High blood pressure is the main cause of cerebral hemorrhage.
Other causes are cerebrovascular malformations, aneurysms, cerebral arteritis, blood disorders, after the application of thrombolytic anticoagulant drugs, amyloid angiopathy and brain tumors.
Mechanism of cerebral atherosclerosis and cerebral hemorrhage in hypertension
High blood pressure, such as exceeding the maximum contractile capacity of cerebral arteriolar smooth muscle, blood vessels will be passively dilated, the smooth muscle and intima is damaged, permeability increases, plasma components penetrate into the arterioles leading to fibrinoid necrosis of arterioles, arteriolar smooth muscle may be hyaline, arteriolar wall thins out and expands into a micro-aneurysm; small arteriolar walls and small aneurysms are ruptured when blood pressure is suddenly increased. Rupture is the most common cause of cerebral hemorrhage when blood pressure rises suddenly.
Brain damage mechanism of cerebral hemorrhage
The hematoma in the brain compresses the surrounding brain tissues, causing ischemia, hypoxia, edema, and elevated intracranial pressure, obstructing venous return, and exacerbating cerebral ischemia, forming a vicious circle with cerebral edema and intracranial hypertension, leading to cerebral herniation and secondary brain stem hemorrhage, which is life-threatening.
Cerebral hemorrhage is mostly a single hemorrhagic focus. The hematoma squeezes the surrounding brain tissue, causing cerebral edema, increased intracranial pressure and tissue displacement, leading to herniation of the canopy, cerebellar tonsil hernia, the former compression of the brain stem, causing secondary hemorrhage and necrosis of the brain stem, which is a common cause of death in cerebral hemorrhage. A few months after the hemorrhage, the hematoma is autolytic, and at the end of the process, it can become a cystic cavity called the stroke capsule, in which yellow fluid can be seen.
The following are the causes of death from cerebral hemorrhage, which are mainly as follows:
(1) Cerebral hemorrhage secondary to brain stem hemorrhage: In the analysis of 52 cases of cerebral hemorrhage by autopsy, 39 cases (75%) had secondary brain stem hemorrhage, including 12 cases of hemorrhage of the midbrain (30.8%), 9 cases of hemorrhage of the pontine brain (23.1%), and 18 cases of hemorrhage of both the midbrain and pontine brain (46.1%).
Secondary mechanism of brainstem hemorrhage: ①Blood was injected into the brainstem from the hemorrhagic foci of the brain along the conduction tract in 7 cases (18%), which was in the form of cords and stripes, and flowed into the basal part of the midbrain along the pyramidal fasciculus. ② The cerebral hemorrhage foci destroyed the thalamus and directly extended to the midbrain in 2 cases (5.2%). ③ Cerebral hemorrhage foci broke into the ventricles, the conduit dilated with blood accumulation, and the blood entered the gray matter around the conduit, ***8 cases (20.5%). ④ Hemorrhage of small blood vessels in the brainstem, ***25 cases (64.1%), mostly point-flake hemorrhage, some isolated, some fused into a piece. Microscopically, there were arteries with damaged walls in the hemorrhagic foci, so they were basically small arterial hemorrhages. In addition, it was also seen that the boundaries of congestion and edema areas of certain blood vessels were quite obvious, which were consistent with the distribution area of the paracentral artery or the long and short rotary arteries, and even in a certain blood vessel distribution area, both obvious congestion and edema and arterial hemorrhage could be seen, which further confirmed that it was arterial hemorrhage. In addition, in the conduit and around the fourth ventricle, venous stasis was sometimes seen, and occasionally a little hemorrhage was seen around the veins.
Clinical manifestations of secondary brainstem hemorrhage: early and severe coma, 38 out of 39 cases (97%) were comatose within 24 hours of the onset of the disease: the blood pressure was relatively high, the highest systolic blood pressure reached more than 200mmHg in 31 out of 39 cases (79.5%), while only 46.1% (6/13) were in the group without brainstem hemorrhage (P＜0.05); the eye position was changed more than 53.85%, which showed the signs of separation, distortion, and the appearance of the brainstem hemorrhage, and the eye position was changed more than 53.85%. The changes in eye position were many, accounting for 53.85% of the cases, which were manifested as separation of kyphosis, skewed strabismus, floating eyeballs, central fixation, etc., and only 10% in the group without brainstem hemorrhage; and the survival period was short. Of the 39 cases in this group, 29 cases (74.4%) died within 48 hours, and only 30.8% (4/13) in the group without brainstem hemorrhage, indicating that brainstem hemorrhage is one of the causes of cerebral hemorrhage death.
