預(yù)見性護(hù)理在蛛網(wǎng)膜下腔出血患者腰大池引流術(shù)中的應(yīng)用效果

陳偉英 黃昭萍

[摘要]目的 觀察預(yù)見性護(hù)理在蛛網(wǎng)膜下腔出血患者腰大池引流術(shù)中的應(yīng)用效果。方法 選取2015年3月～2018年3月我院收治的38例蛛網(wǎng)膜下腔出血采取腰大池引流術(shù)進(jìn)行治療的患者作為研究對(duì)象，按照入院編號(hào)采取數(shù)字法隨機(jī)將患者分為試驗(yàn)組和對(duì)照組，各19例。對(duì)照組患者給予常規(guī)護(hù)理，試驗(yàn)組在其基礎(chǔ)上予以預(yù)見性護(hù)理。觀察、比較出院時(shí)，兩組的護(hù)理效果（頭痛持續(xù)時(shí)間、血性腦脊液消失時(shí)間、住院時(shí)間、治愈率）和不良事件總發(fā)生率（非計(jì)劃性拔管、引流管阻塞、過度引流），評(píng)估住院期間兩組患者的并發(fā)癥（癲癇、腦梗死、腦水腫、感染）發(fā)生率及術(shù)后2周的預(yù)后情況[采用格拉斯哥昏迷評(píng)分量表（GCS）評(píng)估]評(píng)分。結(jié)果 出院時(shí)，試驗(yàn)組患者的頭痛持續(xù)時(shí)間、血性腦脊液消失時(shí)間及住院時(shí)間均短于對(duì)照組，治愈率高于對(duì)照組（P<0.05）。試驗(yàn)組患者的不良事件總發(fā)生率低于對(duì)照組（P<0.05）。住院期間，試驗(yàn)組患者的并發(fā)癥總發(fā)生率低于對(duì)照組（P<0.05）。術(shù)后2周時(shí)，試驗(yàn)組患者的GCS評(píng)分高于對(duì)照組（P<0.05）。結(jié)論 將預(yù)見性護(hù)理用于蛛網(wǎng)膜下腔出血采取腰大池引流術(shù)患者中，可以提高護(hù)理質(zhì)量，降低住院期間的并發(fā)癥總發(fā)生率及出院時(shí)的不良事件總發(fā)生率，進(jìn)而促進(jìn)患者的預(yù)后。

[關(guān)鍵詞]預(yù)見性護(hù)理;蛛網(wǎng)膜下腔出血;引流;預(yù)后

[中圖分類號(hào)] R73.6? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] A? ? ? ? ? [文章編號(hào)] 1674-4721（2019）8（b）-0240-04

[Abstract] Objective To observe the application effect of predictive nursing in the lumbar cistern drainage of of patients with subarachnoid hemorrhage. Methods A total of 38 patients with subarachnoid hemorrhage admitted to our hospital from March 2015 to March 2018 who were treated with lumbar cistern drainage were selected as study objects and they were randomly divided into the experimental group （n=19） and control group （n=19） using the number method according to admission number. The control group was given routine nursing， and the experimental group was given predictive nursing on this basis. The nursing effect （duration of headache， disappearance time of bloody cerebrospinal fluid， hospital stay， cure rate） and total incidence rate of adverse events （unplanned extubation， drainage tube obstruction， excessive drainage） were observed and compared between the two groups at discharge， and the incidence rate of complications （epilepsy， cerebral infarction， cerebral edema， infection） during hospitalization and the prognosis at 2 weeks after operation （Glasgow coma score [GCS] was used to evaluate） were evaluated in patients of the two groups. Results At discharge， the headache duration， disappearance time of bloody cerebrospinal fluid and hospital stay in the experimental group were shorter than those in the control group， and the cure rate was higher than that in the control group （P<0.05）， and the total incidence rate of adverse events in the experimental group was lower than that in the control group （P<0.05）. During hospitalization， the total incidence rate of complications in the experimental group was lower than that in the control group （P<0.05）. At 2 weeks after operation， the GCS score in the experimental group was higher than that in the control group （P<0.05）. Conclusion Predictive nursing in lumbar cistern drainage of patients with subarachnoid hemorrhage can improve the nursing quality， and reduce the total incidence of complications during hospitalization and adverse events at discharge， thus promoting the prognosis of patients.

[Key words] Predictive nursing; Subarachnoid hemorrhage; Drainage; Prognosis

蛛網(wǎng)膜下腔出血是神經(jīng)外科的常見病、多發(fā)病，其致死率和致殘率極高[1]。其中，創(chuàng)傷性蛛網(wǎng)膜下腔出血是由于各種外傷引起的以腦梗死、腦積水為主要病理改變的疾病[2]。目前，持續(xù)腰大池引流術(shù)在治療蛛網(wǎng)膜下腔出血中的效果顯著，不僅操作簡(jiǎn)單，而且安全有效，臨床應(yīng)用廣泛[3]。但是在置管引流過程中，可能會(huì)出現(xiàn)感染、非計(jì)劃拔管等情況，導(dǎo)致加重病情。因此，術(shù)后的優(yōu)質(zhì)護(hù)理對(duì)患者的預(yù)后顯得尤為重要。田先等[4]將預(yù)見性護(hù)理用于重型顱腦損傷中發(fā)現(xiàn)，經(jīng)過干預(yù)能有效降低重型顱腦損傷患者的死亡率和并發(fā)癥發(fā)生率，改善患者的心理狀態(tài)和提高其生存質(zhì)量。……