北大人民医院神经内科健康教育指南

北大人民医院神经内科健康教育指南 一、 脑血管疾病健康教育 急性脑血管病又称为脑卒中～是各种原因导致脑血管发生病变～引起脑部疾病的总称。我国脑卒中的发病率为120~180/10万～死亡率为60~120/10万。它与心脏病、恶性肿瘤并称为大多数国家的三大致死疾病。由于公众对脑血管病的危险因素认识不足～不重视体检～不健康的生活方式向年轻化、普遍化蔓延～因而在我国脑血管病病死率有降低趋势的状况下～脑血管病的发病率却在上升。因此它的早期诊断、治疗和预防极为重要～预防脑卒中的关键是健康教育。特别提醒大家～脑卒中是可以预防的～并且大多数是可以治愈的～脑血管病的早期治疗对于降低死亡率和致残率非常重要～因此～患者应尽量熟悉脑血管病的相关知识。脑卒中分为两大类～它们是缺血性卒中,短暂性脑缺血发作、脑血栓形成、脑栓塞、动脉硬化性脑梗死、腔隙性脑梗死,和出血性卒中,脑出血、蛛网膜下腔出血,。 二、 脑出血病人的健康教育 脑出血,intracerebral hemorrhage～ICH,俗称“脑溢血”～是指原发性非外伤性脑实质内出血。 1、病因:绝大多数脑出血是因高血压所致～以高血压病伴发的小动脉硬化在血压骤升时破裂所致。其他因素:脑动脉粥样硬化、先天性脑血管畸形、动脉瘤、血液病、脑动脉炎等。 2、诱发因素:高血压(服用降压药物不当～导致血压不降或降得过低)、情绪不佳,指生气、激动、焦虑、悲伤、惊吓、恐惧等,、用力排便、气候变化、饮食不节,暴饮暴食、酗酒成瘾,、在脑力紧张活动时易诱发脑出血。 3、用药的目的:降低颅内压～控制脑水肿～防止脑疝形成,控制血压防止进一步出血。 ,1,控制脑水肿～降低颅内压:常用药物包括甘露醇、甘油果糖、速尿等。 ,2,控制高血压:血压显著高于正常时给予降压药物～防止再出血。 4、各种检查的注意事项: ,1,CT:头颅CT检查目的是协助诊断和确定病变的部位～对人体无危害～也没有痛苦。 RI,是一种以磁场值标记人体内共振核的位臵～通过原,2,核磁共振,M 子核对外界磁力的反应来获取被检体化学信息的一种全新。常用于脑血管病变的检查。检查时注意事项患者要安静～保持不动,身体内不能有金属物体:如钥匙、手、起搏器、金属支架等。 ,3,其他检查:在发病急性期～可约床旁检查～如胸片、彩超等。 5、饮食指导 ,1,急性期饮食:因脑出血后需要绝对卧床休息～体力活动减少～应食用易消化吸收的流食或半流食。流食如牛奶、豆浆、米汤、菜汤等～易于消化吞咽～每日6次～每次200ml~250ml,半流食如粥、面片汤、面条汤、馄炖等软烂、易消(a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide 化、易咀嚼的饮食～每日5次。必要时给予鼻饲饮食。 ,2,恢复期饮食: 1,低盐:食盐的摄入量<2g/日～少食含盐多的食品～如咸菜、酱菜、酱油、腌制品、海产品等。 2,低脂肪:肉类75g/日～可食瘦肉、牛羊肉、去皮禽肉、鱼～少食肥肉、加工肉制品、油炸食物、动物内脏等,食用油20g/日～可食用色拉油、花生油～避免动物油、黄油等。 3,粗纤维饮食:多食含纤维素多的食物～如芹菜、韭菜、菠菜、粗粮、豆类、谷类、新鲜蔬菜水果类等～可促进肠蠕动～预防大便干燥。 6、活动与锻炼 ,1,开始锻炼的时机 50-60,的病人在脑卒中之后可以恢复到生活自理～80,可以重新获得行走的能力。中风发生后～应在急性期生命体征稳定就立即开始～中风病人在发病头3个月中～功能改善最大～即便如此～康复锻炼也应持续更长时间～以防功能减退。 ,2,锻炼的原则 早期开始～先主动～后被动,瘫痪肢体各个肌肉、关节都要锻炼到,不能过分劳累～要在病人能承受的范围内,要重视对病人的心理治疗,应重视对于深静脉血栓形成的预防,应重视对于卒中复发和卒中合并症的治疗。 ,3,急性期的锻炼方法 病人生命体征平稳后即可进行活动与锻炼～脑出血后7，14天。 1,急性期:要绝对卧床休息。每2小时翻身1次～尽量减少仰卧位。同时保持各肢体于功能位。功能位是将患肢是将患肢平放～手关节稍背屈～肘关节稍屈曲～上肢稍高于肩部水平～避免关节内收～下肢用夹板将足底垫起～使踝关节呈90度角～避免足下垂～膝关节下垫一小枕～使腿微屈～并支托外侧～避免下肢外旋。