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　　脑出血，又叫脑溢血，多发生于40～70岁的人群，近年来，发病年龄有愈来愈年轻的趋势。其发病原因75％为高血压病及脑动脉硬化等。由于精神紧张、情绪激动、激烈运动、过度体力劳动、用力排便等促使血压突然增高，使血管破裂所致。脑出血是危害人们健康和生命的常见疾病。 
中国论文网 http://www.xzbu.com/6/view-2702821.htm
　　怎样预防脑出血呢?根据发病因素及临床实践，可归纳为十个必须。 
　　一、必须早期发现并及时治疗高血压病。做到定期检查，一经确诊，必须坚持服药治疗，以降低及稳定血压，防止反跳及过度波动。 
　　二、一旦发现动脉硬化，必须及早采取措施，降低血脂以保持血管的弹性。丹参注射液、复方丹参片、地巴唑、脑益嗪等有益气活血、增加血液循环作用，可酌情服用。 
　　三、必须乐观，避免情绪激动，防止血压突然升高。 
　　四、必须劳逸结合，合理安排工作，保证足够的睡眠，避免过度劳累。 
　　五、饮食必须清淡，少食动物脂肪或含胆固醇高的食物，糖也不宜多食，可多吃豆类、水果、蔬菜和鱼类等，尤其对血压较高、动脉硬化、血脂高者更为重要。 
　　六、必须戒除烟酒。吸烟能加速动脉硬化的发展，对高血压也有害；长期大量饮酒也会促进动脉硬化。 
　　七、大便必须保持通畅，避免过度用力大便，以防血压突然升高。 
　　八、必须注意季节变化，防寒避暑，防止寒冷、高温对机体的影响，避免使血管舒缩功能障碍、血压波动幅度剧增而发生意外。 
　　九、蹲、弯腰、起身或改变体位时，动作必须缓慢，切勿突然改变体位，防止脑部一时供血不足而发生意外。 
　　十、必须适当坚持体育锻炼，从事力所能及的工作，应避免激烈的运动或过度疲劳。 
　　还必须具有正确对待疾病的态度，树立同疾病作斗争的信心。牢记十个必须，坚持合理用药，注意发病规律，做好预防措施。这样，脑出血的机会就会大大减少。

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　　【摘要】目的探讨高血压脑出血术后护理方法。方法回顾性分析65例高血压脑出血患者的临床资料、术后护理方法，观察护理效果。结果通过针对性的护理措施后，78例患者中完全清除血肿63例，大部分清除血肿10例；总有效率93.58%。结论对于高血压脑出血，在手术治疗的基础上采取有效的心理护理及术后康复护理指导，有助于术后神经功能的恢复，降低患者致残率及病死率。 

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中国论文网 http://www.xzbu.com/6/view-5124411.htm
　　【关键词】高血压；脑出血；术后护理 
　　doi：10.3969/j.issn.1004-7484（x）.2013.06.429 文章编号：1004-7484（2013）-06-3210-01 
　　随着人们生活水平的不断提高，生活及社会压力的增加，高血压发病率也呈逐年上升趋势。高血压脑出血是高血压最严重的并发症，起病急，发展快，病情凶险多变，致残率和病死率高[1]。目前治疗该病最重要手段是手术清除血肿，术后的精心护理及康复指导是保证手术成功、预防并发症、提高治愈率的重要环节。我院2011年1月――2012年12月共收治78例高血压脑出血患者，均通过血肿清除术，效果满意，现报告如下。 

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　　1 临床资料 
　　本组78例，其中男52例，女26例，年龄43-83岁，平均56.5岁，患者发病前均有高血压病史。 

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　　2 手术方法 
　　定向置管引流术22例，开小骨窗血肿清除术26例，脑室引流术14例，去骨瓣减压术16例。 

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　　3 疗效判定标准及结果 
　　判断标准共分6级[2]：Ⅰ级为完全恢复社会和家庭日常生活能力；Ⅱ级为独立日常生活并恢复部分社会生活；Ⅲ级为日常生活稍许别人帮助，可拄拐行走；Ⅳ级为保留意识但卧床不起，日常生活需人帮助；Ⅴ级为植物生存；Ⅵ级为死亡。结果：Ⅲ级以上为63例，Ⅳ级为10例，死亡5例。 