(2) Cerebral hemorrhage secondary to subthalamic injury: 1) Anatomical characteristics of the subthalamus: the subthalamus includes the wall of the third ventricle below the subthalamic sulcus and a number of structures on the floor of the ventricle, which contains more than 15 pairs of neuronal nuclei, and tens of thousands of neurosecretory cells, such as the paraventricular nucleus, the periaqueductal nucleus, the ventral medial nucleus, the dorsal medial nucleus and so on, which are located in the third ventricle wall, and the subthalamus is about 1 cm in length and about 4g in weight, which is the total brain weight. The subthalamus is about 1cm long and weighs about 4g, which is about 3‰ of the weight of the whole brain. However, the mechanism is complex, with the vegetative nerve, visceral activities. Endocrine, metabolism, emotion, sleep and wakefulness are related. The region also has the following characteristics: there is a rich capillary network, more than double the other parts of the brain, and the blood-brain barrier is not sound enough, there is a high degree of permeability, so in hypoxia, intoxication, increased cranial pressure, infections and other injuries are prone to edema and hemorrhage, and other changes; the funnel handle is the thalamus and the pituitary gland between the nerve fiber connection, when it is under pressure, swelling, hemorrhage, the connection is destroyed. ② clinical symptoms of subthalamic injury: cerebral hemorrhage caused by increased intracranial pressure, the occupying effect, resulting in subthalamic pressure, pituitary stalk edema, displacement, distortion, etc., and secondary ventricular hemorrhagic injury to the third ventricular wall are involved in the subthalamic area, the emergence of symptoms, often manifested as hemorrhagic gastric erosions or ulcers, vomiting of coffee-like gastric contents, acute pulmonary edema, leukocyte elevation, blood glucose elevation, central sexuality of gastrointestinal tracts and the brain, the blood sugar elevation. Elevated blood glucose, central hyperthermia, and profuse sweating.
(3) Cerebral hemorrhage secondary to cerebral hernia; cerebral hemorrhage can be complicated by herniation of the canopy, central hernia, occipital foramen magnum hernia, pterygoid crest hernia, cingulate gyrus hernia and supracerebellar hernia. The latter three generally do not appear obvious clinical symptoms, mostly found at autopsy; the first three clinical symptoms are obvious, mostly for symptomatic exacerbation or the cause of death. Dilatation of the ipsilateral pupil occurs along the canopy. When the center hernia, both pupils are small and irregular breathing. Its pathological signs are: (1) downward displacement of the erythrocyte and red nucleus, (2) downward displacement of the third ventricle, and (3) downward displacement of the lower thalamus and upper brainstem. In the case of central hernia, occipital foramen magnum hernia is likely to occur, and the respiratory heartbeat dissociates to death.
The clinical manifestations and pathological process of cerebral hemorrhage depend on the site of hemorrhage and the amount of bleeding. Most of the patients dynamic sudden onset, the onset of acute, often accompanied by headache, vomiting, which is due to the sudden increase in intracranial pressure. The illness peaks within minutes or hours, and in severe cases there is a life-threatening loss of consciousness. Therefore, the key to medical treatment is to reduce intracranial pressure, cerebral edema, and control blood pressure, and to properly manage complications such as asphyxia, gastrointestinal bleeding, pulmonary infection, and cardiac symptoms. This article discusses the acute phase treatment of cerebral hemorrhage, focusing on measures to manage complications.
The acute phase of cerebral hemorrhage refers to 3 to 4 weeks of onset. The three main principles of resuscitation of cerebral hemorrhage are management of blood pressure, management of cerebral pressure, and management of comorbidities. The patient is absolutely bedridden, avoid emotional stress, keep quiet, pay attention to the head elevated 15 to 20 degrees. Comatose patients take half lateral position, head to one side, give intermittent oxygen, keep the airway open, observe the vital signs at any time, and prevent the occurrence of vomiting after aspiration, etc., strictly according to the coma patient treatment routine for disposal.
1 Management of blood pressure
Cerebral hemorrhage lesions are mostly in the brain parenchyma of the penetrating small arteries (bean lines, bean mounds). Due to long-term high blood pressure so that the small arteries in the brain expansion, the formation of microaneurysms or small arterial walls of the fibrotic necrosis, so when the blood pressure rises sharply easy to cause small arterial rupture and hemorrhage. Long-term hypertension to small arterial intima-media damage, lipid deposition, smooth muscle layer degeneration and necrosis, in the pressure and blood flow rapid changes, a small artery hemorrhage can cause severe vascular response to appear around the fusion of multiple hemorrhages, the formation of hematomas or hemorrhage of the scattered distribution. Blood pressure should be controlled below 180/100mmHg and should not be too low,or it will cause irreversible consequences such as brain damage after insufficient blood supply.