以上方法由护士协助。病情稳定后～由护士指导或家属协在床上锻炼～适于体力弱的病人。 2,关节活动:被动运动活动顺序为先大关节后小关节～幅度从大到小。患者也可用健侧帮助患肢进行被动运动～以避免健侧肢体功能退化。按摩可促进血液、淋巴液回流～对肢体功能恢复也有帮助。 ,4,恢复期的锻炼方法 1,良肢位的摆放: ?仰卧位方法:头部放在枕头上～面部朝向患侧～枕头高度要适当～胸椎不得出现屈曲。患侧臀部下方垫一个小枕头～使患侧骨盆向前突～防止髋关节屈曲、外旋。患侧肩关节下方垫一个小枕头～使肩胛骨向前突。上肢肘关节伸展～臵于枕头上～腕关节背伸～手指伸展。下肢大腿及小腿中部各放一沙袋～防止髋关节外展、外旋。 ?患侧在下方的侧卧位方法:患侧肩胛带向前伸、肩关节屈曲～肘关节伸展。 前臂旋后～腕关节背伸～手指伸展。患侧下肢伸展～膝关节轻度屈曲。健侧下肢髋关节、膝关节屈曲～下面垫一个枕头～背部挤放一个枕头～躯干可依靠其上～取放松体位。 (a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide 以上两种卧位对患侧不良刺激较大～容易诱发异常的反射活动～因此不宜长时间采用。 ?患侧在上方的侧卧位方法:最佳选择。在侧卧着的患者躯干的前面和后面～各垫放一块高枕～用以保持身体的稳定。患侧上肢充分前伸,肩关节保持在屈曲о约100的位臵,患侧上肢下方垫一高枕。患侧下肢的下方需垫放一长枕～一直放至足部～防至踝关节出现内翻,髋关节和膝关节保持屈曲位。 2,卧位锻炼方法:为了预防关节挛缩和早期使患者体会正常的运动感觉～促使运动功能改善～在卧床期进行被动关节活动度维持训练是非常必要的。具体的被动活动范围可参考下列标准: оо 肩关节:屈曲0~90 оо 外展0~90 оо 外旋0~30оо 肘关节:屈曲20~120о 前臂:90旋后位，中立位 ?上肢的关节活动度训练 A:肩关节的屈曲和外展 治疗者一手握住患侧上肢做肩关节的屈曲和外展运动～另一侧手固定肩关节加以保护。 B:肩关节的内旋和外旋 另一手固定腕关节在90度范围内活动。做肩关节 治疗者一手固定肱骨近端, 的内旋、外旋被动运动要注意保护关节。 C:活动肩胛骨 在临床上～很多患者即使全身处于松弛状态的发病初期～肩胛骨周围的肌肉也会是异常紧张～在此期间不做任何处臵～肩胛骨会被周围的肌肉及其他组织固定住。所以充分活动肩胛骨～保持肩关节活动范围很重要。 治疗者一侧手握住患侧上肢～将患侧上肢固定于外旋位～另一侧手沿肩胛骨内侧缘将肩胛骨向上方、下方、前方推动。 D:肘关节的屈曲和伸展 治疗者一手扶持患肢腕关节上方～另一手固定肱骨远端～在完成肘关节屈曲的同时前臂旋后～屈曲135度。完成肘伸展的同时完成前臂旋前～伸展可达0，5度。 E:肘关节的旋前、旋后 治疗者一手扶持患侧腕关节使其背曲～另一手固定肱骨远端～使肘关节屈曲90度～并固定在体侧～进行从掌心向下与地面平行的位臵至掌心向上与地面平行的180度旋转。 F:腕关节的运动 治疗者一手固定前臂～另一手四指握患手的掌面～拇指在手背侧～充分地做好腕关节屈曲和伸展被动运动。 G:手指关节 掌指关节和手指关节都是挛缩的好发部位。治疗者一手在患手的尺侧固定～另一手四指在患手的手背侧～拇指在患手掌侧使掌指关节完成屈曲90度～伸展30，45度运动。 ? 下肢的关节活动度训练 A:髋关节的伸展 (a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide 治疗者一手将健侧下肢充分屈曲～以固定骨盆～另一手下压患侧膝关节～使髋关节充分伸展。 B:髋关节内收和外展 轻度外展健侧下肢～利用沙袋固定健侧下肢～治疗者一手托膝关节后方～另一手握足跟～做髋关节的内收和外展运动。 C:髋关节的内旋和外旋 患者呈髋关节屈曲位～治疗者一手扶持患者小腿近端～另一手固定足跟～以髋关节为轴～向内、外侧摆动小腿～完成髋关节的内旋和外旋。 D:股二头肌牵拉训练 方法1:治疗者一手固定健侧下肢维持伸展位～另一手保持患肢膝关节伸展～同时用肩部上扛动作完成髋关节屈曲～使股二头肌牵拉。 