I. Introduction of the disease
1. Hypertensive cerebral hemorrhage is mostly seen in patients aged 50-60 years old who suffer from hypertensive atherosclerosis, often triggered by strenuous activities or emotional excitement. The site of hemorrhage is mostly in the internal capsule area.
2.The main manifestations are sudden impairment of consciousness, shortness of breath, slow pulse rate, elevated blood pressure, followed by hemiplegia, incontinence, coma and complete paralysis in severe cases.
3.Surgery is often used to remove the diseased vessels or remove the hematoma.
4.CT and MRI can clarify the site and nature of bleeding.
II. Psychological guidance
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.
Three, dietary guidance
1.Eating should be light and easy to digest, rich in coarse fiber food 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.
IV. Pre-operative guidance
1.Visiting 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 interrupt their medication to avoid triggering grand mal seizures.
4.Training bed urination and defecation to avoid constipation and urinary retention after surgery due to unaccustomed defecation in bed.
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 urine and stool unobstructed. Do not use force to defecate; for patients with habitual constipation, use light laxatives or low-pressure enemas.
7, high blood pressure patients, adhere to drug therapy. Do not miss or discontinue antihypertensive drugs at will, because when blood pressure rises, it can lead to rupture of the lesioned blood vessels.
8. Skin preparation: wash the head with soap and hot water after shaving to avoid postoperative wound or intracranial infection; when it is cold, wear a cap after skin preparation to prevent cold.
V. Postoperative guidance
1. 6 hours after awakening from anesthesia, a small amount of liquid diet may be given 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, and the head of the bed should be elevated 15~30 degrees during nasal feeding. Do not change the patient’s position 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 and excrete 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 may cause blood vessel rupture and bleeding at the surgical site; too low blood pressure may cause cerebral ischemia and cerebral infarction.
Sixth, discharge guidance
1.Rational nutrition, keep bowel movement smooth.
2. Insist on taking antihypertensive drugs under the guidance of the doctor. Do not change the dosage or stop taking drugs at will. To avoid the rise of blood pressure and induce bleeding.
3.Rehabilitation helps to restore the functional position of the limbs and restore the body mass.
4.Rehabilitation guidance.
(1) Paraplegia: ①Take drugs conducive to tissue repair under the guidance of the doctor, together with hyperbaric oxygen, physiotherapy and acupuncture treatment to promote the recovery of brain function. (2) Massage the paralyzed 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 aphasic patients: ① Start from pronouncing monotone sounds and gradually move to teaching patients to speak everyday words to train motor language function. (2) Use the form of listening to radio and broadcasting to let the patient listen to familiar songs and favorite programs in the past to train the patient’s auditory language function. ③Train patients’ visual language function by teaching them to recognize their own names and simple written symbols.
(3) Secondary epilepsy: not to go out alone, not to 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.