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　　4 术后护理方法 
　　4.1 严密观察生命体征①血压：血压平稳是高血压脑出血患者术后治疗的成败及防止再次出血的关键因素之一。血压监测要达到四定，即定时间、定部位、定体位、定血压计，才能反映血压的真实情况[3]。控制血压收缩压在18-23kPa，舒张压在10-12kPa，降压药最好用微泵经静脉输入，随血压变化而调整用量。②呼吸：严密观察呼吸音、频率、节律、深度的变化，血氧饱和度保持在95%以上，避免低氧血症加重脑水肿，必要时使用呼吸机。③体温：体温38℃以上者要给退烧药物、物理降温或给人工冬眠，降温的同时要查明发烧的原因。④其他：严密观察神志、瞳孔及四肢运动变化。通过严密观察病情，一旦出现颅内压升高或再出血症状应及时报告医师。 
　　4.2 一般护理患者取去枕平卧位，头偏向一侧，防治呕吐物的误吸；对于长期卧床的患者应每2h翻身1次；吸氧、吸痰；监护仪监测生命体征。 
　　4.3 引流管的护理①脑室引流管的护理：要严格按照无菌操作规程，妥善固定，防止头部活动、翻身的时候脱落，放置引流管受压、扭曲。密切观察引流液的量、颜色及性质，作好记录，一旦发现颜色由暗红变为鲜红色，应警惕出血的可能，应及时报告医师处理。②导尿管的护理：尿道口及其周围要定期消毒，防止感染，防止导尿管扭曲，保持导尿管的通畅，记录24h尿量。 
　　4.4 并发症的护理①口腔护理：昏迷患者用湿纱布覆盖口鼻处，防止黏膜干燥，每天用生理盐水棉球擦洗口腔及鼻腔黏膜，防止感染。②预防褥疮：定期翻身，经常按摩受压部位，床铺保持平整干燥，翻身时保护好头部。③呼吸道的护理：保持环境清洁，注意气道湿化，每2-3h翻身叩背一次，及时吸痰，保持呼吸道通畅，清醒患者鼓励咳嗽、咳痰，必要时可用糜蛋白酶4000U，庆大霉素8万U，地塞米松5mg加生理盐水20ml雾化吸入。④预防应激性溃疡：高血压脑出血急性期由于边缘系统、脑干、丘脑下部的损伤，导致植物神经功能紊乱，易引起应激性溃疡。消化道出血是高血压脑出血患者常见并发症，也是其主要死亡原因之一[4]。早期应用西米替丁或洛赛克，如发现异常及时通知医师处置。 
　　4.5 饮食护理急性期禁食，静脉供给营养，及时补充热量、蛋白质、水、电解质、多种维生素类营养物质。神志清醒者恢复吞咽动作后给予高蛋白、高维生素、低脂肪、低盐、易消化食物，定期评估患者营养状况，及时调整营养素供给量和配方。 
　　4.6 心理护理脑出血病人均有不同程度的偏瘫、失语，生活自理能力差，心理上常表现为焦虑、急躁、悲观、自卑。护理人员应根据患者的具体情况，针对性的采取不同的健康教育方式，使患者及其家属了解康复训练的重要性，使患者及其家属从思想上重视康复训练，积极主动配合康复治疗。 
　　4.7 出院指导密切关注血压的变化，控制好血压。严格按照医嘱用降压药物，不可自行随意停药或减量。加强瘫痪肢体的功能锻炼，遵循循序渐进的规则，从被动锻炼到主动锻炼、从小幅度到大幅度、从小运动量到大运动量。语言障碍者要多阅读，要大声的朗读，模仿收音机、录音机等进行发音练习。 

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　　5 结果 
　　78例病例，顺利出院73例，死亡5例。随访生活自理63例，长期卧床生活需要照顾10例。住院期间腹部感染2例，应激性溃疡消化道出血1例。 

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　　6 小结 
　　高血脂、糖尿病、高血压、血管的老化、吸烟等引起脑血管的病变、硬化，脑小动脉病变在血压骤升时容易破裂，称为高血压性脑出血。本病病情发展迅速，致残率和病死率高，是高血压病最严重的并发症，预防本病最重要的措施是控制血压。术后针对性的护理及康复期功能锻炼的有效护理，可以减少患者的术后并发症，降低了致残率，提高了患者的生存质量，对疾病的预后起到了重要作用。 

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脑出血是现在很常见的脑血管疾病的一种，并且现在这个疾病越来越年轻化，如果出现头颅出血会有什么后果呢？

 

\"头颅出血会有什么后果\"


小脑出血主要表现为眩晕和共济失调，为什么会表现为眩晕和共济失调呢？因为小脑的功能主要是管平衡的，就是你手脚能够很协调，你走路能够很稳当，你能站在一个高杆上不晃、不摔，这就叫平衡，也叫共济，小脑主要就是管这个的，所以有小脑萎缩、小脑病变的患者比如长肿瘤、出血的，这些患者就会出现共济失调。