The most common site of hemorrhage is the internal capsule, in which the patient is comatose, drowsy, or awake, and has the typical symptoms of the three hemiplegias (hemiparesis, hemiplegia, hemianopsia, and hemianopsia), in addition to a marked increase in blood pressure. If the hemorrhage is large and breaks into the cerebral ventricle, the coma will deepen, and cerebral edema and brain hernia will appear, so the condition is critical and the prognosis is very poor.
2 Management of cerebral pressure
Cerebral edema is a major complication of cerebral hemorrhage and one of the fatal factors. Dehydration treatment is usually not less than 15 days. Surgical removal of hematoma or local drilling and suction treatment is also an active and feasible measure for patients with hemorrhage greater than 50-70 ml and under 70 years of age. Stereotactic drainage is usually followed by urokinase injection after 3 days.
3 Handling complications
After cerebral hemorrhage, due to the damage of the vegetative nerve center, neurohumoral regulation function disorder, can lead to lung infection, gastrointestinal bleeding and water electrolyte disorders and other clinical complications, coupled with the fact that most of the patients have hypertension and diabetes mellitus, coronary artery disease and other chronic disease history, thus very easy to combine heart, lung, kidney and other organ dysfunction. The complications of cerebral hemorrhage that we often encounter in the clinic and their management principles are as follows:
3.1 Fever
Fever can occur in patients with cerebral hemorrhage, and there are four main cases:
(1) Infectious fever: It is mainly caused by pulmonary infection. Patients accompanied by consciousness disorder, dysphagia, speech disorder and abnormal cough, vomiting or oral secretions blocking the airway can occur aspiration pneumonia or aspiration pneumonia. In addition, lung infections can result from medical infections caused by improper mechanical respiratory assistance, secondary infections caused by the use of adrenocorticotropic hormones, and cross-infections caused by prolonged hospitalization.
The main measures to prevent respiratory infections are as follows: ①The head of the bed should be elevated as much as possible by 30 degrees during the day, and by 90 degrees when eating. Encourage patients to cough and breathe y, and do not use a straw to drink water. Patients with obvious consciousness disorder should take the lateral position and lower the angle of the mouth, or take the supine position, in order to facilitate the discharge of pharyngeal secretions. For comatose vomiting patients, after vomiting should be in the mouth with the bedside suction suction clean, in order to prevent inhalation of trachea. ② in order to prevent nasal feeding diet reflux, nasal feeding speed should not be too fast, and must pay attention to the appropriate temperature, nasal feeding before adequate suction, nasal feeding after the head of the bed elevated 30 degrees for 2 hours, try not to suction for a short period of time, in order to prevent the cause of vomiting. In case of gastric reflux, the daily nasal feeding volume can be appropriately reduced, and in severe cases, no food should be taken for the time being. A small amount of gas should be injected when removing the tube so that the food at the head of the tube will not fall into the trachea when it is withdrawn. ③ Strengthen respiratory care, those who are unable to eat with impaired consciousness must strengthen oral care, and turn over and pat the back every 2 to 3 hours. More attention should be paid to sputum aspiration. If the sputum of patients with complicated pneumonia cannot be thoroughly aspirated, even if a large amount of antibiotics is used, the pneumonia cannot be controlled satisfactorily. If severe lung infection causes high temperature, thick and sticky sputum which is not easy to cough out, and the consciousness disorder cannot be recovered in a short time, and the drug treatment is ineffective or the patient has asphyxia, tracheotomy can be considered to facilitate sputum expulsion, intratracheal administration of medicines, and to reduce mucous membrane damage caused by pharyngeal sputum suctioning. ⑤ Actively treat cerebral hemorrhage, control cerebral edema, and strive for early recovery of consciousness to facilitate early control of pulmonary infection. ⑥ If there is existing lung infection, a large amount of broad-spectrum antibiotic treatment must be applied. Respiratory tract infections complicated by cerebral hemorrhage are mostly hospital-acquired pathogenic bacterial infections, with gram-negative bacterial infections being the most common (50%-60%), such as Escherichia coli, L. pneumophila, Pseudomonas aeruginosa, etc., while staphylococcus accounts for about 10% and pneumococcus is less common (5%). The empirical drugs for gram-negative infections are: aminoglycosides + semisynthetic penicillins (broad-spectrum) or cephalosporins; ecthyma + carboxyaminobenzylpenicillin; and butamidokanamycin + cephalosporin antibiotics.
