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Jingdong book

中风康复手把手

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中风康复手把手

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脑卒中康复是一个需要极大恒心鞠毅力的艰难过程,正确、有效、专业的康复指导,是康复成功的关键因素。在这里,最权威的康复中心的医学专家手把手教你康复。
Author Description

王征美,男,1952年生,主任医师、教授,北京博爱医院中西医结合康复科主任、北京中医药老年病委员会专业委员、首都医科大学中医康复专业任课教授、14届全国康复医师和脑瘫治疗技术培训教授、中国残联就业辅导中心考试培训和职业教育教授。参与多部中西医结合康复论著和教材的编写,在国内外医学期刊发表近40篇文章。
Catalogue

认识脑卒中
(一)什么是脑卒中
(二)脑卒中的分类
1. 缺血性脑卒中
2. 出血性脑卒中
(三)脑卒中的危险因素
1. 不可控的危险因素
2.可控的危险因素
(四)脑卒中的发病诱因
1. 季节、气候
2. 情绪
3. 睡眠
(五)脑卒中带来了什么
1.运动障碍
2.吞咽障碍
3.感觉障碍
4.言语障碍
5.视觉障碍
6.认知障碍
7.心理障碍
8.生活能力下降


脑卒中来了,我们怎么办
(一)应急处理
1.识别脑卒中早期表现
2.紧急呼叫及简单处理
3.脑卒中患者的运送
4.现场及救护车上的处理和急救
5.急诊室的诊断及处理
(二)尽快入院,平稳度过急性期
(三)脑卒中急性期的治疗
1. 短暂性脑缺血发作(transient ischemicattack,TIA)
2.脑梗死
3.脑出血
4. 蛛网膜下腔出血
(四)脑卒中的康复治疗
1.要进行康复治疗的原因
2.急性脑卒中三级康复体系的康复流程
3.康复治疗需要具备的条件


如何康复受损的功能
(一)运动功能的康复
1. 康复训练三大原则
2. 主要训练内容
3. 中医分期运动康复治疗
(二)感觉功能的康复
1. 感觉障碍的分类
2. 康复方法
(三)认知功能的康复
1. 认知功能分类
2. 康复内容
3. 注意事项
(四)言语障碍的康复
1. 言语障碍的分类
2. 言语障碍的评估标准
3. 言语康复的六要素
4. 言语康复治疗的方法
5. 中医治疗
(五)吞咽障碍的康复
1. 吞咽障碍程度的分级
2. 吞咽功能的训练
3. 吞咽障碍训练注意要点
(六)心理障碍的康复
1. 心理障碍的发生机制
2. 心理障碍的临床表现
3. 常见的心理反应分期及特点
4. 各期的应对方法
5. 常用的心理治疗方法


日常生活活动的康复细节
(一)住宅改造
1. 房屋出入口
2. 走廊
3. 室内设施
4. 卧室改造
5. 厨房改造
6. 卫生间
(二)辅助器具
1. 矫形器
2. 助行器具
3. 自助器具
(三)如何完成日常生活活动?
1. 进食
2. 清洁
3. 更衣
4. 移乘动作
5. 步行
6. 卧床的体位
7. 日常生活活动中患者与家属的自身安全是首先要注意的问题
(四)家庭成员的帮助
1. 建立长期康复的正确观念
2. 家庭成员的重要作用
3. 特殊患者的家庭帮助
(五)健身运动
1. 臂跑
2. 其他运动项目
3. 运动中的注意事项
(六)一些常见并发症的预防及护理
1. 肩关节半脱位
2. 肩-手综合征
3. 关节挛缩
4. 骨质疏松症
5.深静脉血栓
6. 直立性低血压
7. 压疮
(七)特殊管理
1. 二便管理
2. 安全管理
(八)坚持社区康复、融入社会


卒中后的饮食方略
(一)正确饮食对脑卒中患者的康复意义重大
(二)饮食方案总原则
1. 低食盐饮食
2. 低脂肪饮食
3. 低胆固醇饮食
4. 多维生素饮食
5. 多蛋白质饮食
6. 多微量元素饮食
7. 食物搭配
8. 食物的选择
(三)卒中各病程的饮食宜忌
1. 卒中先兆期
2. 卒中急性期
3. 卒中后遗症期
(四)各证型脑中风的食疗方及制作方法
1. 肝肾阴虚型
2. 肝阳上亢型
3. 气血不足型
4. 气虚痰瘀阻络型
(五)伴有高血压的饮食禁忌及食疗方法
1. 饮食宜忌
2. 饮食治疗原则
3. 食疗方法
(六)伴有糖尿病的饮食禁忌及食疗方法
1. 饮食宜忌
2. 饮食治疗原则
3. 食疗方法
(七)伴有高血脂的饮食禁忌及食疗方法
1. 饮食宜忌
2. 饮食治疗原则
3. 食疗方法
(八)脑卒中患者常用食物
1. 豆腐
2. 土豆
3. 南瓜
4. 黄瓜
5. 芹菜
6. 蕹菜
7. 胡萝卜
8. 枸杞头
9. 茄子
10. 菠菜
11. 大蒜
12. 甘薯及其茎叶
13. 西瓜皮
14. 苹果
15. 草莓
16. 豆芽
17. 黄豆
18. 绿豆
19. 荞麦
20. 玉米
21. 芝麻
22. 核桃
23. 香菇
24. 花生
25. 木耳
26. 牛奶
27. 醋
28. 海蜇
29. 鱼类