 

因为有严重的眩晕症状伴有频繁呕吐和枕部疼痛，在出血不大的时候表现为小脑症状、病变侧共济失调、眼球震颤、构音障碍和吟诗样语言，就是说话像唱歌一样、像念诗一样。出血量大的时候可以导致脑干受压，尤其是小脑蚓部出血的时候，患者很快就会昏迷，这个是为什么呢？

 

因为小脑的前部就是脑干，所以它出血量大多的时候，很快就会压迫桥脑、脑干一部分，使患者进入昏迷状态，最后可以导致枕骨大孔疝而死亡，所以小脑出血可以说比大脑出血更危险。大脑出血10毫升没什么事是可以不处理的，但是小脑出血10毫升就不得了了，就跟脑干出血2毫升、5毫升不得了是一样的。主要是小脑的体积太小了，它才占到整个大脑脑容量的20%都不到，它腔特别狭小，所以有10毫升、20毫升出血它就不得了了，压力一下就上去了，就会直接压迫脑干导致昏迷，所以就会导致整个大孔疝而死亡，所以小脑出血也是很危险的，但幸好小脑出血在临床上不是很多见，如果出血量小及时治疗处理的话还是不会有太大影响的。

 

找良医网温馨提示：以上就是关于“头颅出血会有什么后果”的介绍，希望对大家有所帮助，建议大家平时养成良好的生活饮食习惯，适当的运动锻炼身体，学会调节控制自己的情绪，保持良好的心态，做好心脑血管疾病的预防保健工作，如果检查出病情，请及时确诊接受治疗，祝大家身体健康！

 

\"头颅出血会有什么后果\"


大家可以阅读傅相平作者的《脑溢血解密》多媒体课件，想了解更多关于脑出血的知识可以加入找良医网的脑出血交流群。


","barId":"1854","topicTypeId":null,"topicThemeId":"1034","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":11},{"id":"20275","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"脑出血症状及表现","content":"

脑出血症状及表现有什么？有知道的病友或者医生吗？给解释一下。


","barId":"1854","topicTypeId":null,"topicThemeId":"1033","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":59},{"id":"26034","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"胃管尿管最长能下多长时间","content":"

大家好，请教大家一下，母亲术后已经20天了，还插的胃管尿管，不能说话，偏瘫，一天只能醒两三个小时。体温一直在38度左右，医生说有可能是肺炎，可是消炎药也用了，温度也一直没降下来，医生一会说再观察观察，一会又建议转到其他医院的呼吸科专门看肺炎。我们作为家属的心急如焚，实在不知道该怎么办了，，，还望大家不吝赐教！谢谢！


","barId":"1854","topicTypeId":null,"topicThemeId":"1032","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":59},{"id":"19498","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"脑出血引起偏瘫","content":"

就说右侧手脚不能动或者左侧手脚不能动，不管是哪一侧，这叫偏瘫，指的是一侧，不会双侧，这叫偏瘫，偏身感觉障碍，右手右脚不能动了，不但不能动了，你现在用手掐它，或用针刺它，怎么样，没有感觉了，运动和感觉，在内囊这个位置是连在一块的，内囊出血既会影响运动也要影响感觉，所以运动没有了，感觉也可能丧失。

 \"脑出血引起偏瘫\"

对这方面的知识，推荐你看看《脑溢血解密》，这里面对脑卒中讲解的很详细，淘宝上就有卖的，内容丰富，通俗易懂！

\"脑出血引起偏瘫\"

找良医网温馨提示：脑溢血总群成立，患者在群内可以互相讨论，定期会有专家解答问题，Q群号：877071646，欢迎广大患友加群！

","barId":"1854","topicTypeId":null,"topicThemeId":"1029","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":16},{"id":"24575","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"脑出血15毫升能痊愈吗","content":"

脑出血15毫升能否痊愈，这个是跟很多因素有关系的，脑出血的位置，出血量，救治时间等等，这些都是会影响患者的好转程度的，在《脑溢血解密》中，作者傅相平对此就有很明确的讲解，脑出血15毫升，根据不同的地方，有不同的表现和恢复。

\"脑出血15毫升能痊愈吗\" 

脑出血15毫升如果是在脑干，小脑，丘脑等地方，这个情况会造成患者死亡的现象发生，尤其是脑干部位，超过5毫升就会造成患者死亡几率提高，所以对于是否能痊愈，出血点极为重要，其次就是出血量的多少，如果是在额叶这样的不重要的部位，出血量极少，甚至不到5毫升，这样的情况下，患者通过保守治疗，完全康复是有很大可能的，但是出血量多的话，患者是会有后遗症表现的。