The incidence of urinary tract infections after cerebral hemorrhage is second only to respiratory tract infections, and the infecting bacteria are mostly gram-negative bacilli residing in the skin mucosa. Long-term indwelling urinary catheterization (more than 1 week) should pay attention to prevent urinary tract infection, especially female patients. In order to reduce urinary tract infection should be avoided as much as possible catheterization, if the need for catheterization should be strictly disinfection, and the use of disinfection closed drainage system. Asymptomatic bacteriuria generally do not need to be treated, so as not to cause drug-resistant bacteria colonization. Symptomatic patients can be based on the isolation of pathogenic bacteria and drug sensitivity test selection of antibiotics, most bacteriuria in the catheter removal or the addition of antibiotics after elimination. General urinary tract infections can use aminoglycosides + ampicillin or third-generation cephalosporins + ampicillin.
(2) central fever: it is caused by damage to the thermoregulatory center in the lower thalamus, and is common in severe cerebral hemorrhage breaking into the ventricle, primary ventricular hemorrhage, brain stem hemorrhage, or heavy brain stem infarction. Clinical manifestations of persistent high fever, body temperature is more than 39 ℃, the patient has no sweat, the trunk skin temperature is high and the extremities are cold, not accompanied by chills, there is no change in heart rate corresponding to the change in body temperature, and antipyretic drugs are ineffective. The treatment of antipyretic is based on physical hypothermia, including alcohol bath, warm water bath, ice pad ice cap cooling and ice water enema. The use of antipyretics in frail elderly patients requires caution to prevent defecation. When conditions permit and there are indications, subcooling therapy can be used. It has been reported that central hyperthermia is associated with dysfunction of dopamine receptors in the brain, so the use of bromocriptine, an agonist at this receptor, may be effective.
(3) Dehydration fever: the fever is caused by overhydration and insufficient water supplementation, resulting in blood concentration and involvement of intracranial thermoregulatory center. In addition, excessive dehydration can also lead to the patient due to insufficient body fluids to cause difficulty in expectoration, which also increases the occurrence of dehydration fever. For patients who develop unexplained fever, dry skin, decreased urine output and increased erythrocyte pressure volume during treatment, the possibility of dehydration fever should be considered. Treatment should firstly adjust the dehydration dose, and secondly, physical cooling can also be performed.
(4) Absorptive fever: mainly seen in hemorrhagic stroke, with subarachnoid hemorrhage is common, the process of blood absorption, erythrocyte lysis and release a variety of heat-producing factors caused by fever, common in the first two weeks after the onset of the disease, low to moderate fever, not accompanied by signs of infection and poisoning and symptoms of damage to the hypothalamus, the treatment of physical hypothermia can be used.
3.2 Respiratory complications
Respiratory complications after cerebral hemorrhage include not only respiratory infections, but also neurogenic pulmonary edema (NPE), which is a result of the release of a large amount of sympathetic nervous system substances due to the damage of the hypothalamus, and the peripheral vasoconstriction that leads to the rise of blood pressure, and the blood is shifted from the peripheral circulation, which is characterized by a high resistance, to the pulmonary circulation, which has a low resistance, and as a result, the fluid in the pulmonary artery increases in static pressure and damages the capillaries. As a result, the hydrostatic pressure rises and damages the capillaries, and the fluid leaks out into the alveoli. Recent studies have shown that NPE is mainly caused by low blood oxygen, the incidence of NPE is closely related to the condition of cerebral hemorrhage, and the incidence of NPE is high in those with large amount of hemorrhage and severe condition.NPE is mostly sudden onset, and most of the patients will die within 24 hours if they are not treated in time, and should be given high concentration of oxygen as early as possible. Nifedipine 10-20mg sublingualized, which is recommended in recent years, can rapidly reduce peripheral and pulmonary arterial pressure, and has good effect on NPE. Dobutamine therapy can improve myocardial contractility, but also accelerate blood flow to the heart, often the drug of choice for NPE treatment.
