Acute cerebrovascular disease, also known as stroke and cerebral stroke, is a general term for cerebrovascular diseases. Common in middle-aged and elderly people, the common diseases are hypertension and arteriosclerosis. Due to the rupture of cerebral vessels, blood flows into subarachnoid space, which is called subarachnoid hemorrhage; When blood flows into the brain parenchyma, it is cerebral hemorrhage. Transient ischemic attack (TIA) is caused by cerebral vascular stenosis and occlusion, and the duration of symptoms does not exceed 24 hours. Symptoms lasting more than 24 hours are called cerebral infarction, including cerebral thrombosis and cerebral embolism. Clinical manifestations have some localized neurological symptoms. There is contralateral triple paralysis in one hemisphere, that is, contralateral hemiplegia, mild hemiplegia, hemianopia or aphasia occur at the same time. Occurring in the brain stem and cerebellum are ipsilateral cerebral palsy, contralateral hemiplegia or hemiparalysis, and ipsilateral limb ataxia. Severe cases include headache, vomiting, disturbance of consciousness, and even brain hernia or death.
The incidence and mortality of acute cerebrovascular disease in China are significantly higher than those of coronary heart disease, and the incidence of cerebral hemorrhage is relatively high. On the contrary, the incidence of coronary heart disease in western countries is very high. Besides race, heredity, environment and other factors, differences in diet structure and nutrition are very important reasons. Therefore, correcting nutritional disorders and dietary nutrition therapy are one of the important ways to prevent and treat acute cerebrovascular diseases.
First, the nutritional impact of diet
1. Malnutrition and brain mid-year; Hypertension, atherosclerosis, diabetes and so on are important causes of stroke, so the related dietary and nutritional factors are also closely related to stroke. Epidemiological investigation shows that the incidence of cerebral ischemia and cerebral infarction is high in areas with excessive fat intake, accounting for 40% of the total thermal energy, while the incidence of cerebral hemorrhage is high in areas with low fat, low protein and high salt diet. Experimental studies have confirmed that high serum cholesterol is prone to atherosclerotic thrombosis, while low cholesterol hypertension will make the arterial wall fragile, increase the fragility of red blood cells, and easily lead to bleeding. Nutritional imbalance is not only the imbalance of the quantity of main nutrients, but also the influence of quality is more important than quantity to some extent. For example, polyunsaturated fatty acids and saturated fatty acids in fat can reduce blood cholesterol, but too much will promote lipid peroxidation and destroy cell membranes, while the latter will increase blood cholesterol. Therefore, it is considered that the ratio of polyunsaturated fatty acids to saturated fatty acids is 1: 2, and the best ratio recommended now is p: m: s =1:1. High-quality protein in protein, that is, animal protein with high sulfur amino acid content, such as fish, poultry, lean meat, soybean protein, etc., accounts for less than 50% of the total protein, and is prone to diseases such as hypertension and stroke. If the diet is high in sodium, low in calcium and low in potassium, it is also prone to hypertension and stroke.
2. Affect the prognosis and rehabilitation of stroke: Because stroke patients have different degrees of brain failure, the course of disease may be accompanied by infection, gastrointestinal bleeding and renal insufficiency; The application of dehydrating agents and hormones can cause water-electrolyte disorder; Light people eat less, heavy people fast, and the dietary nutrition intake is obviously lower than the required amount. Therefore, on the basis of the original malnutrition, stroke patients may be aggravated by reduced intake, leading to more serious malnutrition. If there is not enough heat energy, essential amino acids, phospholipids and vitamins, it will inevitably affect the prognosis and recovery of stroke.
Second, diet nutrition therapy
The purpose of dietary nutrition therapy is to support systemic nutrition, protect brain function and promote the repair and functional recovery of nerve cells. Individualization is required in dietary nutrition supply, that is, different dietary nutrition treatment schemes are put forward according to the patient's condition, complications, normal diet, digestion and absorption function, weight, blood lipid, blood sugar, electrolyte and other factors. In the acute phase, dietotherapy is to help patients get through the critical period and create conditions for recovery. Suggestions on reasonable diet should be put forward in the recovery period to correct malnutrition or malnutrition, promote recovery and prevent recurrence.
1. Diet therapy for severe patients: Severe or coma patients who have vomiting or gastrointestinal bleeding within 2 ~ 3 days after onset should fast and be supplemented with nutrition through veins. Nasal feeding began after 3 days. In order to adapt to the absorption function of digestive tract, rice soup and sucrose were mainly used in the first few days, 200 ~ 250 ml each time, 4 ~ 5 times a day. In the case of tolerance, add heat, protein and fat to the mixed milk, and use milk, rice soup, sucrose, eggs and a small amount of vegetable oil. For those who have been in a coma for a long time and have complications, they should be supplied with high-calorie and high-fat mixed milk, with protein 90 ~ 1LOG, fat 300g and carbohydrate 300g, total heat energy/kloc-0 10.46MJ(2500kcal), total liquid 2500ml, 300 ~ 400 ml each time, and 6 ~ 6 per day. Nasal feeding speed should be slow to prevent reflux from entering trachea. If necessary, you can choose a homogeneous diet or an elemental diet.
