阶梯式个体化护理在颅脑损伤手术患者中的应用效果观察_朱燕燕.pdf

护理论著CHINESE COMMUNITY DOCTORS中国社区医师2023年第39卷第2期阶梯式个体化护理在颅脑损伤手术患者中的应用效果观察朱燕燕郑珊邓小灵514300广东省丰顺县人民医院，广东 丰顺doi:10.3969/j.issn.1007-614x.2023.02.041摘要目的：探讨阶梯式个体化护理在颅脑损伤手术患者中的应用效果。方法：选取2018年7月-2020年7月广东省丰顺县人民医院收治的46例颅脑损伤拟行手术治疗者为研究对象，以随机数字表法分为试验组与对照组，各23例。对照组实施常规护理，试验组实施阶梯式个体化护理，并随访6个月。比较两组抢救成功率、预后情况、术后24 h与术后1周格拉斯哥昏迷指数量表(GCS)、急性生理与慢性健康(APACHE)评分、术后1周与随访6个月的生活活动能力(ADL)、神经功能缺损(NIHSS)评分。结果：试验组抢救成功率、预后恢复良好率高于对照组，差异有统计学意义(P0.05)；试验组残疾率低于对照组，差异有统计学意义(P0.05)；两组植物状态率、死亡率比较，差异无统计学意义(P0.05)；术后24 h，两组GCS、APACHE评分比较，差异无统计学意义(P0.05)；术后1周，两组GCS高于术后24 h，且试验组高于对照组，差异有统计学意义(P0.05)；术后1周，两组APACHE评分低于术后24 h，且试验组低于对照组，差异有统计学意义(P0.05)；两组术后1周ADL、NIHSS评分比较，差异无统计学意义(P0.05)；随访6个月，两组ADL高于术后1周，且试验组高于对照组，差异有统计学意义(P0.05)；随访6个月，两组NIHSS评分低于术后1周，且试验组低于对照组，差异有统计学意义(P0.05)。结论：在颅脑损伤手术中，运用阶梯式个体化护理，可明显提升患者的抢救成功率，改善昏迷情况，降低监测治疗密度，减少神经功能缺损，提升生活活动能力，效果理想。关键词阶梯式；个体化护理；颅脑损伤；手术护理Application Effect Observation of Stepped Individualized Nursing in Patients of Craniocerebral Injury SurgeryZhu Yan-yan,Zheng Shan,Deng Xiao-lingFengshun County Peoples Hospital of Guangdong Province,Fengshun 514300,Guangdong Province,ChinaAbstractObjective:To explore the application effect of stepped individualized nursing in patients of craniocerebral injurysurgery.Methods:A total of 46 patients with craniocerebral injury who were candidates for surgical treatment in Fengshun CountyPeoples Hospital of Guangdong Province from July 2018 to July 2020 were selected as the study subjects.They were divided intocontrol group and experimental group according to random number table method,with 23 cases in each group.The control groupimplemented routine nursing,and the experimental group implemented stepped individualized nursing.The patients were followedup for 6 months.The rescue success rate,prognosis,Glasgow Coma Scale(GCS)and Acute Physiology and Chronic HealthEvaluation(APACHE)scores at 24 h and 1 week after operation,activity of daily living(ADL)and neurological deficit(NIHSS)scores at 1 week after operation and 6 months of follow-up were compared between two groups.Results:The rescue success rateand good prognosis recovery rate in the experimental group were higher than those in the control group,and the difference wasstatistically significant(P0.05).The disability rate in the experimental group was lower than that in the control group,and thedifference was statistically significant(P0.05).At 24 h after surgery,there was no significant difference between two groups in the GCS and APACHEscores(P0.05).At 1 week after