1.Quiet rest
(1) Create a quiet environment for the patient Avoid indoor noise and crying, and restrain your sad and painful expressions to reduce the adverse stimulation to the patient, which will help stabilize the patient’s blood pressure and intracranial pressure and reduce rebleeding.
(2) Remove the causes of patient agitation. Patients who are irritable should first look for adverse stimuli, such as headache due to high cranial pressure, bladder distension, hypertension, postural discomfort, bed discomfort, etc. If the patient is still agitated after excluding the above causes of agitation, sedation can be used to calm the patient. Valium, phenobarbital, chlorpromazine and other drugs can be used appropriately, but the dose should not be too large, so as not to affect the observation of the state of consciousness, and morphine drugs should be used carefully to avoid inhibiting breathing.
2.Control hypertension
Hypertension leads to cerebral hemorrhage occurs its inescapable responsibility. Control of hypertension to the normal line or slightly above normal can greatly reduce the risk of cerebral rebleeding. If the blood pressure is lowered to below the patient’s usual blood pressure, a reduction in cerebral blood flow will occur, leading to cerebral infarction. Therefore, blood pressure should not be lowered too low, and reference should be made to the original blood pressure level. Appropriate antihypertensive drugs should be selected to gradually lower the blood pressure to the original level before cerebral hemorrhage or to a slightly higher level. In the acute stage, it is not advocated to apply oral hypotensive drugs because their effect is slow, which is not conducive to effective and rapid blood pressure lowering and prevention and control of rebleeding, so the route of intravenous administration is mostly chosen, and nitroglycerin injection 5-10mg or sodium nitroprusside injection 50mg diluted with 5% glucose solution 250 can be used for slow sedation or pumped slowly with a micropump, and blood pressure is monitored every 15 minutes or half an hour, according to the blood pressure Monitor blood pressure every 15 minutes or half an hour, and control the titration rate of antihypertensive drugs according to the blood pressure until the blood pressure drops to the upper line of normal systolic blood pressure or slightly above normal. The systolic blood pressure (i.e. high pressure) is usually controlled between 130-150 mmHg. Ye, Department of Neurology, Jingdezhen First People’s Hospital
3.Keep the airway open and prevent lung infection
Most patients with cerebral hemorrhage have impaired consciousness and are prone to posterior tongue drop, while there are more secretions in the mouth, throat and trachea, which are not easily discharged, and the respiratory tract is not open, making it easy to have life-threatening lung infections due to lack of oxygen. Prevention of pulmonary infection in comatose patients with cerebral hemorrhage becomes an indispensable rescue measure in the treatment of cerebral hemorrhage. Maintain the lateral position to prevent vomit aspiration into the trachea to aggravate the lung infection; timely aspiration to remove respiratory secretions, sodium heptaoside drug to control pulmonary venous exudate, oxygen, prophylactic application of antimicrobial agents, nutritional support and other comprehensive treatment can only be effective. Some patients with heavy pulmonary infection, oxygen saturation below 90% for a long time, by the above comprehensive measures can not correct hypoxia, it is necessary to perform tracheotomy to control pulmonary infection.
4.Control cerebral edema
Acute cerebral hemorrhage is often accompanied by different degrees of cerebral edema, which reaches its peak within 5-7 days and can cause life-threatening cerebral herniation, so active control of cerebral edema and reduction of intracranial pressure are the top priorities in the treatment of cerebral hemorrhage. The program is as follows.
(1) 20% mannitol 250ml IV, finished within 30 minutes, and every 6-8 hours depending on the condition. Since cerebral edema continues for 3-5 days after reaching its peak, it is advisable to start reducing the dosage of mannitol 12-14 days after the onset of the disease and stop using it after 3-5 days.
(2) Diuretics: often used in combination with dehydrating agents to enhance the effect of lowering cranial pressure. Generally, tachyphylaxis 20-40mg is used for 2-3 times daily for 3-5 days. The side effect is easy to cause low potassium, should pay attention to correct.
5.Low temperature treatment
Put an ice bag on the head to reduce the metabolism of brain cells, while cooling can reduce cerebral edema.
6.No or less use of hemostatic drugs
Although it is generally believed that intracerebral hemorrhage is difficult to be stopped by drugs, but for punctate hemorrhage, oozing blood, especially when complicated by gastrointestinal bleeding, or when accompanied by coagulation disorders and bleeding tendency, hemostatic drugs may play a certain role, so clinically appropriate for patients with cerebral hemorrhage can be used. Such as haemostatic aromatic acid, anlagen, etc. Modern research believes that: hemagglutinin is the main cause of inducing and aggravating cerebral edema. However, blind application of hemostatic agents has the risk of ischemic stroke or myocardial infarction by arteriosclerosis, and there is a risk of aggravating cerebral edema and life-threatening cerebral herniation. Therefore, the need for hemostatic drugs should be based on the situation.
7. Maintain nutrition, water-electrolyte, acid-base balance
The daily intravenous rehydration of adult patients in coma and fasting should not be too much and too fast, and the daily intake should not exceed 2500ml, including 500ml of saline, and the intake of fluid should be limited to 1500ml for those with complications of heart disease and poor cardiac function, and the water-electrolyte and acid-base balance should be adjusted according to the laboratory index. The nasal tube should be changed once a week.) The nasal feeding tube should be changed once a week to prevent esophagitis.
8.Actively prevent and treat complications
There are many complications in patients with cerebral hemorrhage, such as pulmonary infection, urinary tract infection, central respiratory failure, decubitus ulcer, gastrointestinal bleeding, cardiac arrhythmia, renal failure, etc. While actively resuscitating, pay attention to the detection and timely treatment of these complications.
9. Routine review of cranial CT after 24 hours
The purpose is to detect early whether there is rebleeding and the amount of rebleeding, and adjust the treatment strategy in time. The reason for the review is that the chance of rebleeding within 24 hours is extremely high, so early review, early detection and early treatment.
In conclusion, the treatment of cerebral hemorrhage in the acute stage lies in controlling blood pressure, preventing rebleeding, controlling cerebral edema, preventing and controlling complications, etc., so that the patient can gradually get out of danger and enter the recovery period smoothly.