摘要
目的探讨全面系统护理干预在重型对冲性颅脑损伤患者双侧去骨瓣减压开颅术围手术期中的应用效果。方法选取2015年3月至2017年10月遂宁市中心医院108例重型对冲性颅脑损伤患者,均经临床诊断拟行双侧去骨瓣减压开颅术治疗,根据入院单双号分为对照组和观察组各54例。对照组给予围术期常规护理,观察组在对照组基础上给予全面系统护理干预,干预1个月后,采用神经功能缺损量表(NHISS)、简化Fugl-Meyer运动功能量表(Fugl-Meyer)、格拉斯哥昏迷量表(GCS)及Barthel指数评估两组患者护理前后的神经功能、肢体功能、恢复情况和日常生活能力,采用Karnofsky预后评定表(KPS)评估患者的预后,并统计对比两组患者的护理满意度和并发症发生率。结果干预后观察组患者的NHISS评分为(17.39±3.28)分,显著小于对照组的(21.44±3.46)分,差异具有统计学意义(P<0.05);干预后观察组患者的GCS评分、Fugl-Meyer总分、Barthel指数、KPS评分分别为(10.89±2.03)分、(76.42±4.33)分、(46.83±6.43)分、(92.10±6.36)分,对照组分别为(8.46±2.25)分、(69.10±4.49)分、(39.75±6.45)分、(88.12±7.51)分,观察组患者的上述指标均小于对照组,差异均有统计学意义(P<0.05);观察组患者的护理满意度为96.30%,明显高于对照组的81.48%,差异有统计学意义(P<0.05);观察组患者的中枢性高热发生率和关节僵硬发生率分别为3.70%、1.85%,明显低于对照组的18.52%、16.67%,差异均有统计学意义(P<0.05)。结论全面系统护理干预能有效改善重型对冲性颅脑损伤行双侧去骨瓣减压开颅术患者术后肢体功能,能促进患者神经功能恢复,降低并发症发生率,提高患者生活质量及护理满意度,改善预后。
Objective To investigate the application effect of comprehensive systematic nursing intervention in perioperative period of bilateral decompression craniotomy for patients with severe contrecoup craniocerebral injury.Methods A total of 108 patients with severe contrecoup craniocerebral injury undergoing bilateral decompression craniotomy after clinical diagnosis in Suining Central Hospital from March 2015 to October 2017 were selected. They were divided into control group and observation group according to even and odd number, with 54 cases in each group. The control group was given routine nursing during the perioperative period, and the observation group was given comprehensive systematic nursing intervention on the basis of the control group. After 1 month of intervention, the nerve function, body function, recovery, and daily life ability of patients before and after nursing care were evaluated by neurological deficit scale(NHISS), simplified Fugl-Meyer motor function scale(Fugl-Meyer), Glasgow Coma Scale(GCS) and Barthel index. The prognosis of patients was evaluated by Karnofsky prognostic evaluation table(KPS), and the nursing satisfaction, the incidence of complications were compared between the two groups. Results After intervention, the NHISS score of the observation group was(17.39±3.28), which was significantly smaller than(21.44±3.46) of the control group(P<0.01). The GCS score, Fugl-Meyer total score, Barthel index, and KPS score in the observation group were(10.89±2.03),(76.42±4.33),(46.83±6.43) and(92.10±6.36), which were significantly lower than(8.46±2.25),(69.10±4.49),(39.75±6.45) and(88.12±7.51) in the control group(P<0.05). The nursing satisfaction of the observation group was 96.30%, which was significantly higher than 81.48% of the control group(P<0.05). The incidence of central hyperthermia and joint stiffness in the observation group were 3.70% and 1.85%, respectively, which were significnatly lower than 18.52% and 16.67% of the control group(P<0.05). Conclusion Comprehensive systematic nursing intervention can effectively improve the postoperative limb function in patients with severe contrecoup craniocerebral injury undergoing bilateral decompression craniotomy. It can promote the recovery of neurological function, reduce the incidence of complications, improve the quality of life and nursing satisfaction, and improve the prognosis of patients.
作者
蔡珍
CAI Zhen(Department of Neurology,the Second Unit of the Nerve Center,Suining Central Hospital,Suining 629000,Sichuan,CHINA)
出处
《海南医学》
CAS
2018年第22期3249-3253,共5页
Hainan Medical Journal
关键词
对冲性颅脑损伤
全面系统护理干预
双侧去骨瓣减压开颅术
围术期
生活质量
神经功能
Contrecoup craniocerebral injury
Comprehensive systematic nursing intervention
Bilateral decom- pression craniotomy
Perioperative period
Quality of life
Neurologic function
