集束化护理对重型颅脑外伤患儿颅内压及预后的影响  

Application of cluster nursing on intracranial pressure and prognosis in children with severe traumatic brain injury

作　　者：徐微[1] 李仁芳 陈苗苗[1] Xu Wei;Li Renfang;Chen Miaomiao(Department of Children Intensive Care Unit,the Second Hospital Affiliated to Wenzhou Medical College,Wenzhou 325000,Zhejiang,China;Department of Cerebral Surgery,the Second Hospital Affiliated to Wenzhou Medical University,Wenzhou 325000,Zhejiang,China)

机构地区：[1]温州医科大学附属第二医院儿童ICU,浙江温州325000 [2]温州医科大学附属第二医院脑外科,浙江温州325000

出　　处：《中国中西医结合急救杂志》2018年第4期383-387,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省温州市公益性科技计划项目（Y20170397）

摘　　要：目的探讨集束化护理对重型颅脑外伤患儿颅内压及预后的影响。方法选择温州医科大学附属第二医院儿童2016年4月至2018年1月收治的110例重型颅脑外伤患儿，按护理方法的不同分为两组，每组55例。常规组按标准方案实施常规护理；集束组在常规护理基础上由5人护理小组实施集束化护理方案（包括心理护理、认知干预、营养支持、康复护理、皮肤护理、对症护理等）。比较两组患儿神经功能、日常生活活动能力（ADL）、运动功能、颅内压、护理满意度、预后及并发症发生情况。结果两组护理后美国国立卫生研究院卒中量表（NIHSS）、ADL评分和颅内压较治疗前明显降低，运动功能评分（Fugl-Meyer）较治疗前明显升高，且集束化方案护理组的变化较标准的常规护理对照组更显著[NIHSS评分（分）：16．14±3．45比20．12±4．23，ADL评分（分）：17．16±4．03比22．06±4．92，Fugl—Meyer（分）：72．56±5．13比63．47±4．06，颅内压（mmHg，1mmHg=0．133kPa）：16．89±1．41比18．12±1．69，均P〈0．05]。与常规组比较，集束组护理满意度[94．55％（52／55）比81．82％（45，55）]、人员满意度[98．18％（54，55）比83．64％（47，55）]、预后良好率[92．73％（51／55）比74．55％（41，55）]均明显增加，并发症发生率[14．55％（8／55）比30．91％（17／55）]明显减少（均P〈0．05）。结论集束化护理可有效改善重型颅脑外伤患儿神经功能、ADL和运动功能，提高满意度和预后，降低颅内压和并发症发生率。Objective To explore the effect of using cluster nursing on intracranial pressure and prognosis in children with severe traumatic brain injury. Methods One hundred and ten children with severe traumatic brain injury admitted to Department of Children Intensive Care Unit of the Second Hospital Affiliated to Wenzhou Medical University were enrolled, and they were divided into two groups according to different nursing methods, 55 patients in each group. The conventional group was given routine nursing care according to the standard scheme, and based on the routine nursing care, the cluster nursing care was additionally applied by 5-person nursing group in the cluster group （including psychological nursing, cognitive intervention, nutritional support, rehabilitation nursing, skin care, symptomatic nursing, etc.）. The nerve functions, the ability of daily life activities, movement function, intracranial pressure, the degree of satisfaction with nursing care, incidence of complications and prognosis were compared between the children in two groups. Results After nursing care in the two groups, the score of American national institutes of health stroke scale （NIHSS）, activity of daily living （ADL） scale and intracranial pressure （ICP） were significantly decreased compared with those before nursing care, while the movement function score （SFS） was significantly increased than that before nursing care, and the degrees of improvement in the cluster group were obviously more significant than those in the conventional control group [NIHSS score： 16.14±_3.45 vs. 20.12±_4.23, ADL score： 17.16±_4.03 vs. 22.06±4.92, Fugl-Meyer score： 72.56±5.13 vs. 63.47±4.06, ICP （mmHg, 1 mmHg = 0.133 kPa）： 16.89±1.4l vs.18.12± 1.69, all P 〈 0.05]. Compared with conventional group, the degree of satisfaction toward nursing care [94.55% （52/55） vs. 81.82% （45/55）], the degree of satisfaction toward employee [98.18% （54/55） vs. 83.64% （47/55）], the rate of good prognosis [92.73% （51/55�

关 键 词：集束化护理 颅脑外伤 颅内压 预后 

分 类 号：R651.15[医药卫生—外科学]