\"脑出血15毫升能痊愈吗\" 

另外要注意的一点就是救治的时间，患者第一时间发现，及时送医救治，就是最好的，这个情况下，患者一般都会有个好的恢复，但多数脑溢血患者还是有不同的后遗症表现，所以，对于脑溢血疾病来说，预防是最重要的。

\"脑出血15毫升能痊愈吗\" 

找良医网温馨提示：如有身体不适，请及时就医。对这方面的知识，也推荐你看看《脑溢血解密》，这里面对脑溢血讲解的很详细，淘宝上就有卖的，内容丰富，通俗易懂！


","barId":"1854","topicTypeId":null,"topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":60},{"id":"29195","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"脑出血有什么症状前兆","content":"

脑出血俗称脑溢血，随着生活条件的好转，患上脑溢血的病人越来越多，不止老年，现在越来越多的年轻人也被困扰。我们只有及时预防才能将伤害降到最低。那么脑出血有什么症状前兆？下面小编带大家了解一下。

\"脑出血有什么症状前兆\"

1.剧烈头痛

当如果出现突然的头疼症状，但是又没有其他特别的诱因的话要注意警惕。这种突发性的头疼可能是脑出血的症状。很多患者最先是出现间断的头疼，但是随着病情的加重会发展成连续性的头疼。

2.头晕

脑出血的先兆之一还有头晕。患者在头晕发作时会感到以自身为原点，周围的食物在不停的旋转，自己站立的时候会出现站不稳或是无法站立直接晕倒在地的现象。这种症状刚开始时是短暂的，但是随着病情的发展会越来越严重。

3.侧身体麻木

如果突然感到一侧身体麻木、无力、活动不便，手持物掉落，嘴歪、流涎、走路不稳，要提高警惕。

4.呕吐

呕吐也是脑出血比较常见的症状，通常为喷射性呕吐。如果呕吐物呈咖啡色，则可能伴随上消化道出血，这是病情高危的表示。

5.视力障碍

如果突然出现视力不清，看东西模糊、重影，或者是突然眼前蒙黑，出现短暂的视物模糊，之后又自行恢复了，很有可能是脑出血前兆。

6.常流鼻血

如果正常的流鼻血并不可怕，但是如果伴有高血压，还经常会出现流鼻血的症状就要小心了。专家介绍，高血压患者经常的鼻出血，半年内很有可能出现脑溢血。

以上这几方面就是引发脑出血的前兆，当朋友这几方面任何一种症状应该引起重视，因为脑出血会严重危害人们的身体健康，是一种死亡率极高的疾病。所以我们在生活中要注意预防这类疾病的发生。有高血压的患者要尤其注意控制血压，合理健康的饮食，有效的运动，戒烟戒酒，这样才能预防脑溢血的发生。

另外，脑出血发生后的三个小时，被称为“黄金三小时”。如果发现，并及时送患者就医，对以后的抢救效果有很大影响！

\"脑出血有什么症状前兆\"


 

欢迎扫描二维码加入QQ群，听听病友们怎么说，听听医生怎么说



 


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脑溢血病人是否要手术，这个是跟患者的出血点，出血量多少有很大关系的，脑溢血一般多是由于高血压引起，造成一个急性的脑溢血发生，这个情况下，尽快的送医救治是关键，在《脑溢血解密》中，作者傅相平对脑溢血是否必须做手术有很明确的解释。

\"脑溢血病人必须手术吗\" 

脑溢血患者如果出血点在较为严重的地方，手术是有风险的，比如丘脑部位，一旦出血，患者是不能通过开颅手术治疗的，手术对丘脑没有帮助，相反还会影响丘脑部位，这不是一个好的现象，如果出血量大，是需要通过引流手术排除多余的血液来减缓颅内压力。

\"脑溢血病人必须手术吗\" 

当然，对于不同的出血点，有不同的治疗方法，如果是少量出血，出血点也在额叶等不重要的区域，患者甚至是可以通过保守治疗达到一个好转的，所以，是否要手术，还是要看诊断检查的结果，医生会根据不同的结果，有一个不同的治疗方法。

\"脑溢血病人必须手术吗\" 

找良医网温馨提示：如有身体不适，请及时就医。对这方面的知识，也推荐你看看《脑溢血解密》，这里面对脑溢血讲解的很详细，淘宝上就有卖的，内容丰富，通俗易懂！


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