surgery,the GCS in the two groups was higher than that at 24 h after surgery,and the experimentalgroup was higher than the control group,and the difference was statistically significant(P0.05).at 1 week after surgery,theAPACHE score in the two groups was lower than that at 24 h after surgery,and the experimental group was lower than thecontrol group,and the difference was statistically significant(P0.05).At 6 months of follow-up,ADL in the two groups was higher than thatat 1 week after surgery,and the experimental group was higher than the control group,and the difference was statisticallysignificant(P0.05).At 6 months of follow-up,the NIHSS score in the two groups was lower than that at 1 week after surgery,andthe experimental group was lower than the control group,and the difference was statistically significant(P0.05).Conclusion:Incraniocerebral injury surgery,the use of stepped individualized nursing can significantly improve the rescue success rate ofpatients,improve the coma situation,reduce the density of monitoring treatment,reduce the neurological impairment,improve theability of life activities,and has ideal effect.Key wordsStepped;Individualized nursing;Craniocerebral injury;Surgery nursing123护理论著CHINESE COMMUNITY DOCTORS中国社区医师2023年第39卷第2期脑损伤通常是由于头部受到暴力作用造成了脑膜、脑组织、脑血管、脑神经的损伤，分为原发性与继发性1。伴随着我国交通、建筑业的不断发展，交通、工矿事故，由于钝、锐器，爆炸，跌落对头部的伤害，所造成的颅脑损伤发生率呈上升趋势，具有一定的死亡率及致残率2-3。常规护理由于缺乏针对性效果并不理想，本研究开展阶梯式个体化护理，对于患者不同疾病表现及不同疾病阶段，开展更符合患者疾病情况的针对性护理措施。而本文旨在探讨阶梯式个体化护理在颅脑损伤手术患者中的应用效果，现报告如下。资料与方法选取2018年7月-2020年7月广东省丰顺县人民医院收治的46例颅脑损伤拟行手术治疗者为研究对象，以随机数字表法分为试验组与对照组，各23例。试验组男17例，女6例；年龄2577岁，平均(44.14.1)岁；受伤至就诊时间1.718.9 h，平均(6.81.0)h。对照组男18例，女5例；年龄2476岁，平均(42.33.7)岁，受伤至就诊时间1.718.9 h，平均(6.20.9)h。两组患者基本资料比较，差异无统计学意义(P0.05)，具有可比性。纳入标准：患者颅脑损伤诊断明确；患者拟行手术治疗；患者知情同意本研究；患者资料完整。排除标准：患者合并其他脏器损伤出血；患病前患有其他脑科疾病者；存在卒中后遗症者；其他问题引发的肢体活动不灵活者。方法：(1)对照组实施常规护理：入院后评估患者情况，根据评分实施护理，术后密切监测生命体征。(2)试验组实施阶梯式个体化护理：急救：迅速判断病情，保持呼吸道通畅，侧卧位，协助患者做好相应检查，做好紧急术前准备。转运：迅速启动急救绿色通道，严密观察病情，防止坠床。重症监护：做好术前准备与术后护理准备工作。观察患者意识状态、瞳孔变化、颅内压、骨窗压力，异常时报告医生。完善术前准备。术后：完善伤口及引流管、气道、呼吸机、泌尿系统、应激性溃疡护理。加强基础护理。康复：分阶段康复锻炼，生命体征稳定后 2448 h 进行早期的肢体功能锻炼；伤后47 d，肢体按摩23次/d，10 min/次，循序渐进、缓慢节律。从被动到主动。语言功能需要早开始，先听再理解，逐渐语言表达及书写训练。营养支持需高蛋白、高维生素、高热量、低脂的饮食，鼓励自己进食。观察指标：观察两组抢救成功率及预后情况。观察两组术后24 h与术后1周时格拉斯哥昏迷指数量表(GCS)、急性生理与慢性健康(APACHE)评分，GCS：正常为14 分，轻度昏迷为 1314 分，中度昏迷为912分，重度昏迷为38分，评分越高表示患者的意识状态越好，治疗效果越好；APACHE：071分，分数越高所需监测治疗密度越大，患者风险越高。观察两组术后1周与随访6个月的生活活动能力(ADL)、神经功能缺损(NIHSS)评分。ADL 量表：20分为完全依赖，100分为独立生活活动，分数越高代表患者的生活能力越高。NIHSS评分：总分42分，分数越高代表神经功能缺损越严重。统计学方法：数据运用SPSS 17.0统计学软