方法2:用沙袋固定健侧下肢～治疗者一手下压膝关节维持伸展～另一手上抬足部使髋关节屈曲。 E:踝关节的被动运动 足下垂严重影响步行能力～必须早期开始预防其发生。治疗者用一手固定踝关节上方～另一手握住足跟向后下方牵拉～同时用右手前臂将足底向踝关节屈曲方向运动。做被动的屈曲踝关节运动十分重要。 F:足趾被动运动 治疗者左手固定前脚掌～右手活动跖趾关节和趾趾关节。 ?训练的原则 A:早期开始～一般可在发病后病情稳定的2，3天进行。 B:患者应取仰卧位。 C:两侧均要进行训练～先做健侧～后做患侧。 D:活动某一个关节时～近端关节必须予以固定。 E:手法要轻柔适度～避免产生疼痛。 F:手法的速度要缓慢～有节奏～一般一个动作需要3，5秒。 G:被动关节活动每日3次～各关节的诸运动方向均要进行训练～每种运动各3，,次为宜。 оH:保持最大关节活动范围～肩水平外展不要超过90～否则易引起软组织损伤。 卧位的锻炼方法也可采用下列方法: ?深呼吸～6-8次, ?轮流屈曲一肘～同时握拳～再伸肘松拳～2-3个八拍, ?轮流屈曲一腿～足跟不抬起～再伸直～2-3个八拍, ?轮流举起一臂触摸头部～再放下～2-3个八拍, ?轮流抬起一腿～足跟离床～再放下～2—3个八拍。如有上肢瘫痪～举臂和屈肘需护理人员及家属协助进行。 3)坐位锻炼方法: ?双手上举挺胸吸气～放下呼气～6—8次, ?两手前平举～上举～侧举～放下～2-4个八拍, ?两下肢轮流抬起～伸膝～屈膝～放下～2-4个八拍, ?两上肢前平举～侧平举～同时挺胸～前平举放下～2—4个八拍, ?两下肢伸直～轮流抬高～放下～2-4个八拍。 4)站位锻炼方法: ?双手握住床尾栏杆～练习踏步动作3分钟～时间可根据体力逐渐延长, (a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide ?练习下蹲动作～必须有人保护～每次可做下蹲2-3次～先慢慢下蹲～慢慢站起～瘫痪肢体可进行被动练习～配合物理疗法～促进功能恢复。 三、 脑梗死病人的健康教育 脑梗死,cerebral infarction～CI,又称缺血性脑卒中～是由于脑部血液供应障碍～缺血、缺氧引起的局限性脑组织的缺血性坏死或脑软化。临床常类型有脑血栓形成、腔隙性脑梗死和脑栓塞等。脑梗死约占全部脑卒中的80%。脑血栓形成是血管内血栓逐步形成～管腔进行性狭窄～脑组织逐渐坏死～所以患者的症状可以逐渐加重到3，5天后才达到高峰。脑栓塞是血管、心脏内的栓子突然脱落～阻塞了远端的血管～引起急性的缺血发生～因此病人的其病很急～当时病情即到高峰。腔隙性脑梗死是指脑组织的小灶坏死～通常在1，2cm以内～可以没有急性起病的过程～也可以没有任何临床症状。 1、病因 引起脑梗塞的病因是动脉粥样硬化(动脉粥样硬化使脑血管的管腔狭窄闭塞)及各种原因的动脉炎。常见的伴发病是高血压～因高血压使动脉粥样硬化的发展加速、加重～因此高血压也是脑梗塞发病的病因之一。 2(脑梗塞的发生过程 脑梗塞可发于任何年龄～以脑动脉硬化为多～多数病人在睡眠、安静等血液流速缓慢、血压降低的情况下发生。发病前可有头昏、肢体麻木、短暂的失语等症状～但在数十分钟、数小时至24小时内可恢复～数天、数周或数月后可反复出现。 3(避免和减少脑梗死复发的因素 (1)控制高血压～减慢动脉硬化的发展～按要求服药～使血压维持在正常范围内。 (2)吸烟的患者应戒烟～因为吸烟使血小板聚集增高～促进血栓形成。 (3)患有糖尿病的患者～血糖应控制在正常水平～血糖升高可加速动脉硬化～促进脑梗死发生。 4(脑梗死的用药目的 ,1,静脉内溶栓治疗:在无禁忌症的情况下于发病6小时内溶栓。药物有尿激酶、巴曲酶、组织纤溶酶元激活物,rtPA,。 ,2,扩张血管～改善脑组织供血～常用药物有维血栓通、尼膜地平、西比灵等。 ,3,治疗脑水肿～降低颅内压～减轻头痛～控制脑疝的形成～常用药物为20,甘露醇。 (4)扩溶剂的使用～降低血粘度～增加血流速度～改善微循环。常用的有丹参等。 (5)抗凝治疗～常用的有口服阿斯匹林。阿斯匹林有抑制血小板聚集的作用～降低血小板粘附率。 ,6,预防深静脉血栓形成:速避凝等。 ,7,脑细胞保护治疗:目前没有特效的脑保护药物～但是降低体温～避免感染～可以有保护脑细胞的作用。也可用胞二磷胆碱、醒脑静等。 5(CT检查的目的 ,1,头颅CT:在发病48，72小时可发现病灶区呈低密度影。目的是鉴别和(a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide 协助诊断病变的部位～便于制定治疗。准备工作同脑出血。 ,2,核磁共振,MRI,是一种以磁场值标记人体内共振核的位臵～通过原子核对外界磁力的反应来获取被检体化学信息的一种全新方法。常用于脑血管病变的检查。检查时注意事项患者要安静～保持不动,身体内不能有金属物体:如钥匙、手表、起搏器、金属支架等。 ,3,颈动脉-椎动脉超声检查～TCD～ECG～超声心动图检查～凝血等。 6、饮食 ,1,流食或半流食:适用于大面积的脑梗死～病情稳定后可食用普通饮食。 ,2,普通饮食:同脑出血。 7、活动与锻炼:同脑出血。 四、 蛛网膜下腔出血病人的健康教育 蛛网膜下腔出血是指由各种原因引起的软脑膜血管破裂～血液流人蛛网膜下腔所致的临床综合症。 1、病因 最常见的原因是先天性动脉瘤～其次是脑血管畸形和高血压动脉硬化～各种感染引起的动脉炎、肿瘤破坏血管、血液病等。各个年龄均可发病～脑血管畸形多发生在青少年～先天性颅内动脉瘤破裂多在青年以后～老年以动脉硬化而致出血为多。 2、诱发因素 一般发病突然～发病前有明显的诱因～如剧烈运动、过劳、激动、用力排便、咳嗽、饮酒以及紧张的脑力活动等。 3、诊断要点 突然起病的剧烈头痛、呕吐、脖子硬～即可高度提示本病。如腰穿脑脊液呈均匀血性～压力增高～则可确诊。 4、用药的目的:原则是防止继续出血～防止继续发生血管痉挛～除去出血病因并预防复发。 ,1, 止血～预防再出血:常用的有6—氨基己酸、止血芳酸、止血敏等。 ,2, 预防和治疗脑血管痉挛:常使用钙离子拮抗剂～如尼莫通、尼膜地平 ,3, 控制血压:使血压维持在发病前平时所测的水平范围内～防止继续出 ,4, 治疗脑水肿:给予脱水剂20,甘露醇静脉快速滴注。 ,5, 绝对卧床4，6周～避免用力及情绪激动。 5、各种检查的项目、目的及注意事项 (1)cT检查:目的是确定蛛网膜下腔出血的原因～起到鉴别作用～检查前的准备与脑出血检查前的准备相同。 (2)脑脊液检查:目的是协助诊断～检测脑脊液的压力。 (3)方法及注意事项: ?方法:需行腰椎穿刺手术～手术很小～但需要病人很好的配合～在护士的协助下～病人双手抱膝～双膝向胸部屈曲～头向前屈～抱成球形～靠床沿侧卧～以增加腰椎间隙～使腰椎穿刺手术顺利进行。腰椎穿刺无任何危害～痛苦小～在穿刺部位局部麻醉后穿刺时无疼痛。 ?注意事项:腰椎穿刺后～去枕平卧4—6小时后～起床活动～术后3天不(a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide 洗澡～以防穿刺针眼未愈合发生感染。 6、饮食指导 蛛网膜下腔出血病人的饮食同脑出血病人的饮食。 7、活动与锻炼的方法同脑出血。 蛛网膜下腔出血的活动与锻炼方法与脑出血的活动与锻炼方法相同。 五、 脑卒中家庭急救要点 1、早期脑卒中发病的特点是:突然、一侧肢体无力或者麻木～主要的表现有: ,1,一侧面部或上、下肢突然感到麻木、无力～手持物掉落～口角歪斜、流口水。 ,2,突然说话不清～或听不懂别人讲话。 ,3,突然视物旋转～站立不能。 ,4,一过性视力障碍、眼前发黑～视物模糊。 ,5,突然性对近事遗忘。 ,6,出现难以忍受的头痛～症状逐渐加重或呈持续性～伴有恶心、呕吐。 2、脑卒中家庭急救方法 ,1,初步判断为脑血管意外以后～应使病人仰卧～头肩部稍垫高～头偏向一侧～防止痰液或呕吐物回吸入气管造成窒息～如果病人口鼻中有呕吐物阻塞～应设法抠出～保持呼吸道通畅。 ,2,解开病人领口纽扣～领带、裤带、胸罩～如有假牙也应取出。 ,3,如果病人是清醒的～应注意要安慰病人～缓解其紧张情绪。宜保持镇静～切勿慌张～不要悲哭或呼唤病人～避免造成病人的心理压力。 ,4,注意给病人保暖～防止受凉。 ,5,密切观察病情变化～经常呼唤病人～以了解意识情况。