【摘要】 目的分析维持性血液透析患者并发出血性脑卒中的原因及临床表现,探讨维持性血液透析患者并发出血性脑卒中的护理对策,以降低维持性血液透析患者出血性脑卒中的发生率。方法采用回顾性研究方法,对2009年7月—2015年2月收治的维持性血液透析治疗患者324例的临床资料进行分析,其中并发出血性脑卒中患者26例。针对维持性血液透析患者并发出血性脑卒中的原因及临床表现,对患者进行病情认知、饮食指导、合理用药、个性化使用抗凝剂、生活指导等护理干预措施。结果维持性血液透析患者并发出血性脑卒中的主要原因为高血压、糖尿病、左心功能衰竭及抗凝剂的应用,出血性脑卒中发生后患者的主要临床表现为头痛、头晕、恶心呕吐,肢体感觉、运动障碍,严重的患者可出现烦躁不安、嗜睡、肢体抽搐、昏迷等,均经头颅CT检查可明确诊断,其中基底节出血9例,脑干出血17例。通过护理干预,并发出血性脑卒中的26例中,死亡21例,存活5例,存活率19.2%。结论对维持性血液透析患者,应根据每例患者不同的基础疾病和脑出血发病的因素,对患者进行全面护理评估,结合患者的个体情况,实施病情认知、饮食指导、合理用药、个性化使用抗凝剂、生活指导等针对性的护理对策,预防维持性血液透析患者出血性脑卒中的发生,降低维持性血液透析患者出血性脑卒中的发生率。更多还原

【Abstract】 Objective To analyze the causes and clinical manifestations of hemorrhagic stroke in maintenance hemodialysis patients and to explore the nursing strategies to reduce the incidence of hemorrhagic stroke. Methods The clinical data of 324 patients on maintenance hemodialysis in our hospital from July 2009 to February 2015 were analyzed retrospectively,26 patients among them were complicated withhemorrhagic stroke. The nursing intervention measures such as illness perceptions,diet guidance,rational administration of drug,personalized anticoagulants therapy and life guidance were performed in patients with hemorrhagic stroke according to thecauses and clinical manifestations. Results The main cause of hemorrhagic stroke in maintain hemodialysis patients included hypertension,diabetes,left heart function failure and the use of anticoagulant. The cerebral stroke patients were usually accompanied with dizziness,headache,nausea,vomiting,limb movement and sensory disturbance,and even fidgety uneasy,drowsiness,limb twitching,coma in some severe patients,which can be confirmed by CT. Among the 26 hemorrhagic stroke patients,there were 9 cases of basal ganglia hemorrhage,17 cases of brain stem hemorrhage; after the treatment,21 cases died and 5 cases survived,the survival rate was 19. 2%. Conclusion For the maintenance hemodialysis patients,comprehensive nursing assessment should be performed according to the underlying diseases and cause of cerebral hemorrhage,,and nursing countermeasures such as illness perceptions,diet guidance,rational administration of drug,personalized anticoagulants therapy and life guidance should be taken based on the condition of patients,so as to preventhemorrhage stroke of patients on maintenance hemodialysis,and reduce the incidence of hemorrhage stroke.更多还原