2. Diet therapy for general patients: the heat energy supply can be at125.52 ~167.36 kJ (30 ~ 40 kcal), and the overweight person can reduce it appropriately. Protein takes the ratio of L 5 ~ 2.0g/kg, in which the protein of animals is not less than 20g/d, including fish, poultry and lean meat with low fat and high protein, and beans are not less than 30g per day. Fat should not exceed 30% of total heat energy, cholesterol should be less than 300 mg/d, and viscera with high fat, animal fat and saturated fatty acid should be eaten as little as possible. Overweight people's fat should account for less than 20% of total energy, and cholesterol should be limited to less than 200mg. Carbohydrates are mainly cereals, and the total heat energy is not less than 55%, which needs to be mixed with fine and varied. Limit salt intake to less than 6 grams per day. If dehydrating agent or diuretic is used, it can be increased appropriately. In order to get enough vitamins, more than 400 grams of fresh vegetables should be supplied every day. The dining system should be regular and quantitative, with small meals, four meals a day, and the dinner should be light and digestible.
Nursing care of elderly patients with stroke
If the elderly have a stroke and cannot take care of themselves, they have the responsibility and obligation to take care of the seriously ill elderly. So what should they do as children? First of all, we should convince the elderly to build up confidence and exercise their limbs to avoid muscle and nerve atrophy. Massage every joint and muscle regularly is a good way to prevent joint stiffness and muscle atrophy. When the limbs can take the initiative to move, the elderly should be encouraged to sit on the bed or chair, pedal the bed or step on the ground, or turn walnuts by hand (fitness balls can be used for those with mild symptoms). Furthermore, you can help the elderly practice standing and walking.
Some children are afraid that the "stroke" elderly people will fall and have misfortune, so it is not appropriate for them to engage in activities. In fact, the earlier you start exercising, the faster your limb function will recover and the lower your mortality rate will be. According to statistics, the five-year mortality rate of bedridden "stroke" elderly people is 54.7%, while only 12. 1% of active "stroke" elderly people die.
In order to prevent deformity, the limbs of paralyzed old people should be fixed in the "functional position" with bandages, sandbags or pillows. Elbows should be at 90 degrees and wrists should be in pronation position. Old people are prone to drooping feet, so don't press the quilt directly on the instep. It is best to support the quilt with a support and put a pillow under your feet to make your ankle joint at 90 degrees.
It is very important to prevent bedsores. After paralysis, it is inconvenient for the elderly to turn over, often due to the pressure between the protruding part of the bone and the mattress, the skin appears necrotic ulcer, and it is necessary to turn over frequently. Generally, you should turn over every two hours. After turning over, gently massage the protruding parts of the bones with alcohol or talcum powder to facilitate blood circulation. Using an air cushion or foam pad on the bony process can reduce the pressure. In addition, we should always scrub the skin of the elderly and spray some prickly heat powder on the folds, perineum and buttocks to keep them clean and dry. Once bedsore appears, you can dry the affected area with a big light bulb, apply purple liquid medicine, or sprinkle traditional Chinese medicine powder for promoting granulation, and press the pressure sore surface.
Old people who stay in bed for a long time have a bad appetite. They should eat some chewy, digestible and nutritious foods, such as custard, soybean milk, milk, lotus root starch, rice porridge, jiaozi, chicken soup, fine noodles and so on. Be patient when feeding, swallow one mouthful before feeding another, and don't rush to avoid aspiration pneumonia.
If the paralyzed elderly are not used to urinating in the lying position and have difficulty urinating, they can gently massage their lower abdomen with their hands, or apply a hot water bag to their lower abdomen, which will have certain effects.
Elderly people in bed often suffer from constipation due to slow intestinal peristalsis, and constipation is often the cause of recurrence of "stroke", which cannot be taken lightly. If you don't understand the stool for 3 days, you should choose medication under the guidance of a doctor.
For the elderly with paraplegia and hearing impairment on the right side, we should persuade them to speak slowly and listen to the radio more, so that their children and grandchildren can talk to him or her more and rebuild their language functions. Of course, this process is slow and requires great patience.
About 60% of the "stroke" elderly people died of pneumonia during the recovery period. Therefore, we should pay attention to indoor ventilation, increase or decrease clothes in time, keep warm and prevent colds.
Taking care of the elderly with stroke is like taking care of your own children. If the "stroke" elderly people can be carefully taken care of, most of them can recover within one year and half can take care of themselves.