对躁动不安的病人～要加强保护～防止意外损伤。 ,6,有条件者呼叫救护车来运送病人～急救电话有120或999。若自行运送～在搬运病人时正确的方法是:2—3人同时用力～一人托住病人的头部和肩部,如果还有一人～则要托起病人腰背部及双脚～3人一起用力～平抬病人移至硬木板或担架上～不要在搬运时把病人扶直坐起～勿抱、拖、背、扛病人。 ,7,在没有医生明确诊断之前～切勿擅自作主给病人服用止血剂、安宫剂牛黄丸或其它药物。 ,8,尽量快速到达医院～最好在发病3小时之内。 六、 脑血管疾病保健与预防 一、 生活起居 1、饮食调整 按照多品种、适量与平衡的饮食原则～安排好一日三餐的食物～多吃对预防中风有益的食物。据报道～牛奶、鱼肉、黄豆、豆豉、花生、(a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide 大蒜、洋葱草莓等对预防血栓是有益的。 2、饮水充足 每日正常饮水量应达2000，2500毫升～老年人在不同程度上其血液具有浓、粘、聚、凝的特点～多饮水有利于降低粘度～减少脑血检形成的危险性。心脏病患者应限制入量。 3、戒降烟酒 要戒降烟酒～限制食盐摄入量～每天最好不超5克～同时饮食不要肥腻。 4、劳逸结合 用脑要适度～不要持续时间太长～避免过于疲劳而诱发脑中风。 5、生活规律 老年人生活要有规律～因为老年人生理调节和适应机能减退～生活无规律易使代谢紊乱～促进血栓形成。 6、忌饭后就睡 饭后血液聚集于胃肠～以助消化器官的血供～而脑部血供相对减少～同时吃过饭就睡～血压下降～可使脑部血供进一步减少～血流缓慢～易形成血栓。因此～最好饭后半小时再睡。 7、体位变化要缓慢 脑血栓形成往往发生于夜间～尤其是上厕所时刻～所以夜间入厕时一定清醒后～缓慢起床。其实～平时做家务也要注意体位变化不要太快～以免引起脑部缺血。 8、注意天气变化 老年人天气适应能力减弱～过冷过热皆可使血粘度增加～诱发脑中风～因此～气温变化骤冷骤热时一定要采取相应防护。 9、控制体重 通过运动消耗体内过多脂肪～以降低血脂减少脑中风危险性。 二、情志调养 情绪要稳定～经常保持乐观、豁达、愉快的心情～切忌狂喜、暴怒、忧思、悲痛。因长期精神紧张、情绪波动～易使神经体液调节机能紊乱～引起心脑血液循环紊乱而诱发中风。 三、运动疗法 生命在于运动～运动能使人强壮、K寿。运动的方式很多～如散步、慢跑、太极拳、气功等～根据自己的体质和病情～选择适合自己的运动项目～长期坚持。运动能促进血液循环和降低血脂～增强抗病力。 四、要预防脑卒中～除去保持良好的生活习惯和生活规律～还应尽量按以下要求做～早期干预治疗～力求防止或推迟脑卒中的发生。 1、每年至少测量血压一次～并积极治疗高血压。 2、检查心脏情况。 3、戒烟 4、饮酒适量 5、测定血浆胆固醇水平～如果水平过高～应采用膳食调节和药物疗法。 6、糖尿病人应遵医嘱调控好血糖水平。 7、进行有规律的体育锻炼。 8、减少钠与脂肪的摄入。 (a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide 9、检查是否有循环系统疾病～注意有无头晕、指趾变色、耳鸣等症状。 10、认识脑卒中的症状～一旦出现可疑的脑卒中发作～立即就诊。时间就是生命～3小时以内的治疗～效果明显提高。 七、 重症肌无力病人的健康教育指导 重症肌无力,myasthenia gravis～MG,是乙酰胆碱受体抗体,AchR-Ab,介导的、细胞免疫依赖的及补体参与的一种神经-肌肉接头,NMJ,处传递障碍的自身免疫性疾病～病变主要累及NMJ突处后膜上乙酰胆碱受体。 1(重症肌无力病因及表现 重症肌无力是一种慢性、自体免疫失常的疾病。发病原因与胸腺的慢性病毒感染有关～遗传为内因～感染为主要的外因。临床表现为部分或全身骨骼肌易于疲劳～呈波动性肌无力～通常在活动后加重～休息后减轻～晨轻暮重～病人自觉乏力、懒动、精神不佳～可累及眼肌、呼吸肌和膈肌等。 2(重症肌无力的诱发因素 发病诱因多为感染、精神创伤、过度疲劳、妊娠、分娩等。如患者为女性～应避免妊娠～减少病情发展恶化至危象。 3(用药的目的及注意事项 (1)加强肌肉的力量与耐力。 (2)缓解症状。 (3)维持营养及健康。 (4)抗胆碱酯酶药物常用的为溴化吡啶斯的明。如病人有饮食困难可在餐前半小时给药～如病人晨起行走困难～可在起床前服长效吡啶斯的明。因此病症状为晨轻暮重～给药剂量不同～应按时按量服药。其副作用是腹痛、腹泻、呕吐、支气管分泌物增多等。 (5)忌用对神经—肌肉传递阻滞的药物～如各种氨基甙类的抗生素、喹宁、喹宁丁、普鲁卡因酰胺、心得安、氯丙嗪～以及各种肌肉松弛剂等。 4(各种检查的目的和方法 (1)常用的试验方法:新斯的明皮下或肌肉注射～以协助诊断。 (2)取神经、肌肉做活检:重症肌无力活检的检查～一般是取肌肉活体组织做病理检查～了解神经肌肉接头处的变化。方法是取小腿或肩峰部肌肉～局部麻醉～切一小口～取出很小的一块肌肉神经做标本～伤口只须缝合一至两针～麻醉过后有些疼痛～服些一般的止痛药物均可止痛。伤口很快长好～一周内可以拆线。如取的是小腿肌肉标本～下床活动时有伤口的腿不要用力～可用拐杖协助行走～避免伤口愈合时间延长。 5(饮食指导 根据吞咽咀嚼困难及严重程度～选择易吞咽的食物～采用少量多餐的方式～应食用半流食～每日5次～要营养平衡～易消化～易咀嚼～便于重症肌无力病人吞咽咀嚼。无吞咽困难者可食用普通饮食～给予充分的时间用餐～不要催促。 6(活动与锻炼的方法 (1)维持适当的活动量。 (2)发病通常是在用力之后或晚上～最易感到肌肉无力～因此应给病人制(a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide 定适当的活动计划～根据病人情况～应在上午结合体力安排～体力很弱的病人应在床上进行活动～活动方法同脑出血。下午病人午休后再安排一次～能下床的病人～上午治疗后可在室内、楼道等进行活动～下午仍是午休后再进行一次活动锻炼～以病人不感疲劳为原则。 八、 单纯疱疹病毒性脑炎/病毒性脑膜炎病人的健康教育 单纯疱疹病毒性脑炎是由单纯疱疹病毒所引起的一种急性中枢神经系统的感染。本病无季节性～可见于任何年龄～20岁以下和40岁以上为多见～男女无差别。病毒性脑膜炎是一组由各种病毒感染引起的软脑膜,软膜和蛛网膜,弥漫性炎症综合征。 1(病因 ,1,单纯疱疹病毒性脑炎病因:单纯疱疹病毒感染以口、眼、脑的感染为主～大多数感染后病毒潜伏于三叉神经半月节内～于机体免疫功能降低时～潜伏的病毒激活～沿轴突人脑～也可通过嗅神经轴突直接侵犯脑组织～发生脑炎。 ,2,病毒性脑膜炎病因:85%，95%是由肠道病毒引起。 2(临床表现 ,1,单纯疱疹病毒性脑炎的临床表现:发病前有发热、全身不适、头痛、腹泻、明显精神行为异常、抽搐、意识障碍、口唇或生殖道等皮肤粘膜有疱疹等。 ,2,病毒性脑膜炎的临床表现:发热、头痛、脑膜刺激征等。 诱发因素的预防 3( 首先预防全身性的感染～预防感冒～增加机体抵抗力及免疫力。口周围、眼周围及鼻部有感染要及早、彻底治疗。预防肠道病毒感染。 3(各种检查的目的、方法及注意事项 (1)脑脊液检查:目的是协助诊断～检测压力。方法及注意事项同蛛网膜下腔出血。 (2)脑电图的检查:目的是鉴别诊断～在做检查前3天禁止服用安眠、镇静、止痛、抗癫痫等药物～避免影响检查结果。 (3)CT检查方法同脑出血。 4(用药目的 (1)病因治疗～抗疱疹病毒最理想的药物是无环鸟苷。 (2)脱水降颅压～常用药物为甘露醇、地塞米松等～常用于严重的脑水肿。 (3)降温、抗痉、镇静～保持水、电解质平衡。 5(饮食指导 根据病情的变化～随时变换饮食～病人在高热阶段～应吃半流食～易消化吸收～如粥、面条、面片汤、蒸蛋羹等～高热控制后～应改为高蛋白饮食～以补充热量～如瘦肉、鸡蛋、鱼等～蛋白质的含量可按标准体重计算～每千克体重每日1.5g，2g。 6(活动与锻炼的方法 如体力很弱～可按脑出血病人在床上锻炼的方法进行锻炼～能下床者开始可在床旁活动～根据病情的好转可到楼道活动～每日2-3次。 (a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide 九、 格林巴利综合征病人的健康教育 急性感染性多发性神经炎又称格林一巴利综合征,,uillain-Barre syndrome～GBS,～是以周围神经炎症改变并伴有脱髓鞘的多发性神经根神经病。