Clinical frequently-occurring hypertensive cerebral hemorrhage mostly occurs in basal ganglia, showing acute progress? Three-bias sign? Among them, hemiplegia symptoms have the most obvious influence on the quality of life of patients.
Objective To explore the influence of health education on the rehabilitation of hemiplegic patients with hypertensive cerebral hemorrhage. Methods 122 patients with hemiplegia after hypertensive cerebral hemorrhage were randomly divided into two groups, 6 1 patient in each group. The observation group was given comprehensive health education, while the control group was given traditional nursing. The intervention effects of the two groups were compared. Results After the intervention, the rehabilitation compliance score of the patients in the observation group was (167 1? 198), the satisfaction rate of patients was (95.08%), which was better than that of the control group, and the difference was statistically significant. The incidence of complications in the observation group (1 148%) was lower than that in the control group (34.43%), and the difference was statistically significant (P
Health education; Hypertension; Cerebral hemorrhage; hemiplegia
In recent years, the incidence of cerebrovascular diseases has been rising. Hypertensive cerebral hemorrhage is a common cerebrovascular disease with high mortality and disability rate. According to statistics, at present, cerebral hemorrhage accounts for 21%~ 48% of all cerebrovascular diseases in China [1]. Operation is an effective treatment, but early postoperative rehabilitation nursing has not been paid attention to, especially for postoperative hemiplegic patients. If the hemiplegic limbs are not treated accordingly, abnormal movements will occur in a few days, and even develop into irreversible dyskinesia [2]. In order to better improve the rehabilitation effect of hemiplegic patients with hypertensive cerebral hemorrhage, the research group conducted a comprehensive health education for some hemiplegic patients with hypertensive cerebral hemorrhage in June 20 14, and made an evaluation. The report is as follows.
1 objects and methods
1. 1 object
20 14 1 month? From June 2065438 to June 2005, the Department of Neurosurgery of Haikou People's Hospital treated 122 patients with hemiplegia after hypertensive cerebral hemorrhage.
1.2 method
The grouping method and inclusion criteria of 1.2. 1 were divided into two groups according to the random number table method, each group was 6 1 case, and the inclusion criteria were: age 18 ~ 75 years old; Patients with hypertensive cerebral hemorrhage diagnosed by head CT [3]; With aphasia; Vital signs are stable; Able to understand and execute simple instructions; Informed consent of this study. Exclusion criteria: combined with other craniocerebral injury or body compound injury; Accompanying infection; Have a history of mental illness or cognitive impairment; Unable to cooperate to complete the relevant scale, etc.
1.2.2 Health education Patients in the two groups were made targeted plans by the same group of doctors according to the patients' condition, while patients in the control group were given routine oral care guidance. On this basis, the observation group was given early comprehensive health education. ① Mental health education: make personalized psychological rehabilitation plan for each patient in different states in time, and make corresponding treatment goals for patients, and make comprehensive analysis according to the progress of patients reaching the goals, so as to improve the treatment plan [4]. Psychological communication time is 30 minutes/time, depending on the patient's condition, L ~ 3 times/week. Among them, psychological rehabilitation includes establishing a close relationship of mutual trust and interdependence with patients, giving patients psychological support, correcting their cognitive bias and family support [5]; ② Disease-related knowledge education: explain the correct lifestyle of hypertension and cerebral hemorrhage, analyze the influence of patients' current bad lifestyle on the disease, establish health awareness, and guide patients' determination to change their current bad lifestyle; ③ Rehabilitation training: passive training is the main training in the stage of brain edema, which requires patients to maintain good functional position. Supine position: the affected shoulder joint is in abduction and rotation position to prevent dislocation of shoulder joint, and the elbow joint is dorsiflexion 30 ~ 40? The hip joint is slightly flexed and rotated internally, and sandbags are placed outside the thigh to avoid abduction deformity of the hip joint and straighten the knee joint [6]. When the patient lies on his side, the affected limb keeps shoulder abduction and external rotation for 90? . Forearms extend outward and rotate, palms up and fingers apart. Bend the healthy knee on the bed in front of the affected leg to ensure that the bilateral hip joints are in the adduction and internal rotation position. When lying on the healthy side: the affected limb palms down, fingers apart, palms pressed on the chest bed, pillows