重型颅脑损伤患者压疮危险因素评估及护理干预

目的 评估重型颅脑损伤患者压疮的危险因素,针对性地进行护理干预,以预防压疮发生.方法 对92例重型颅脑损伤患者采用压疮危险因素评分表进行评分,对压疮高危患者实施个体化、综合性的护理干预.结果 入院时92例重型颅脑损伤患者压疮危险因素评分≤14分,均为压疮高危患者,出院时38例≤14分,住院期间无1例发生压疮.结论 重型颅脑损伤患者入院时立即进行压疮危险因素评估并针对性地进行护理干预,能有效预防压疮.     

Waterlow危险因素评估表及分级护理法预防压疮效果观察

目的探讨应用Waterlow危险因素评估表及分级护理法预防压疮（PU）的效果。方法按入院顺序随机将838例患者分为观察组420例、对照组418例。观察组用Waterlow危险因素评估法及分级预防护理法，对照组行传统临床经验法及常规护理。结果观察组PU发生率为0．48％（2／420），对照组为4．78％（20／418）．两组比较，χ^2=15．21．P〈0．01，差异有显著性意义。结论Waterlow危险因素评估法及分级护理法能有效控制压疮发生率，提高临床护理质量。     

儿童重型颅脑损伤的危险因素及干预对策

为了探讨儿童重型颅脑损伤的危险因素及干预对策，我们对1998年1月至2003年1月救治131例儿童重型颅脑损伤进行研究。     

重症颅脑损伤伴低蛋白血症患者皮肤状况评估及护理干预

目的总结重症颅脑损伤伴低蛋白血症患者皮肤状况评估及护理干预,以预防或减少压疮的发生.方法对33例重症颅脑损伤伴低蛋白血症患者进行皮肤状况动态评估,给予保护性干预和个体化护理.结果 33例中,仅6例出现压疮(Ⅱ度4例,Ⅲ、Ⅳ度各1例),护理干预后平均20.2d压疮痊愈.结论重症颅脑损伤伴有低蛋白血症患者经有效的皮肤护理,可降低压疮的发生率及感染率,提高压疮的治愈率.     

Waterlow危险因素评估表及分级护理法预防压疮效果观察

目的探讨应用Waterlow危险因素评估表及分级护理法预防压疮(PU)的效果。方法按入院顺序随机将838例患者分为观察组420例、对照组418例。观察组用Waterlow危险因素评估法及分级预防护理法,对照组行传统临床经验法及常规护理。结果观察组PU发生率为0.48%(2/420),对照组为4.78%(20/418),两组比较,χ2=15.21,P<0.01,差异有显著性意义。结论Waterlow危险因素评估法及分级护理法能有效控制压疮发生率,提高临床护理质量。     

不同气垫床翻身间隔时间预防重型颅脑损伤患者压疮效果比较

目的比较不同类型气垫床及翻身间隔时间预防重型颅脑损伤患者压疮的效果。方法将180例压疮高危患者随机分为A、B、C、D、E、F六组,A、B、C组采用喷气式气垫床,翻身时间分别间隔2h、3h、4h;D、E、F组采用动态交替式气垫床,翻身间隔时间同前;连续观察72h,每次翻身观察记录患者皮肤压疮发生情况、压疮前期表现及Braden评分。结果六组患者均未发生压疮。干预后不同时间六组压疮前期发生率比较,差异有统计学意义(P0.05,P0.01);干预72hB组和E组、C组和F组差异有统计学意义(均P0.00313)。六组Braden评分在干预前、干预后各时间段组内比较差异无统计学意义(均P0.05)。组内比较,F组有统计学差异(P0.01)。结论重症颅脑损伤患者应用两种气垫床均能有效预防压疮,动态交替式气垫床效果更优。使用动态交替式气垫床可将翻身间隔时间延长至4h。     