脑卒中预防
(一)无病防病
1. 有氧运动
2. 深呼吸
3. 戒烟
4. 戒酒
5. 限盐
6. 保持心情舒畅,减少应激
(二)防病复发
1. 血压管理
2. 抗血小板聚集
3. 抗凝治疗
4. 干预其他心脏病
5. 干预颈动脉狭窄
6. 干预高同型半胱氨酸血症
7. 干预短暂性脑缺血发作(TIA)
8. 血脂与血糖的管理
(三)防病加重
1. 一级康复
2. 二级康复
3. 三级康复
Book Abstract

案例
小吴,男性,33岁,已婚,公司业务经理。发病时间:2009年11月21日。症状:左侧肢体活动不利。
小吴是公司的业务经理,为了好业绩、高收入,经常加班加点工作,还得抽出时间应酬客户,每天晚上都要很晚才回家,而且常常是酩酊大醉,年纪轻轻就有了大肚囊、脂肪肝,还常常自诩是“三高人员”——高收入、高脂肪、高血压,惟一欠缺的就是高血糖。但他对此不以为意,因为在同龄人中,像他这样的并不少见。
2009年11月21日晚上11点左右,小吴一如往常陪客户应酬完回到自己家中,妻子敦促着他快点洗漱休息。就在洗漱时,他突然觉得一阵头晕恶心,想着可能是酒喝多了,并没在意,可要步出洗漱间时,他的左腿却怎么都抬不起来,一下子跌倒在地上。
妻子听到声音,跑来一看,发现小吴怎么爬都爬不起来,嘴也歪了,急忙叫了救护车,直奔离他们最近的宣武医院,经过影像检查后,医生告诉小吴的妻子,小吴的右侧大脑中动脉出现堵塞,导致右侧大脑大面积脑梗死,需要抓紧时间抢救治疗。
妻子知道小吴身体算不上健壮,但还是不错的,就是这几年忙工作,身体素质有些下降,可得的也都是周围人当中的常见疾病,医生现在却用了“抢救”这个词,让她非常紧张,难道小吴有生命危险?更让她百思不得其解的是:小吴这么年轻,怎么就患上了一般老年人才得的中风了呢?得了这个病,意味着什么?如果抢救过来了,以后会怎么样呢?会半身不遂?人会变傻?一大堆的疑问冒了出来。现在,就让我们跟她一起来好好认识一下脑卒中,看它到底是怎样一种疾病。
(一)什么是脑卒中
脑卒中(stroke),俗称“中风”,是指由于急性脑循环障碍所导致的脑功能缺损的疾病,在急性期,患者常常会出现昏迷、恶心呕吐、舌头麻木、一侧肢体不听使唤等症状。脑卒中的含义就是指大脑在短时间内受到了迅猛打击。脑卒中会有生命危险,所以需要抓紧时间送患者到医院的神经内科、急诊就诊。脑卒中具有高发病率、高致残率、高复发率的特点。

从上图我们可以看到大脑丰富的血管网络,脑组织的营养供应、代谢产物的排出都有赖于这一网络的畅通无阻,一旦这些大大小小的血管出现了问题,也就埋下了“卒中”发生的隐患。图中血管内的颗粒也就是我们常说的“动脉硬化斑块”。
(二)脑卒中的分类
现代医学把脑卒中分为缺血性和出血性两类,由于脑梗死、脑出血的部位不同,引起相应的功能障碍。
1. 缺血性脑卒中
又称脑梗死,指脑部血液供应障碍,引起脑组织、脑细胞的缺氧性坏死,从而出现相应的神经功能缺损。
脑血栓形成是脑梗死最常见的类型,是在血管壁病变的基础上,脑动脉主干或分支动脉的管腔动脉狭窄、闭塞或血栓形成,引起脑局部血流减少或供血中断,致使脑组织缺血、缺氧性坏死,出现局灶性神经系统症状和体征。
脑栓塞是指各种栓子随血液流入颅内动脉,使血管管腔急性闭塞,引起相应供血区脑组织缺血坏死,从而出现功能障碍。栓子分为气栓、脂肪栓和血栓等,主要来源于心脏内膜、动脉血管瓣膜。
2. 出血性脑卒中
是指原发性非外伤性脑实质内出血,死亡率较高。
蛛网膜下腔出血:通常为脑底部或脑表面的病变血管破裂,血液直接流入蛛网膜下腔引起的一种临床综合征,约占急性脑卒中的10%。
另外,基底节出血、脑干出血、脑室出血等等都是依据出血部位不同来命名的。
(三)脑卒中的危险因素
我们常常把脑卒中称作“脑血管意外”,那么它真的是“意外”吗?完全不是,它是很多危险因素长期作用的结果。
……

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Jingdong book