3.3 Digestive complications
Mainly upper gastrointestinal bleeding, which is one of the serious complications of cerebral hemorrhage, and is particularly common in brainstem hemorrhage, often correlates with the severity of stroke, i.e., the more severe the condition, the higher the incidence of gastrointestinal bleeding. The prognosis of patients with gastrointestinal bleeding is poor, and the mortality rate can be more than half. Lesions that cause GI bleeding include ulcers, hemorrhagic erosions of the mucosa, hemorrhagic gastritis, and acute attacks of chronic ulcers. Gastrointestinal bleeding occurs mostly in the first to second week after cerebral hemorrhage.
The focus of prevention and treatment of upper gastrointestinal bleeding is to protect the gastric mucosa, reduce and neutralize gastric acid, keep gastric pH above 4 and actively treat cerebral hemorrhage. Specific measures are as follows:
(1) Correcting insufficient oxygen supply: to improve the oxygen supply of the body, the first step is to ensure the smoothness of the respiratory tract and the exchange function of the lungs. In critical cerebral hemorrhage patients should pay attention to the supply of oxygen.
(2) Maintain water, electrolyte, acid-base balance: although upper gastrointestinal hemorrhage is a local manifestation of the stomach, it is a part of the systemic response, and the internal homeostasis has a direct or indirect effect on it. Appropriate and effective blood volume should be maintained, but too much water will cause cardiac and pulmonary damage. The pH of the arteries will also cause changes in the pH of the gastric mucosa, and acidemia can increase the acidity of the gastric mucosa. Therefore, maintaining water, electrolyte and acid-base balance disorders is also one of the preventive measures for upper gastrointestinal bleeding.
(3) Early nutritional support: The gastric mucosa needs energy to regenerate and secrete mucus to protect the mucosa. Enteral nutrition can promote the recovery of gastrointestinal tract, stimulate visceral and hepatic circulation, improve mucosal blood flow, and prevent intramucosal acidosis and osmotic disorders. In patients with cerebral hemorrhage, enteral nutrition can be given early, and formula diet should be applied within 24-48 hours, gradually increasing from 25ml/h to 100ml/h, and increasing antioxidants such as glutathione, vitamin E and β-carotene, etc. Dietary fiber improves the nutrition of the colonic mucosa in order to prevent intestinal infections, and the daily requirement should be more than 10g. When it cannot be taken orally, the addition of glutamine to parenteral nutrition will also favor the growth of the gastric mucosa and provide it with the necessary energy.
(4) Hemostatic agent: can be used Anluo blood, Lixian and other drugs, can also be used in ice water 100 ~ 200ml plus norepinephrine 4 ~ 8mg intragastric instillation.
(5) Surgery: when the above hemostatic measures are ineffective, early endoscopy should be performed to try microscopic hemostasis or surgical treatment.
In addition, it is necessary to closely observe the condition, to know the condition of vomitus and stool, to pay attention to the change of mental state and limb skin temperature and color; to monitor the blood pressure and pulse, and to regularly recheck the erythrocyte count, hemoglobin, hematocrit, etc.; to do a good job in the care of gastric tube, and each time to inject the drug or before eating, should be back to draw the gastric fluid for visual observation, and if necessary, to perform the occult blood test.
Cerebral infarction cerebral hemorrhage
*First of all, you need to rest in bed, have an optimistic and cheerful mentality, have full confidence in the recovery of the disease, and work closely with us, active treatment, early recovery.
*Some patients may have one or both sides of the hands and feet can not move, weakness, or temporary inability to speak, there may be a certain impact in the future life, you have to have a correct understanding of their own disease, as long as the early control of medication, a variety of functional exercises and language rehabilitation training (such as counting, look at the picture and talk, etc.), and persistent, which is paralyzed hands and feet and language function of the recovery has a positive effect.
*Diet to high protein, high vitamin, low fat, light and easy to digest nutrient-rich food, such as fish, soy products, grains, soybeans, etc., avoid spicy stimulation, greasy food (such as strong tea, coffee, fried food), more vegetables, fruits, and to maintain smooth bowel movement. If there is facial muscle paralysis, can enter the semi-fluid, such as milk paste, porridge, feeding to the healthy side (without facial paralysis) delivery of food, feeding speed should be slow, to avoid the patient choking and coughing, resulting in choking. If the patient's condition is critical and swallowing is difficult, the doctor will insert a gastric tube and give him nasal fluid to ensure nutritional supply.
*Patients because the limbs affected by the disease appeared to feel the cold and hot stimuli, so remind the family forbidden to use hot water bags and other warming devices to help warm up when it is cold. Otherwise it will cause serious consequences such as burns.
