中风.ppt

2019/12/9,1,2019/12/9,2,中风Apoplexy/Stroke,上海中医药大学护理学院高健,class.ibucm/neikehl/main.htm,2019/12/9,3,LearningObjectives,熟悉中风的概念、病因病机熟悉中风诊断、鉴别诊断、特征与范围掌握各型的辨证施护了解其预防与调养,2019/12/9,4,TeachingContents,概述病因病机诊断与鉴别诊断辨证施护预防与调养,2019/12/9,5,概述Introduction,2019/12/9,6,概述Introduction,概念conception以突然昏仆、半身不遂、口舌歪斜、语言不利、偏身麻木或不经昏仆而仅以歪僻不遂为主证的一种疾病。主要是由于阴阳失调,气血逆乱，使风、火、痰、瘀痹阻脑脉或血溢脑脉之外引起。亦称“卒中”。,2019/12/9,7,历史沿革EvolutionHistory,内经对中风的记载伤寒论对中风的论述唐宋对病因重新认识的分水岭其他医家的论述,概述Introduction,2019/12/9,8,内经始见对中风的记载对卒中、昏迷有仆击、大厥、薄厥等描述对半身不遂有偏枯、偏风、痱风等名称,历史沿革EvolutionHistory,2019/12/9,9,素问调经论：“血之与气，并走于上，则为大厥，厥则暴死，气复返则生，不返则死。”素问生气通天论：“阳气者，大怒则形气绝，而血菀于上，使人薄厥。有伤于筋，纵，其若不容。汗出偏沮，使人偏枯。”素问通评虚实论：“仆击、偏枯肥贵人则膏粱之疾也。”,历史沿革EvolutionHistory,2019/12/9,10,张仲景金匮要略中风历节病脉证并治首创中风的病名及临证分类法“邪在于络，肌肤不仁；邪在于经，即重不胜；邪入于腑，即不识人；邪入于脏，舌即难言，口吐涎。”,历史沿革EvolutionHistory,2019/12/9,11,唐宋以前多以“内虚邪中”立论唐宋以后突出以“内风”立论,刘河间心火暴盛李东垣正气自虚朱丹溪痰湿生热张景岳内伤积损,历史沿革EvolutionHistory,2019/12/9,12,其他学说：王履“真中”和“类中”李中梓“闭证”和“脱证”王清任“气虚”立说,历史沿革EvolutionHistory,2019/12/9,13,急性脑血管病,缺血类,出血类,短暂性脑缺血发作脑血栓形成脑栓塞,脑出血蛛网膜下腔出血,范围Scope,2019/12/9,14,主证：神昏、半身不遂口舌歪斜言语謇涩或不语偏身麻木,兼证：头痛、呕吐、烦躁、抽搐、痰多、呃逆、二便失禁或不通,昏、瘫、喎、謇、麻,证候特征Characterofsyndrome,2019/12/9,15,病因病机Etiology&pathogenesis,2019/12/9,16,病因病机Etiologyandpathogenesis,积损正衰痰浊内生情志失调气虚邪中,2019/12/9,17,年老体弱,思虑劳心,肝肾阴虚,肝阳偏盛,阴亏于下,肝阳亢盛,阳风化动,气血并逆,上蒙元神,积损正衰,2019/12/9,18,嗜食肥甘或劳倦伤脾,肝阳素旺横逆犯脾,痰浊内生,痰湿或痰热夹肝风,脾失健运,横窜经络,蒙蔽清窍,痰浊内生,2019/12/9,19,肝气郁滞,五志过极,风火相煽,心火暴盛,肝阳暴张,气血逆乱,上冲犯脑,情志失调,2019/12/9,20,气血不足,中于经络,脉络空虚,风邪入侵,气血痹阻,肌肉筋脉失于濡养,气虚邪中,2019/12/9,21,病因病机小结Summeryofetiologyandpathogenesis,基本病机气血逆乱，上犯于脑。虚（肝肾阴虚、气虚）火（肝火、心火）痰（风痰、湿痰）风（肝风）气（气逆）血（血瘀）病性本虚标实证，上盛下虚证。病位脑,与心、肝、脾、肾有关,2019/12/9,22,诊断Diagnosis,鉴别诊断Differentialdiagnosis,&,2019/12/9,23,诊断Diagnosis,主证神志恍惚，迷蒙，甚至昏迷或昏愦，半身不遂，口舌歪斜，舌强语蹇或不语，偏身麻木病程急性起病，有渐进发展过程诱因病发多有先兆常有头晕，头痛，肢体麻木，力弱等,2019/12/9,24,诊断Diagnosis,好发年龄40岁多见辅助检查脑脊液检查，眼底检查颅脑T，核磁共振等检查,2019/12/9,25,正常眼底视神经乳头水肿,2019/12/9,26,鉴别诊断Differentialdiagnosis,2019/12/9,27,病情分析Analysesofpathologicalconditions,2019/12/9,28,急性期Acutestroke中经络Apoplexyinvolvingmeridians&collaterals中脏腑Apoplexyinvolvingzangfu恢复期Recoveryperiod后遗症期sequelperiod半身不遂hemiplegia言语不利dysphasia口眼歪斜facialdistortion,发病后周或个月至半年。