I. Disease description of hypertensive cerebral hemorrhage
1, hypertensive cerebral hemorrhage is common in patients suffering from hypertensive atherosclerosis aged 50 to 70 years old, often triggered by strenuous activities or emotions, and bleeding sites in the internal capsule area are common.
2.The main manifestations are sudden impairment of consciousness, shortness of breath, slow pulse rate and elevated blood pressure, followed by hemorrhagic hemiplegia, incontinence, coma and complete paralysis in severe cases.
3.Surgery is often used to remove the diseased blood vessel or remove the hematoma.
4.CT and MRI can clarify the site and nature of hemorrhage.
Psychological guidance for hypertensive cerebral hemorrhage
Avoid emotional excitement, because when emotional excitement, sympathetic nerve excitation, causing small artery spasm, resulting in increased blood pressure, can trigger cerebral hemorrhage, or even life-threatening.
3. Dietary guidance for hypertensive cerebral hemorrhage
1, the diet should be light, into easy to digest, rich in coarse fiber food, in order to prevent constipation.
2. The speed of eating should not be too fast to prevent choking and coughing.
3, quit smoking and alcohol, avoid spicy, cold and stimulating food and excitatory drinks.
4. Fasting for 10-12 hours and drinking for 6-8 hours before general anesthesia to avoid vomiting after anesthesia, which may cause accidental aspiration.
Preoperative guidance for hypertensive cerebral hemorrhage
1. Visitation should be minimized to ensure sufficient sleep to promote appetite, restore physical strength and enhance body resistance.
2. Elevate the head of the bed 15-30 degrees when lying in bed to facilitate intracranial venous reflux and reduce intracranial pressure.
3, patients with a history of seizures should not take medication in the middle, so as not to induce a grand mal seizure.
4.Training bed urination and defecation to avoid constipation and urinary retention caused by unaccustomed defecation in bed after surgery.
5, do not go out alone, bed rest is the main, with intracerebral hemorrhage absolute bed rest; restless patients should be restrained limbs, sedation when necessary.
6.Keep the bowel movement smooth. Do not use force to defecate; for patients with habitual constipation, use light laxatives or low-pressure enemas.
7, patients with high blood pressure, adhere to drug therapy. Do not miss or discontinue antihypertensive drugs at will, as elevated blood pressure can lead to rupture of the diseased blood vessels.
8. Skin preparation: shave the head and then suck it clean with soap and hot water to avoid postoperative wound or intracranial infection; when it is cold, wear a cap after skin preparation to prevent cold.
V. Postoperative guidance for hypertensive cerebral hemorrhage
1. 6 hours after awakening from anesthesia, a small amount of liquid diet can be introduced without swallowing disorder, and then gradually changed to soft food.
2.Patients with persistent coma and swallowing dysfunction 24 hours after surgery should be fed nasal fluid diet. The temperature of nasal diet should be 38～40℃, elevate the head of the bed 15～30 degrees when nasal feeding, and do not change the body position of the patient half an hour after feeding to prevent food reflux.
3.After waking up, if the blood pressure is stable, elevate the head of the bed 15-30 degrees to facilitate intracranial venous reflux.
4.Encourage the patient to cough up sputum to increase lung capacity and prevent pulmonary complications.
5.Keep blood pressure stable: Postoperative blood pressure should be controlled at the patient’s basal blood pressure level, and the speed of antihypertensive drugs should not be adjusted faster or slower at will. Too high blood pressure can cause blood vessel rupture and bleeding at the operation site; too low blood pressure can cause cerebral ischemia and cerebral infarction.
Sixth, hypertensive cerebral hemorrhage discharge guidance
1, reasonable nutrition, keep the bowel movement smooth; diet should be light, easy to digest and rich in crude fiber to prevent constipation.
2, patients with high blood pressure, adhere to the doctor’s guidance to take medication. Do not change the dosage or stop taking the medication at will, so as not to increase blood pressure and induce bleeding.
3. Rehabilitation treatment.
(1) Hemiplegia.
①Take drugs that are beneficial to tissue repair under doctor’s guidance, together with hyperbaric oxygen, physiotherapy and acupuncture treatment, in order to promote the recovery of brain function.
(2) Massage the hemiplegic limb 6 to 10 times/day regularly to promote local blood circulation.
③Perform passive exercise of the paralyzed limb and active exercise of the healthy limb to prevent muscle atrophy.
④ Maintain the functional position of the limb. Use “L” splint to fix the ankle joint to prevent foot drop.
(2) Pronunciation instruction for aphasics.
(1) Start from pronouncing monotone sounds and gradually move to teaching patients to speak everyday words to train motor language function.
(2) Use radio and radio to let patients listen to familiar songs and favorite programs in the past to train their auditory language function.
③Train patients’ visual language function by teaching them to recognize their names and simple written symbols.
(3) Secondary epilepsy: Do not go out alone, do not climb high, ride a bicycle, swim, etc. Carry a certificate of illness with you and insist on taking anti-epileptic drugs for 3 to 5 years.