*The patient's limb activity is unfavorable with incontinence, pay attention to the protection of the skin, clean the perineal skin after each stool, keep dry, can be appropriate to apply talcum powder, every two hours the nurse will be given to the patient to turn over, patting the back, to avoid paralyzed limbs of the skin for a long time under pressure, necrosis, the occurrence of bedsores.
*1~2 weeks after the onset of the disease, the condition is basically stable, can be carried out as early as possible for the affected limbs functional exercise, three times a day, each time ranging from 10~20 times, massage, passive activities, can prevent the joints adhesion, muscle atrophy. Later, the number of exercises can be increased to help early recovery.
Exercise methods:
*Begin with deep breathing and simple active movements, focusing on the stretching of the hemiplegic side of the arms and legs: shoulder abduction, upper limb stretching, lower limb bending.
*Maintain the functional position of the limbs with pillow pads and wooden frames between exercises to prevent deformities such as upper limb flexion and foot drop.
*Can gradually increase the sitting, standing, walking exercises, correct gait walking, going up and down the stairs. Pay attention to strengthen protection to prevent accidents such as falls.
*After the initial recovery of upper limb function, focus on wall climbing, grasping and placing objects, coiling walnuts and other exercises, and strengthen the self-care ability to practice: eating, combing, dressing and undressing.
*Further improvement of the situation, can be writing, knitting, gardening and other labor therapy.
How to communicate with aphasic patients?
1). Speak in short, clear sentences, a little slower than normal.
2). Encourage speech, don't force it, and ask simple, direct questions so that the patient can answer "yes" or "no".
3). For people with serious communication problems, you can use gestures and facial expressions to express your opinion, and you can also encourage the patient to use gestures to communicate.
4). Whenever you talk to a patient, give him enough time to think and organize what he is saying.
5). Talk to him using names and terms he is familiar with.
What is cerebral hemorrhage? In medical terms, it means ruling out traumatic brain hemorrhage, of which high blood pressure is the most common trigger. If someone has a sudden severe headache, dizziness with nausea, vomiting, unfavorable movement of the hands and feet or suddenly can not speak, confusion, incontinence, and elevated blood pressure, a cerebral hemorrhage may have occurred.
Health education
1. The patient needs a quiet, comfortable environment, especially within 2 weeks of the onset of the disease, should minimize visits, maintain a calm, stable mood, to avoid all kinds of adverse emotional effects.
2. Absolute bed rest for 2 weeks, the head can gently turn to the right and left, should avoid excessive moving or elevating the head, limbs can be in bed for a small turn, once every 2 hours, do not have to be overly nervous. Urination and defecation must be carried out in bed, do not get out of bed to defecate, in order to prevent the accidental occurrence of bleeding again.
3. Some patients may have symptoms of restlessness and agitation, for which we will take protective measures such as restraining belts and bed stalls to prevent unnecessary accidents such as removing the infusion tube or gastric tube by themselves or falling out of bed. Some family members may be reluctant to do so, and we understand their feelings. Once the condition is stabilized and no longer irritable, we will immediately withdraw the restraint of the torso, but the bed gear still needs to be guarded at all times, especially for patients with air mattress beds, to prevent falling out of bed. I hope you can cooperate.
4. Different degrees of headache will also occur during the course of the disease, such as head swelling, pinprick-like pain, severe pain and so on, which is the most common symptom. We will give reasonable treatment. As the condition improves, the headache will gradually disappear, so you do not need to be overly nervous and learn to distract yourself. If you still feel the pain is so severe that you cannot tolerate it during the treatment, please inform us in time so that the doctor can take more effective treatment.
5. Elderly patients, cardiovascular and cerebrovascular aging, high degree of brittleness, seasonal changes are easy to induce disease. Long-term bedridden easy lung infection, sputum is not easy to cough up, medication expectorant, strengthen turning, patting the back, so that sputum loose coughing, reduce lung infection. Those who are unable to cough up sputum, take suction measures, hope to be able to cooperate.
6. Long-term bed rest, skin pressure for more than 2 hours, easy to occur bedsores, should strengthen turning. Massage the pressure place, keep the skin clean and dry. The limbs are placed in functional positions to prevent deformity.
7. Diet: nutritious, low-fat, light soft food, such as eggs, soy products. For those who have difficulty in eating, head can be tilted to one side, feeding speed is slow, avoiding conversation, preventing choking and suffocation.
