paper roll. Cushion the back and make it forward and upward; The lateral hip of the lower limb is padded to make the hip joint adduction, the pelvis stand forward, a soft pillow is padded under the knee joint to make the knee joint bend, and the ankle joint should be kept at 9 degrees to prevent the foot from drooping, so that the patient can put his foot on the bed or wall or make a splint by himself. When lying on your back, the head height should be 3, not too high. In lateral position, the paralyzed limbs should be placed as far as possible, and a pillow should be placed in front of the chest and lower limbs, with the upper limbs extended and the lower limbs flexed on the pillow. ?
(5) pay attention to the patient's emotional changes?
Patients suddenly lose their activity ability and language ability, and even their ability to take care of themselves and work, which is unbearable emotionally, so they often have emotional changes such as depression and anxiety, moodiness and even personality changes. Family members should actively cooperate with medical staff to comfort and encourage patients to cooperate with treatment and rehabilitation exercises. Try to avoid making patients emotional. ?
family nursing and treatment of cerebral thrombosis in convalescence?
When blood vessels are blocked, brain cells die due to ischemia and hypoxia. The later the treatment starts, the larger the blocked blood vessels are, the more brain cells die, and the brain cells cannot regenerate after death. Therefore, although doctors have taken many positive measures, patients still inevitably have to leave different degrees of disability, also known as "sequelae." These sequelae can't be solved in hospitals, especially in general hospitals whose main purpose is to save lives. They need to go home for further recuperation and rehabilitation in rehabilitation hospitals. ?
(1) Take medicine regularly to prevent the recurrence of cerebral thrombosis? After leaving the hospital, patients still need to take medicine according to the doctor's instructions, control the basic diseases of arteriosclerosis such as diabetes and hypertension, and go to the hospital for re-examination regularly. Commonly used drugs are anti-platelet aggregation drugs, such as low-dose aspirin and ticlopidine; Brain protective drugs, such as nimodipine; Oxygen free radical scavengers, such as vitamin E, vitamin C, etc. Some patients hate taking medicine, and they want to try all the advertised drugs, or think that the more drugs they take, the better. In fact, it's bad for your health. Not to mention that the efficacy of drugs is not necessarily as magical as advertised. Just saying that any drug must be metabolized by liver and kidney, taking too much medicine will aggravate the already unhealthy burden of liver and kidney for the elderly; Pharmacologically speaking, too many drugs enter the body, which will interact with each other, reduce their respective curative effects, and even aggravate side effects, causing harm to the body. What medicine to take and how to take it? You'd better follow the doctor's advice and don't blindly follow advertisements. ?
(2) actively start rehabilitation treatment as soon as possible?
As mentioned above, cerebral thrombosis will leave many sequelae, such as paralysis, hemiplegia, aphasia, etc. The effect of drugs on these sequelae is very limited, and through active and formal rehabilitation treatment, most patients can take care of themselves, and some can return to work. It is best to go to a regular rehabilitation hospital for systematic rehabilitation if conditions permit. If you can't go to the rehabilitation hospital for treatment for various reasons, you can buy some books and videos about it and do it at home. Rehabilitation should be carried out as soon as possible. 3 ~ 6 months after illness is the best time to recover. After half a year, due to muscle atrophy and joint contracture, it is more difficult to recover, but it will also help. ?
(3) daily life training?
Many previous living habits have been broken after illness. Besides training the affected limbs as early as possible, we should also pay attention to developing the potential of healthy limbs. Patients with right hemiplegia who are used to using their right hand (right-handed) at ordinary times should train their left hand to do things at this time. Clothes should be made loose and soft, and special styles can be sewn according to special needs. For example, a zipper can be installed on the sleeve of the affected limb to measure blood pressure when going to see a doctor. Wear the paralyzed side first and then the healthy side when dressing; When undressing, take off the healthy side first and then the affected side. ?
(4