脑血管病的护理体会 摘要：目的：探讨脑血管病的护理方法。方法：通过对60例脑血管病患者的护理，根据疾病的不同时期采取不同的护理措施。结果：60例患者中，治愈38例，好转18例，无变化2例，死亡2例。结论：根据疾病的不同时期采取不同的护理措施有助于疾病恢复及减少并发症的发生。 关键词： 脑血管病； 护理体会 The Nursing Experience on Cardio-cerebral Vascular Disease Abstract：Objective: To probe the nursing of cardio-cerebral vascular Method: 60 patients of cerebral ascular disease were selected and different nursing cares were adopted dy different stages of the Result: In all 60 patients，38 cases were cured，18 cases were improved，2 cases had no change， and 2 cases Conclusion: The nursing method above can help cardio-cerebral vascular disease recovered and can decrease the Key words： Cardio-cerebral vascular disease； The nursing experience 1 临床资料 1 一般资料：本组男8例，女22例，最大年龄76岁，最小年龄36岁，脑血栓形成35例，脑出血25例，其它4例。 2 治疗转归：治愈38例，好转18例，无变化2例，死亡2例。 2 观察与护理 1 病情观察 1 意识：意识的变化往往能提示病情的轻重，应了解发病时意识状态和昏迷程度，本组病人有意识障碍21例。 2 瞳孔：观察瞳孔是否等大等圆、对光反射是否存在等。瞳孔的改变能提示病变的部位及病的加重或减轻。 3 生命体征：①血压可以反映颅内情况改变，颅内压升高要引起血压升高，血压升高对脑出血病人不利，可致再次出血；血压过低可致脑供血不足，可加重脑血栓形成病人的病变；脑出血可以通过多个环节引起颅内压增高，甚至并发脑疝而死。因此，血压高低可作为使用降颅内压药物的依据；②脉搏缓慢时说明有颅内压增高趋势；③发热的原因有中枢性或感染性发热，如果体温低、四肢厥冷则说明有休克的可能;④呼吸频率是否规则和呼吸的深浅，如出现叹息样呼吸、潮式呼吸，鼾音则表示病情严重。 4 观察肢体运动：脑血管病多伴有肢体瘫痪。本组病例几乎全部有程度不一的肢体瘫痪或麻木，活动受限，多为一侧肢体。肢体缓解及加重亦说明脑血管病的变化。 2 急性期的护理 1 休息：脑出血病人应绝对卧床休息，尽量减少探视和不必要的搬动，更换床位时注意移动头部要轻，慢，稳。脑缺血病人在1周以内应完全卧床休息，禁用冰袋。 2 保持呼吸道通畅：呼吸衰竭受颅内压影响，对有缺氧病人要及时给氧，有意识障碍病人为防止其舌根后坠堵塞呼吸道，可插入导气管，及时吸净气管内分泌物。 3 抽搐和瘫痪的护理：因为有抽搐的可能，必须准确地给予镇静药物，仔细观察抽搐状态及持续时间，抽搐的部位。有肢体瘫痪者，为了防止关节变形和肌肉萎缩，要保持肢体功能位置，根据病人的情况进行肌腱伸展运动和关节曲伸运动。 4 排泄的护理：意识障碍的病人常有排尿排便障碍，对于尿潴留者应留置尿管，防治尿路感染，每天膀胱冲洗，尿道口抹洗;有排便困难者，应予缓泻药物或人工排便。 3 预防并发症的护理：由于病人昏迷及长期卧床，易并发肺炎及褥疮，为此，要定时按摩或理疗，还要配合其他辅助方法，经常保持皮肤清洁干燥，床单整洁平坦。 4 脑血管的心理护理及恢复期功能锻炼：瘫痪病人重者终日卧床，轻者有肢体活动不便，尤其是再瘫痪者，常有尿潴留或大小便失禁，生活不能自理，精神萎靡，容易悲观失望。所以，在护理工作中，对病人要有特别的耐心，关怀体贴，尽量做到细致，及时热情满足病人合理要求。同时要注意病人情绪，多安慰病人，解除病人思想顾虑，鼓励病人树立战胜疾病的信心。早期活动能减少肺部感染和下肢静脉血栓的发生。脑血管病人急性期过后可逐步增加活动，进行功能锻炼，护理上通过对瘫痪肢体的按摩及活动，可防止肢体的萎缩和畸形。对后天失语症要积极进行语言的再训练。针灸对神经功能的恢复有帮助，对肢体瘫痪可取穴曲池、合谷、环跳、足三里、昆仑，失语可用哑门、廉泉等穴位。 参考文献： 〔1〕 韩仲岩．实用脑血管病学〔M〕．上海：科学技术出版社，388． 〔2〕 成慧琴，王环宇．微创颅内血肿清除术后潜在并发症的预见性护理31例〔J〕．中华实用护理杂志，20（3）：11．
Increased Blood Sugar on hemorrhagic stroke (hemorrhagic apoplexy) the occurrence and development are very important influence， not only as an important risk factor involved in the beginning of HA， resulting in increased incidence of disease， but also to HA after the occurrence of pathological process has a catalytic role to enable hematoma volume expansion， increased edema， increased impairment， affect the High blood sugar involved in the mechanism of HA， are manifold， including: lipid metabolic abnormalities， carotid artery remodeling， endothelial dysfunction， platelet dysfunction， hypercoagulability， insulin Expansion of infarct size and high blood sugar and promoting the development of HA mainly caused by acid poisoning， ischemic injury in areas of apoptosis and other Vascular endothelial growth factor (VEGF) and cyclooxygenase (COX-2) and cerebral vascular disease， has attracted people's Vascular endothelial growth factor induced by the prominent role of angiogenesis in vivo and improve vascular permeability; discovered in recent years it also has to stimulate the neurons， glial cells， axonal growth and survival COX (cyclooxygenase， COX)， is catalyzed arachidonic acid (arachidonic acid， AA) synthesis of prostaglandins (prostgalandin， PG) and thromboxane (thromboxan， TX) of the rate-limiting One COX-1 for structural type， exist in most organizations， the catalyst is generated to