8. Keep the bowels clear, can eat bananas, honey, more water, strengthen the moderate turning, massage the abdomen, reduce constipation. The patient several days without defecation or defecation, can be used to slow the excretion of agents, induced defecation. Do not hold your breath to prevent cerebral hemorrhage.
9. During the recovery period, according to the doctor's advice, the head of the bed should be shaken up for 10~15○, and then gradually shaken up to semi-recumbent position according to the degree of tolerance and adaptability, ranging from 30 minutes to 1~2 hours per day.
10. Hypertension is a common cause of this disease. Taking antihypertensive drugs should be on time and quantitatively, do not arbitrarily increase or decrease the amount of drugs, to prevent sudden rise and fall of blood pressure, aggravate the condition.
11. After discharge from the hospital, regular outpatient follow-up, monitoring blood pressure, blood lipids, etc., appropriate physical activities, such as walking, tai chi, and so on.
Diet for patients with cerebral hemorrhage
In addition to medication, reasonable diet also plays an important role in recovery.
If the condition of stroke patients has been stabilized, but there are different degrees of impaired consciousness, dysphagia, nasal feeding diet should be used, the easily digestible fluid diet, such as concentrated rice soup, soy milk, milk, fresh vegetable juice, fruit juice, etc., or 5-6 times into the mixed milk 1000-2000 ml, the infused food Should not be too hot or too cold, to 37 ℃ -39 ℃ is appropriate. Mixed milk preparation of raw materials required for fresh milk 600 ml, 350 ml of thick rice soup, 2 eggs, 50 grams of sugar, 10 grams of sesame oil, and 3 grams of salt. Preparation method is divided into three steps: (1) clean eggs cracked into a clean container, add sugar, salt, oil, stir with chopsticks; (2) 600 ml of fresh milk and 350 ml of rice soup mix boiling; (3) made of egg mixture poured into the boiling milk and rice soup, pouring while stirring with chopsticks, that is, 1000 ml of mixed milk. This 1000 ml of mixed milk contains 40 grams of egg white, 40 grams of fat, 120 grams of sugar, 4184 kilojoules of calories (1000 kcal). If you have diabetes, you should not add sugar.
If the stroke patient is conscious, but sometimes choking when eating, it should be given a paste diet, which consists of steamed egg custard, thick congee with minced meat and vegetables, rotten noodles with minced meat and vegetables, milk with lotus root powder, fruit puree or rice with a masher and then give the patient to eat.
Stroke patients recovering without swallowing difficulties, it is appropriate to light, less greasy, easy to digest soft balanced diet.
First of all, animal fats, such as lard, butter, cream, etc., as well as foods containing high cholesterol, such as egg yolks, fish roe, animal offal, fatty meats, etc., should be limited, because saturated fatty acids contained in these foods can significantly increase the concentration of cholesterol in the blood, and promote atherosclerosis; vegetable oils, such as soybean oil, tea oil, sesame oil, peanut oil, etc., can be used, because unsaturated fats can promote the excretion of cholesterol and the conversion of cholesterol into cholesterol, which can be converted into cholesterol by the patient. Cholesterol excretion and conversion to bile acids, so as to reduce blood cholesterol content, delay and reduce the purpose of atherosclerosis.
Secondly, the diet should be appropriate protein, often eat some egg white, lean meat, fish and various beans and soy products, in order to supply the body with the required amino acids. General daily drink milk and sour milk a cup, because milk contains milk factor and whey acid, can inhibit the synthesis of cholesterol in the body, reduce blood fat and cholesterol content. When drinking milk, you can remove the milk skin. Beans contain soybean steroids, also has the role of promoting cholesterol discharge.
Third, we should eat more fresh vegetables and fruits, because they contain vitamin C and potassium, magnesium and so on. Vitamin C can reduce cholesterol, enhance the denseness of blood vessels, prevent bleeding, potassium, magnesium and due to the tube has a protective effect.
Fourth, you can eat more on the knot iodine-rich foods, such as kelp, seaweed, shrimp, etc., iodine can reduce cholesterol deposition in the arterial wall, to prevent atherosclerosis.
Fifth, the daily salt in the 6 grams of salt is appropriate, because salt contains a lot of sodium ions, the human body intake of sodium ions too much, can increase the blood volume and the burden on the heart, and can increase the viscosity of the blood, so that the blood pressure rise, the stroke patients are not good.
Sixth, avoid foods that excite the nervous system, such as wine, strong tea, coffee and stimulating condiments. In addition, eat less chicken soup, broth, to protect the cardiovascular and cerebrovascular system and the nervous system is beneficial, and need to avoid overeating.