between the upper arm and chest to avoid shoulder adduction, and lower limbs in the same lateral position. Rehabilitation nursing. Active rehabilitation training in bed is the main method. After the patient takes the initiative to exercise, use the healthy hand to drive the affected limb to exercise. First, cross the patient's hands and fingers, and use the healthy hand to drive the affected side to move up and down and left and right. Lie on your back, with your hands flat on both sides, palms down, knees flexed, reach to the bed, slowly raise your arms, and put them down after 1min [7]; Before turning over, cross your hands, put the thumb of the affected hand on the thumb of the healthy hand, raise it to the level above the shoulder, straighten your elbows and swing left and right. At the same time, use your eyes to guide your movements, turn your head to the side of the trunk you want to turn over, and turn over with the help of the inertia of swinging. At the same time, the trunk rotates, the healthy side pushes the affected side bed to support the upper body, and the healthy side legs swing out of the bed and gradually become upright, sitting on the bed. In the later stage, patients will gradually realize the movement of bed and chair transfer, standing and walking; ④ Follow-up after discharge: twice a week after discharge 1 month, once a week for 2-3 months, once a week for 4-6 months, and continuous follow-up for 6 months. During the follow-up, patients were mainly asked about medication, diet, sleep quality, mental state and compliance of rehabilitation training after discharge. According to the different educational levels of patients and their families, the corresponding health education is given in easy-to-understand language.
1.2.3 The evaluation standard is 6 months after the patient leaves the hospital. A self-designed questionnaire was used to investigate the satisfaction, rehabilitation compliance, self-care ability and complications of patients in the two groups during the follow-up visit. Based on the questionnaire of nursing job satisfaction of inpatients, we designed it ourselves. Health education effect questionnaire? The questionnaire is divided into patient satisfaction, rehabilitation compliance, self-care ability and complications. There are 40 questions, all multiple-choice questions. The questionnaire was tested for retest reliability before use. All subjects were discharged from neurosurgery department of Haikou People's Hospital, and the inclusion and exclusion criteria were the same as this study. The retest interval is 2 months, and the retest reliability is 0.826. The validity of the scale is 0892. ① The main contents of the satisfaction questionnaire are: nurses' attitude and skills, whether they are valued and cared about, whether they have acquired knowledge about diseases, and whether the relationship between nurses and patients is harmonious. The questionnaire uses a five-level scoring method, and it is very satisfactory: 5 points, satisfactory: 4 points, average: 3 points, dissatisfied: 2 points, very dissatisfied: 1 point. Satisfaction rate = (very satisfied patients+satisfied patients)/total number of patients? 100%; ② The main contents of the patient compliance questionnaire include: whether to take medicine according to the doctor's advice, whether to carry out rehabilitation training and awakening as planned, whether to change the original unhealthy behavior, and whether the nutrition is reasonable. Using the four-level scoring method, it is required to reach: 4 points, basically reach: 3 points, occasionally reach: 2 points, fail to reach: 1 point, score? The score of 15 is high compliance; ③ Complications: Observe the occurrence of pressure sore, constipation, deep venous thrombosis and joint contracture in the two groups; ④ The main contents of the self-care ability questionnaire are: diet, personal hygiene, dressing, defecation and movement. Each aspect is divided into four grades, with severe dependence: 4 points, moderate dependence: 3 points, mild dependence: 2 points, and independent completion: 1 point. The total score is 5 ~ 7: self-care, 8 ~ 14: partial self-care, 15 ~ 20: self-care. The statistical analysis data of 124 were processed by SPSS 140 statistical software to represent measurement data, tested by t, and counted by ratio or composition ratio. 2. In the test, the comparison of performance data adopts Ridit analysis; If p
Two results
2. 1 Basic information
There were 36 males and 25 females in the observation group. The average age is (6652? 437) years old; The time from joining the group to completing the operation is (04 1? 023)d； Diastolic pressure is (147? 2 1)mmHg, systolic blood pressure (88? 17)mm？ Hg, see table 1 for other information. There were 34 males and 27 females in the control group. The average age was (65 14? 525) years old; The time from joining the group to completing the operation is (039? 020)d； Diastolic pressure is (150? 18)mmHg, systolic blood pressure (85? 19) mmhg. See table 1 for other information. There was no significant difference between the two groups (P & gt005), which was comparable.