目前被认为是自身免疫性疾病～可能与某些病毒感染有关。临床以运动障碍为主～可侵犯颅神经～脑脊液检查有蛋白显著升高而细胞数正常的蛋白细胞分离现象～严重时可出现呼吸肌麻痹而死亡。 一、病因 病因尚不明确～可能与某些病毒感染有关。 二、临床表现 急性起病～大多数病人5，10天内达到高峰。多见于青少年～其他年龄也可发病～以夏秋季发病率高。劳累、雨淋、游泳常为诱发因素。发病前可有病毒感冒及肠道感染表现～首发症状多数为双下肢无力～然后向上肢发展。主观感觉手足麻木～并有肌肉疼痛。随病情发展～可出现明显的手套、袜套样感觉减退或消失～吞咽困难～声音嘶哑、复视～头痛～大小便障碍等。 三、用药的目的 ,、辅助呼吸 呼吸肌麻痹是GBS的主要危险～因此密切观察患者有无呼吸困难和缺氧的表现是治疗GBS的关键。 2、抑制免疫反应～促进神经再生 ,1,血浆臵换治疗 是一种较新的治疗措施～通过血浆臵换～可清除血中有害的抗体、免疫复合物、炎性物质～以及某些不利的补体。 ,2,静脉注射免疫球蛋白 ,3,激素治疗 在5,葡萄糖500ml液体中加入地塞米松10，15mg静脉滴人～10，14天为一疗程～应用糖皮质激素同时服用钾盐以纠正电解质紊乱～并观察有无激素治疗的并发症。 ？、预防并治疗各种感染～应遵医嘱使用有效的抗生素应鼓励患者咳嗽～翻身时进行拍背以促进排痰。可进行雾化吸人～必要时用吸引器吸出痰液。 四、各种检查的注意事项 1、腰椎穿刺常规脑脊液检查可见蛋白细胞分离现象。方法及注意事项见蛛网膜下腔出血。 2、肌电图、神经传导速度:是利用电生理学方法显示肌肉组织的电活动～借以了解神经肌肉疾病的状态。检查时将同心圆针电极插入欲检查的肌肉～记录两极间的电位差及波形。 五、饮食指导 1、吞咽困难者应及早予以鼻饲流质～给予高蛋白、高热量、高维生素、易消化营养丰富的饮食～特别是维生素B对神经髓鞘形成有重要作用。 12 2、无吞咽困难者～可给予普通饮食。 六、活动与锻炼 1、注意保暖但禁用暖水袋～每2小时更换体位1次～按摩局部受压部位～(a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide 防止褥疮的发生。 2、对瘫痪肢体保持功能位臵～进行被动运动～当瘫肢肌力恢复时～应鼓励患者做主动运动。活动应循序渐进～练习由卧到靠～由靠到坐～由坐到站～由站到走的阶梯式锻炼方法。同时进行日常生活训练:让病人自己穿衣、解扣、洗脸、刷牙、进餐、入厕等。 七、出院教育 1、加强瘫痪肢体的功能恢复～教给患者自我肢体锻炼的方法。 2、出院后～避免受凉～保持精神愉快～定期复查。 十、 癫痫病人的健康教育 癫痫,epilepsy,是一组由大脑神经元突然异常放电而造成短暂性大脑功能失常的临床综合征。可有运动、感觉、意识、行为、自主神经等不同程度的障碍～或同时存在。本病的特点是发作性及重复性～癫痫持续状态为本病特殊情况。 1、病因 与遗传、脑部疾病或全身性疾病,如颅脑外伤、脑膜炎、脑部占位性病变、脑血管病、尿毒症等,。 2(临床表现 发作性一侧肢体、局部肌肉的感觉障碍或节律性抽搐,意识丧失、全身抽搐、眼球上翻、所有骨骼肌强直收缩、牙关紧闭、口吐白沫等等。 3、诱发因素 感冒、发热、疲劳、感情冲动、药物过量、长期饮酒戒断、睡眠不足等均可诱发。 4、用药的目的 ,1,控制发作 安定、苯妥英钠、卡马西平、苯巴比妥、丙戊酸钠等～应定期监测药物的血药浓度以指导用药。 ,2,对症治疗 ,3,坚持服药～不宜随意减量或停药～以免诱发癫痫持续状态～应遵医嘱用药。 5、各种检查的注意事项 脑电图的检查最重要～脑电图可以用以区别发作类型和明确病灶部位。通过脑电图检查在癫痫发作间歇期亦可出现各种痫样放电～部分性发作患者可出现局灶性异常放电～常规脑电图记录时间短～目前可应用24小时脑电监测。 在做检查前3天禁止服用安眠、镇静、止痛、抗癫痫等药物～避免影响检查结果,检查前一日应用肥皂水洗头～禁用护发素。 6、防止发作时发生意外～应有人保护～加用床挡。 7、饮食指导 饮食应营养丰富、易于消化的食物～禁饮兴奋性饮料～禁食辛辣调味品。 