Family with stroke patients, you can generally choose the following auxiliary dietary supplements: 1. 6 grams of black fungus, soaked in water, added to the dishes or steamed food. Can lower blood fat, anti-thrombosis and anti-platelet aggregation.2. 5 celery root, 10 red dates, water decoction, eat dates and drink soup, can play a role in lowering blood cholesterol.3. Eat fresh hawthorn or hawthorn soak in boiling water, add the right amount of honey, cooled as tea. If stroke complicates diabetes, it is not suitable to add honey.4. 10-15 grams of raw garlic or onion can lower blood fat, and have enhanced fibrin activity and anti-vascular sclerosis.5. 5-10 milliliters of dietary vinegar after meals for stroke patients has the effect of softening blood vessels.
After cerebral hemorrhage--recovery has a trick
After treatment of cerebral hemorrhage patients, part of the life preserved, but left the sequelae of hemiplegia, especially the patient's hand, always like a fist like break can not be broken. Our family ancestry a trick, by pressing the patient's fingernail root, can make the hand stretch, if the pressure once a day, after seven or eight times, even if the original good hand is not restored to the extent of free stretching is not a problem.
The specific method is: the operator, with both hands of the thumb nail, press the patient's affected side of the nail root. Requirements must be pressed to the root of the nail, do not press the nail flesh. Position to find a good, gently a force, the patient's fingers then stretched out on their own, not more than 30 seconds, if you add the idea is better. The operator and the patient are reading "smooth meridians, cerebral blood vessels". The order of pressure is: the first pressure middle finger and thumb nail root (a strong finger will be stretched out), and then press the index finger and ring finger nail root, and finally repeat the pressure middle nail root with the root of the fingernail, before and after the pressure **** three times can be. (Sun Hongde, Changling County, Jilin Province)
After the patients with cerebral hemorrhage through the acute stage, the following issues should be noted:
(l) psychological care: the acute stage of the family and the patient's attention to the life-saving, while in the recovery period is often anxious to functionally restored, and asked to take care of themselves very soon, and even go to work. Request for new drugs, new methods of treatment is quite a lot; some patients show pessimism, disappointment, mental depression. Therefore, it is necessary to encourage patients to establish confidence in overcoming the disease, to be physically disabled, physically disabled, but also to have a strong will; to treat their own disease and function realistically, and strive to achieve a good prognosis. To cooperate well with medical personnel and family, *** with overcoming the disease. "If you are here, you are here." Otherwise, if you are eager to get well, you will be easy to be impatient, but not favorable.
(2) pay attention to the rational use of medication: because patients often suffer from several diseases or a variety of symptoms at the same time, the original doctor prescribed to a variety of drugs, friends or family members do not add their own use of many drugs. Too much, too chaotic application of drugs, the stomach, liver, kidney or hematopoietic system may have side effects, not only can not speed up the recovery, but can lead to other problems.
(3) Prevent recurrence of stroke; it is very meaningful to prevent recurrence during the recovery period. Because stroke can recur suddenly, the more episodes there are, the more the sequelae of each one add up, the worse the prognosis and the mortality rate increases greatly. In order to prevent reoccurrence, attention should be paid to stable blood pressure, appropriate amount of food intake, and the presence of cardiac and pulmonary comorbidities.
(4) Do a good job of family rehabilitation: the rehabilitation period is usually spent in the family, the family should know how to do a good job of family rehabilitation. Drugs are no longer the main therapy in this period.
(5) pay attention to the rehabilitation period care: including psychological care, basic care, to ensure that the patient's basic needs; good special care, depending on the specific patient, the condition of the nursing care, such as nasal feeding tubes, urinary catheters, bedsores care.
(6) Ensure proper nutrition and intake: Because stroke patients are often accompanied by aphasia, can not properly express their will, or choking, swallowing difficulties, can not ensure that the food, intake is often insufficient or excessive, the family should pay enough attention. The family should pay enough attention to this. Recipes should be set, the amount of food should be set, the time should be set for supplying, and if necessary, the food should be fed through the nasal tube.
(7) Smooth bowel movement: constipation and too much force during defecation can induce hemorrhagic cerebral middle age and cerebral embolism. In order to maintain a smooth stool, regular defecation, appropriate to eat celery, carrots, fruits and so on. If necessary, the use of drugs, such as tomato diarrhea when soaked in boiled water, Ma Ren Lunji pill, fruit guide, etc.