2.2 Compliance and satisfaction of patients in two groups after intervention
After intervention, the rehabilitation compliance score of patients in the observation group was (167 1? 198), the control group was (1346? 1 12), the difference was statistically significant (t=2836, P
2.3 Complications of two groups of patients after intervention
After the intervention, the incidence of complications in the observation group was 1 148%, while that in the control group was 34.43%, which was higher than that in the observation group (P
2.4 Self-care ability of patients in two groups before and after intervention
There was no significant difference in self-care ability between the observation group and the control group (P > 0.05). 005)。 Six months after discharge, the proportion of self-care in the observation group reached 5465438 00%, which was higher than that in the control group (2787%, the difference was statistically significant (P
3 discussion
Clinical frequently-occurring hypertensive cerebral hemorrhage mostly occurs in basal ganglia, showing acute progress? Three-bias sign? Among them, hemiplegia symptoms have the most obvious influence on the quality of life of patients [8]. Surgery is only a small part of systematic treatment, so the treatment and early rehabilitation training of hemiplegia after hypertensive cerebral hemorrhage are extremely important. Hemiplegia not only brings untold pain to patients, affects their self-care and quality of life, but also leads to the increase of depression, disgust or hatred towards society and family. Whether hemiplegia can be recovered is not only related to the degree of hemiplegia, the nature and time of the disease, but also related to the patient's psychological state and the training of rehabilitation function. Domestic studies have found that early rehabilitation training can promote the compensation of the contralateral cerebral hemisphere and help the functional recovery of paralyzed limbs. Yang Qing Ping [10] reported that early health rehabilitation guidance can obviously reduce the degree of secondary obstacles such as muscle atrophy, shoulder subluxation, joint contracture deformity, foot drop and varus. Yao Dan [1 1] research shows that early limb rehabilitation nursing is helpful to promote meridian movement and nerve endings of hemiplegic limbs, and can avoid complications such as joint stiffness. In this study, early comprehensive health education was used to intervene hemiplegic patients after hypertensive cerebral hemorrhage. The characteristics of early psychological intervention and rehabilitation are to awaken patients' potential psychological resources, help patients tide over difficulties, face situations and difficulties in the most effective and reasonable way, give patients a sense of security, and enhance their courage to fight diseases, so as to actively strengthen functional training and promote good rehabilitation of various functions [12]. On the contrary, patients have made some progress through active rehabilitation exercise, thus strengthening their confidence and courage in treating this disease. Face the disease with a better mental state and a more positive attitude, thus promoting the confidence of physical rehabilitation training. At the same time, through the health education of disease knowledge, we can provide patients with correct treatment, health care and nursing information, so that patients can gradually form healthy beliefs and attitudes, thus improving their rehabilitation compliance; Discharge guidance supplements the content of in-hospital guidance, meets the needs of patients in time, makes patients feel that nurses and doctors are still concerned about them, and the relationship between doctors and patients is more harmonious, thus further promoting the improvement of patients' self-care ability after discharge. The results showed that the rehabilitation compliance score and satisfaction of patients in the observation group were higher than those in the control group after intervention (P
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