8、健康指导 ,1,避免诱发因素～保持心情愉快、情绪平稳。 ,2,生活要有规律～戒烟酒。 (a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide ,3,禁止游泳、驾驶汽车、高空作业、登高等危险活动。 ,4,应随身携带简要病情诊疗卡～写明家庭住址、联系电话～以便及时处 理。 (a) to further cultivate and practice the socialist core value concept. Human civilization is the core and soul of the city. Created in deepening the urban civilization, to seize cultivation and practice the socialist core value concept of the fundamental task, to everyone talk about civilization, everywhere to see the civilization "as the goal, to promote the creation tasks implemented. First, we must deepen the Delhi City, good deeds sunshine" is the theme of moral practice, to build the brand of "Da Yi Ju, Houde good deeds" moral. Carefully create activity carrier, highlighting to create a theme, to carry out a wide range of "good side" recommended review activities, carry out moral model itinerant preachers and most beautiful people, the series of model characters selection Activities, aggressively push the tree to a group of people around to learn and amiable, respectable moral typical. To focus on the real refinement "good deeds for the four virtues list built, tubes, each link work; let the moral has become an important force for regulating the behavior of the citizens. A hand grasping the education, focusing on governance, the violation of public order, destruction of public facilities and other acts resolutely exposure. Second, we must deepen the activities to create a civilized. Actively carry out civilized units, township of civilization, civilized window created, and further optimize the environment for government service. With the deep development of civilized community and family civilization, civilized community infrastructure to create activities, guide