,半年以上。,分期,中经络发病后至周；中脏腑最长不超过个月。,2019/12/9,29,观察神志,观察瞳仁,察神,神清辨中经络，病位浅，病情轻度。神昧辨中腑，病位较深，病情中度。神昏辨中脏，病位深，病情重度。,2019/12/9,30,辨顺逆,中经络中脏腑,若神志昏愦，双侧瞳仁大小不等，项强或抽搐，吐血，呃逆频频，为病势逆转。,顺,逆,2019/12/9,31,平素头晕头痛，耳鸣目眩，腰膝无力，少寐多梦突然发生口眼喎斜、舌强语蹇、半身不遂舌红苔黄腻，脉弦细数或弦滑,中经络Apoplexyinvolvingmeridians&collaterals,2019/12/9,32,中脏腑Apoplexyinvolvingzangfu,闭证Obstructivesyndrome突然昏倒，不省人事，牙关紧闭，口噤不开，两手握固，大小便闭，肢体强痉,昏、瘫、痉（噤）、闭。,2019/12/9,33,闭证Obstructivesyndrome,阳闭兼有面赤身热、气粗口臭、躁扰不宁苔黄腻、脉弦滑而数阴闭兼有面白唇暗、静卧不烦、四肢不温苔白腻、脉沉滑缓,2019/12/9,34,脱证Depletionsyndrome,突然昏仆，不省人事，目合口张，鼻鼾息微，手撒肢冷，汗多，二便自遗，肢体软瘫舌痿，脉微欲绝,愦、瘫、软、开、遗,2019/12/9,35,半身不遂hemiplegia言语不利dysphasia口眼歪斜facialdistortion,后遗症期Sequelperiod,2019/12/9,36,护理诊断Nursingdiagnosis,2019/12/9,37,护理目标CarePlan,2019/12/9,38,护理措施NursingIntervention,2019/12/9,39,辨证施护Careofsyndromedifferentiation,2019/12/9,40,Principleofnursing：平肝潜阳，熄风通络Entiretynursing,Lifecare:Dietarycare:Drugscare:Othernursingmethods:,中经络Apoplexyinvolvingmeridians&collaterals,天麻勾藤饮天麻、钩藤、生石决明、川牛膝、杜仲、黄芩、桅子、益母草、朱茯神、夜交藤。,镇肝熄风汤（生龙骨、生牡蛎、代赭石、怀牛膝、龟版、白芍、玄参、天冬、川楝子、麦芽、茵陈篙、甘草）,2019/12/9,41,闭证ObstructivesyndromePrincipleofnursing：Entiretynursing：,Lifecare:Dietarycare:Drugscare:Othernursingmethods:,阳闭宜清肝熄风，辛凉开窍阴闭宜豁痰熄风，辛温开窍,中脏腑Apoplexyinvolvingzangfu,2019/12/9,42,脱证DepletionsyndromePrincipleofnursing：益气回阳，救阴固脱Entiretynursing：,Lifecare:Dietarycare:Drugscare:Othernursingmethods:,中脏腑Apoplexyinvolvingzangfu,2019/12/9,43,半身不遂hemiplegia言语不利dysphasia口眼歪斜facialdistortion,后遗症期Sequelperiod,补阳还五汤医林改错黄芪、赤芍、川芎、桃仁、红花、地龙、归尾,2019/12/9,44,护理评价Nursingevaluation,2019/12/9,45,肢体功能锻炼语言锻炼保持乐观情绪中风的预防：慎起居、畅情志、节饮食。,健康指导Nursingevaluation,2019/12/9,46,防护Precautions,对先兆症状的早期治疗：若见眩晕，目花，抽搐等症，为肝阳上亢，肝风内动，应予以平肝熄风之法护治。若见痰浊壅滞，眩晕头重，肢体麻木等症时，宜化痰通