maintain the normal structure of the PG; COX-2 is induced in physiological conditions， COX-2 in most tissues at very low copy number However， IL-1， TNF and many other inflammation-stimulating factor can induce COX-2 However， current vascular endothelial growth factor and cyclooxygenase Most studies focused on the relationship between cerebral ischemia and brain edema after intracerebral hemorrhage on the dynamic changes of VEGF， COX-2 expression in correlation among In recognition of hyperglycemia on cerebral hemorrhage injury in danger at the same time， control， treatment of blood glucose levels become a means of treating cerebrovascular disease， in particular， is used to reduce blood sugar levels of insulin into the acute stroke treatment Has been found that insulin on acute cerebral hemorrhage around the brain tissue has a protective effect of ischemic Possible mechanisms are: the brain has been found that the existence of insulin receptors， insulin and insulin receptor binding may reduce the brain cells of glucose uptake， thereby reducing the storage of sugar within the brain cells， reduce lactic acid produced by the substrate， fundamentally correct cellular acidosis; the same time， can also lower blood sugar， insulin concentration， increased bleeding surrounding edema and effective blood supply， resulting in relatively low perfusion state of high blood sugar， thereby improving effect of brain damage was the In order to understand these two cytokines and diabetes mellitus the relationship between cerebral hemorrhage injury， this study of diabetes on the basis of the model to be adopted by autologous blood injection method to establish a stable animal model of cerebral hemorrhage in this dynamic observation of cerebral hemorrhage on the basis of After the behavioral and brain water content trends， analysis VEGF and COX-2 in the hemorrhagic brain tissue distribution and expression changes， and then explore the VEGF and COX-2 in brain tissue damage in cerebral hemorrhage the role and significance， compared to diabetes rats and normal blood sugar difference between the volume of brain edema in rats with an initial observation of the two factors in diabetic rats and normal blood sugar difference between the expression of rat brain hemorrhage， with a view to the treatment of cerebral hemorrhage provide new ways and Materials and methods Experimental animals and grouping Healthy adult male Wistar rats， a total of 96， weighing 250 to 280 grams from the Experimental Animal Center of Zhengzhou U In accordance with the principles of randomized experimental animals were divided into four groups， namely sham operation group， normal blood glucose group， high glucose group and the insulin intervention Prizes will be awarded 4 points each time: 6h， 24h， 72h， At each time points are located at 6 High blood sugar and insulin production in rat model of intervention methods Prepared by the light of STZ-induced hyperglycemia in With STZ 60mg/kg， high blood sugar and insulin in the intervention group rats a single intraperitoneal Value for four rats with normal blood sugar a 6mmol / L， a week after injection， blood glucose ≥ 1mmol / L for a successful model for alternative Model of high blood sugar after the success of the intervention group I rats were normal insulin， abdominal subcutaneous injection， 3 times / d， 4U / times qd for 3 days， the measured blood sugar value of the normal
