1、The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.内三科内三科 王丽君王丽君2014.12.162014.12.16The guiding ideology should be guided by Deng Xia
2、opings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.概述概述 脑卒中是威胁人类生命健康的一种主要的疾病，主要就是指的脑动脉系统病变引起的血管痉挛、闭塞或者是破裂而造成急性发展的脑局部循环障碍，根据发病的部位不同，可以出现单瘫、偏瘫、四肢瘫，其中以偏瘫为主。主要表现就是以瘫痪为主的肢体功能障碍。脑卒中患者生存质量的
3、高低取决于瘫痪肢体功能恢复的程度，为了能够让脑卒中患者尽可能的恢复到功能障碍前的状态，一般会采取一系列有效的措施，对他们进行精心的照顾。2The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.概述概述 良肢位摆放对于脑
4、卒中患者的恢复，具有极其重要的作用。对于脑卒中患者发病后早期给予良肢位设计与摆放的重要性，美国“脑卒中康复护理临床指南”强调：发病后早期有效的康复干预能促进肢体功能的恢复过程，减轻功能残障，从而降低后续的长期的护理成本。对于脑卒中患者良肢位的设计与摆放，护理人员会按照患者肢体功能所处的阶段不同，而采取不同的方法，并且会贯穿于康复护理的全过程。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 1
5、6th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.概述概述 正确的卧位姿势在康复医学中称为良肢位。良肢位的摆放是基本康复手段的一种。顾名思义，它是为了保持肢体的良好功能而将其摆放在一种位置或保持一种姿势。4The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th
6、CPC National Congress and the third Plenary session of the 16th CPC Central Committee.不正确的卧位姿势可诱发加重痉挛，进而引发关节挛缩，导致患者严重的功能障碍。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary s
7、ession of the 16th CPC Central Committee.良肢位摆放的意义良肢位摆放的意义 促进运动功能恢复 减少残障的发生 提高病人的生活生命质量。预防压疮 使患者感觉舒适6The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC
8、Central Committee.The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.The guiding ideology should be guided by Deng Xiaopings theory,t
9、he important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National C
10、ongress and the third Plenary session of the 16th CPC Central Committee.偏瘫后常见的异常姿态偏瘫后常见的异常姿态下肢可出现的典型姿势是：u患侧骨盆上抬、且向后方旋转、下肢外旋；u髋膝关节伸展；u踝关节趾屈、内翻，足尖着地。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress
11、 and the third Plenary session of the 16th CPC Central Committee.The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.站立位的异常姿势：站立位的异常姿势
12、：u头向患侧屈曲，面部转向健头向患侧屈曲，面部转向健侧；侧；u躯干向患侧弯曲且向后方旋躯干向患侧弯曲且向后方旋转；转；u肩下沉后缩，肩关节内收、肩下沉后缩，肩关节内收、内旋；内旋；u肘关节屈曲于胸腹前，前臂肘关节屈曲于胸腹前，前臂旋前；旋前；u垂腕、手指屈曲呈握拳状。垂腕、手指屈曲呈握拳状。偏瘫后常见的异常姿态偏瘫后常见的异常姿态The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CP
13、C National Congress and the third Plenary session of the 16th CPC Central Committee.偏瘫患者良肢位摆放的开始时间偏瘫患者良肢位摆放的开始时间 多数研究者认为在患者生命体征稳定，神经学症状不再发展后48h可进行。患者病情稳定在监护病房就应该进行。康复越早，肢体功能恢复越好。13The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit
14、of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.偏瘫患者良肢位摆放的开始时间偏瘫患者良肢位摆放的开始时间 有研究者认为脑卒中偏瘫患者康复护理介入时间越早越好，因为肢体功能在脑卒中后3个月内恢复最快，在神经功能恢复的高峰期给予强化训练，即在入院急性期在治疗的同时进行良肢位的摆放并坚持全过程。The guiding ideology should be guided by Deng Xiaopings theory,the important thou
15、ght of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.良肢位摆放的常用方法良肢位摆放的常用方法l仰卧位l健侧卧位l患侧卧位l床上坐位l3种姿势(2H)轮换，最好多采取侧卧位，仰卧位一般要相对少采用。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of thr
16、ee represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.患者头下垫枕，不宜过高患者头下垫枕，不宜过高 。肩胛骨下放一枕头，使肩上抬前挺，上臂外肩胛骨下放一枕头，使肩上抬前挺，上臂外旋稍外展，肘、腕均伸直，掌心向上，手指旋稍外展，肘、腕均伸直，掌心向上，手指伸直并分开，整个上肢放在枕头上。伸直并分开，整个上肢放在枕头上。患侧下肢，在臀部和大腿外侧垫枕头，患侧下肢，在臀部和大腿外侧垫枕头，髋关节稍向内旋
17、。髋关节稍向内旋。膝关节呈轻度屈曲位。膝关节呈轻度屈曲位。脚底不要接触任何东西脚底不要接触任何东西 。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.The guiding ideology should be
18、guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.注意事项注意事项 避免被子太重而压迫偏瘫足造成足尖的避免被子太重而压迫偏瘫足造成足尖的外旋，足底此时不垫物是为了协助患者外旋，足底此时不垫物是为了协助患者活动踝关节以防止足下垂。活动踝关节以防止足下垂。避免使用过高的枕头，头部
