Nursing objectives and measures of brain stem hemorrhage and health education

First aid: keep the respiratory tract unobstructed, and take oxygen to expel phlegm. If respiratory depression occurs, intubate immediately. For patients who have been in coma for a long time, tracheotomy should be performed as soon as possible. This can not only significantly reduce respiratory resistance and dead space, but also maintain good ventilation, which is conducive to sputum aspiration. Use ventilator to assist breathing, improve hypoxia in time and prevent brain tissue damage. During the use of the ventilator, we should closely observe the respiratory and circulatory indexes of patients, regularly check the blood gas analysis, control the partial pressure of CO2 in patients at 30 mmHg ~ 35 mmHg (1mmHg = 0.133 kpa), suck out secretions from trachea, mouth and nose in time, strengthen airway humidification, and reduce sputum scab formation. Intravenous administration, rapid infusion of 20% mannitol, glycerol fructose, furosemide and other drugs, bedside ECG monitoring, closely observe the changes of vital signs, pupils, consciousness, urine volume, observe whether there is electrolyte disorder, and correct it in time if there are abnormal changes. Physical cooling and wearing an ice cap on the head can protect brain cells, reduce the oxygen consumption of brain tissue, help reduce the occurrence of brain edema and increase the tolerance of brain tissue to hypoxia. Puncture and drainage of lateral ventricle should be performed as soon as possible to prevent cerebral hernia and acute respiratory and circulatory failure at an early stage. If the course of disease exceeds 72 h, patients are prone to complications, such as MDSF (including central high fever, stress ulcer, cardiopulmonary insufficiency, etc. ) and cerebrospinal fluid circulation channel adhesion obstruction. The nursing drainage device of the ventricular drainage tube should be kept at a certain height, generally on the drainage incision at the puncture point 10 cm ~ 20 cm. The drainage device shall not be lifted at will. Pay attention to keep the dressing at the drainage puncture point dry, clean the incision and change the dressing in time. When turning over, dressing changing and going out for inspection, the drainage tube should be properly fixed to prevent the drainage tube from coming out. In this group, there were/kloc-0 cases of drainage tube prolapse, so it was necessary to replace the puncture site and puncture and drain again. Keep the drainage tube unobstructed continuously to prevent distortion and oppression. If necessary, rinse with 20 ml normal saline and 1000 U urokinase to facilitate blood clot outflow. Replace the drainage bag every day, the drainage device should be sealed, and pay attention to aseptic operation. The drainage bag should be below the incision site to prevent the drainage fluid from retrograde into the skull and cause intracranial infection. Observe the amount, nature and color of the drainage fluid closely. The ward was irradiated with ultraviolet light or disinfected with air disinfection machine twice a day, and the drainage tube was kept longer than that of ordinary cerebral hemorrhage. CT or MRI showed that most of the hematoma in the brain stem was absorbed and the edema subsided obviously. At the same time, the cerebrospinal fluid was cleared and the drainage volume was significantly reduced. After 48 hours, vital signs (breathing, pupils, consciousness, etc.) did not change. ). Considering extubation, it takes an average of15 d. The purpose of clamping the tube is to determine whether the cerebrospinal fluid circulation channel is unobstructed and prevent obstructive hydrocephalus from appearing again after extubation. After extubation, suture a needle at the scalp puncture point, apply pressure to wrap sterile dressing and elastic bandage, and observe whether cerebrospinal fluid leaks out until the incision is removed. Strengthening nutrition in patients with severe cerebral hemorrhage has caused great physiological and biochemical changes in many organs and systems of the whole body, including the brain. These high metabolism and severe negative nitrogen balance are manifested as weight loss, muscle atrophy and low immune function, which directly affect the survival of patients and the recovery of neurological function. Early nutritional support can promote the formation and regeneration of synapses, so a diet with high calorie, high protein and high vitamins should be given as soon as possible. After the patients who can't eat are in stable condition, they should adopt the method of enteral nutrition with indwelling gastric tube, pay attention to the nutritional structure of diet, eat a small amount, give nasal feeding ≤200 ml each time, and inject slowly at intervals of more than 2 hours to prevent reflux. The temperature of the diet should be around 40℃, and the amount of intake and withdrawal should be strictly recorded. Intravenous drip of amino acids, albumin and fat emulsion as instructed to improve the nutritional status of the body. Do basic nursing. Most patients with severe brain stem hemorrhage have central high fever and sweat a lot. Qin Ying changed clothes and bedding to keep her skin clean, and used 5% sodium bicarbonate solution for oral care twice a day to keep her mouth clean, moist and comfortable, so as to prevent oral infection. Lie on the padded bed, turn over and knock on your back every 2 hours, keep the bed clean, dry and wrinkle-free, and prevent complications such as bedsore and lung infection. Patients with indwelling catheter should use115 iodophor diluent to wipe the urethral orifice and perineum twice a day. For infected patients, 250 ml normal saline and 80,000 U gentamicin should be used to flush the bladder twice a day to keep the urine drainage unobstructed, dump the urine in time and prevent the urine from flowing backwards. Change the urine bag every day, change the urine tube every week, and strictly abide by the aseptic operation procedures to prevent urinary tract infection. Brain stem hemorrhage accounts for about 10% of cerebral hemorrhage, and severe cases are not uncommon. Because the lesions involve the ascending activation system of brain stem, descending sympathetic nerve fibers, respiratory and cardiovascular centers, the clinical manifestations are serious, and coma, intracerebral syndrome, central respiratory, circulatory failure, cerebral hernia, MOSF and so on are prone to occur. Xing et al. [3] reported that 13 patients with brainstem hemorrhage had an average bleeding volume of 7.8 ml, which was more than three times that of the survivors. In this article 19 cases, all of them have coma in different degrees, with low GCS score, dangerous condition and poor prognosis. However, after active treatment, the effective rate (marked improvement) of most cases is as high as 52.6%( 10/ 19), and the mortality rate is 26.3%(5/ 19). Although it is reported that the intracranial hematoma of severe brain stem hemorrhage has been cleared and stereotactic surgery has been successful [4], due to the high risk of surgery and the difficulty of popularization, conservative treatment is still the main treatment in clinic, and most patients have a very poor prognosis, and most of them die within 3 days due to brain stem failure and cerebral hernia. The preliminary results of this paper show that continuous cerebrospinal fluid drainage through lateral ventricle puncture is valuable to improve the prognosis of patients with severe brainstem hemorrhage. Brain stem hemorrhage should be diagnosed and treated early, and severe brain stem hemorrhage should be treated in acute stage (≤72 h). Puncture of lateral ventricle and continuous cerebrospinal fluid drainage as soon as possible, and operation before fatal complications, especially cerebral hernia. Active comprehensive medical measures, including dehydration to reduce intracranial pressure, cooling, prevention and treatment of stress peptic ulcer and bleeding, anti-infection, tracheotomy as soon as possible and ventilator-assisted/controlled breathing, are the basis for successful rescue and treatment.