19、不要有明显避免使用过高的枕头，头部不要有明显的左右偏斜（可以稍偏向患侧的左右偏斜（可以稍偏向患侧）骶尾部、足跟和外踝等处发生褥疮的危骶尾部、足跟和外踝等处发生褥疮的危险性增加。险性增加。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central
20、 Committee.常见错误：l 头向健侧，患肩过高，手握毛巾卷，放在肚子上头向健侧，患肩过高，手握毛巾卷，放在肚子上The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.常见错误：l足尖转向外侧，未保持中立位足尖转
21、向外侧，未保持中立位The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.健侧肢体在下方。患侧上肢，肩向前伸，肘和腕关节保持自然伸展，手心向下自然伸展，腋下垫个软枕，使肩和上肢保持前伸。患侧下肢，骨盆旋前，髋关节呈自然
22、半屈曲位，置于枕上。健侧下肢可放在自觉舒适的放置，轻度伸髋，稍屈膝。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.The guiding ideology should be guided by Deng Xi
23、aopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16t
24、h CPC National Congress and the third Plenary session of the 16th CPC Central Committee.注意事项注意事项 u手腕呈背伸位，防止手屈曲在枕头边缘u足不能内翻悬在枕头边缘u两腿之间用枕头隔开健侧卧位是患者最舒适的体位，也对患侧肢体有益。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC Nati
25、onal Congress and the third Plenary session of the 16th CPC Central Committee.常见错误：l 患肢和躯干成角不够，手悬空患肢和躯干成角不够，手悬空The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of th
26、e 16th CPC Central Committee.l 足悬空足悬空常见错误：The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.u患侧肢体在下方。u患侧上肢：肩和肩胛骨向前伸，前臂往后旋，使肘和腕伸展，手掌向
27、上，手指伸开。u健侧上肢可放在躯干上。u患侧下肢：健肢在前，患肢在后，患侧膝、髋关节屈膝，稍稍被动背屈踝关节 u健侧下肢髋、膝关节屈曲，由膝至脚部用软枕支持，避免压迫患侧下肢肢体。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Co
28、mmittee.The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.The guiding ideology should be guided by Deng Xiaopings theory,the importa
29、nt thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.注意事项注意事项 此侧卧位躯干应稍稍后仰，偏瘫侧肩部略向前伸，避免偏瘫侧肩部过多承受身体压力而引起疼痛；保持偏瘫侧肩胛骨前伸位时，不能直接牵拉患侧上肢，以避免对患侧肩关节的损伤。患侧卧位增加了对患侧的知觉刺激输入，使整个患侧被拉长，对于痉挛可起到一定的抑制作用。而且健侧手臂可以自由活动，因此是最佳体位。The
30、guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.常见错误：l患肩没有牵出，躯干没有后仰，患肩受压患肩没有牵出，躯干没有后仰，患肩受压The guiding ideology should be guided by Den
31、g Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.常见错误：l健腿下垫枕位置太靠前，患髋没有后伸健腿下垫枕位置太靠前，患髋没有后伸The guiding ideology should be guided by Deng Xiaopings theory,the important thought o
32、f three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.床上座位床上座位 在患者背后使用枕头或被子支撑，使上身直立；偏瘫侧肘关节的角度如下图，要避免肘关节的过度屈曲；偏瘫侧前臂和手用被子支撑，以免偏瘫侧肩关节受到上肢重量向下牵拉的力量；手指自然伸展，避免过度屈曲，双腿自然伸直，在偏瘫侧下肢外侧置软垫，纠正偏瘫腿的外旋，达到两侧足尖对称，避免偏瘫侧足尖外旋。The guiding ideol
33、ogy should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three repre
34、sents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.注意事项注意事项 1、健康侧上肢可以自然放置。2、避免患侧上肢长时间处于手心向下的位置，这样容易造成肌肉痉挛。3、大多数时间应保持手心向上或朝向身体对侧。4、如在轮椅或平时坐位时，偏瘫侧前臂和手也要给予良好的支持。The guiding ideology should be guided by Deng Xiaopings theory,the importa
35、nt thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.护理体会护理体会 早期良肢位摆放可有效地防止各种并发症的发生，特别是褥疮、坠积性肺炎和泌尿系感染三大并发症 早期良肢位摆放可为后期康复治疗打下良好的基础，有些患者可从软瘫期跨过痉挛期直接到恢复期，甚至能出现早期分离运动，不同程度地降低患者致残率，为家庭和社会减轻负担。The guiding ideology s
36、hould be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.护理体会护理体会 早期良肢位摆放能增强医护人员对康复知识的了解，同时可增加患者及家属战胜疾病的信心，从而能积极配合医护人员的治疗和康复师的训练，能顺利重返社会。医护人员及家属均应重视脑卒中患者早期良肢位的摆放
37、，尽量缩短康复时间，最大限度地提高患者生活质量。所以我们每位护理人员都会十分谨慎，认真负责。The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.康复了，谢谢!38The guiding ideology should be guided by Deng Xiaopings theory,the important thought of three represents and the spirit of the 16th CPC National Congress and the third Plenary session of the 16th CPC Central Committee.