重症颅脑损伤伴低蛋白血症患者皮肤状况评估及护理干预

目的总结重症颅脑损伤伴低蛋白血症患者皮肤状况评估及护理干预,以预防或减少压疮的发生。方法对33 例重症颅脑损伤伴低蛋白血症患者进行皮肤状况动态评估,给予保护性干预和个体化护理。结果33例中,仅6例 出现压疮(Ⅱ度4例,Ⅲ、Ⅳ度各1例),护理干预后平均20.2d压疮痊愈。结论重症颅脑损伤伴有低蛋白血症患 者经有效的皮肤护理,可降低压疮的发生率及感染率,提高压疮的治愈率。     

重型颅脑损伤昏迷患者的护理

目的总结98例重型颅脑损伤患者的护理体会。方法对98例患者的观察和护理。针对患者的意识、瞳孔、生命体征的观察,进行心理护理、皮肤护理,保持呼吸道的通畅、吸氧、呼吸机的合理应用、测量血氧饱和度,减少患者的并发症。结果98例重型颅脑损伤的患者,经过精心护理,采取有效的护理措施,59例患者度过难关得到良好的恢复,有14例轻、中度残疾,仅有4例损伤过重,多处骨折致使重残;有3例由于伤势过重(农村患者占60%),得不到紧急救护,脑部缺氧时间过长,致使植物生存状;有18例患者合并多脏器功能衰竭,抢救无效死亡。结论有效的护理降低了重型颅脑损伤的死亡率。     

实施护理干预预防颅脑肿瘤患者压疮的体会

目的探讨对颅脑肿瘤术患者实施综合护理干预预防压疮发生的疗效。方法对接受颅脑肿瘤手术的35例患者给予术前压疮风险评估,术后早期预防压疮康复指导等综合护理。回顾性分析患者的临床资料。结果本组围术期仅发生2例(5.71%)压疮,给予对症处理后痊愈。结论在颅脑肿瘤患者围术期实施综合护理干预,可有效减少压疮发生。     

重型颅脑损伤患者心电图异常相关因素分析及护理干预

目的 探讨重型颅脑损伤患者心电图异常的相关因素度护理措施，以提高救治成功率。方法 对47例重型颅脑损伤患者的病历资料进行回顾性分析，分析其心电图变化与颅内压力、体温、电解质、血糖、血氧饱和度之间的关系。结果 心电图异常发生率为76．6％（36／47），多发生在外伤后1周内，主要表现为心律失常和心肌缺血，且心电图异常患者的病死率明显增高。颅内压力〉180cmH2O、体温〉37．8℃、血糖〉6．7mmol／L、血氧饱和度〈0．95、电解质紊乱者心电图异常发生率显著增高。结论 需对上述相关因素采取积极的护理干预措施，以提高重型颅脑损伤患者的救治成功率。     

有创颅内压监测在重型颅脑创伤救治中的应用价值

目的探讨持续动态颅内压监测在重型颅脑创伤治疗中的价值。方法2011年1月-2012年6月对21例重型颅脑创伤采用硬膜下颅内压监测法对术后颅内压进行动态监测,同时观察生命体征和GCS评分变化。结果术后颅内压正常（〈2．0kPa）4例,轻度增高（2．0—2．7kPa）5例,中度增高（〉2．7—5．5kPa）6例,重度增高（〉5．5kPa）6例,死亡5例。结论颅内压动态监测有助于对病情变化的正确判断,可为颅脑创伤的早期诊断、正确治疗及预后提供重要的参考依据。     

呼唤治疗-护理模式对重型颅脑损伤患者的促醒作用

目的探讨呼唤治疗护理模式(call- mode)对重型颅脑损伤(TBI)患者的促醒作用及预后的影响。方法将55例重型TBI患者分为对照组与观察组。对照组(25例)行常规治疗护理;观察组(30 例)在此基础上加用call mode行治疗护理。于伤后6个月评定两组临床疗效、清醒率及清醒时间。结果两组临床疗效比较,差异有显著性意义(P<0.05),且观察组清醒率及清醒时间显著优于对照组(均P<0.01)。结论应用call- mode治疗护理重型TBI患者,能加速患者清醒,提高其生活质量。     

3种压疮评估工具的临床效度测定

目的 测定Braden、Norton、Waterlow 3种压疮评估工具在新疆患者中使用的临床效度.方法 运用3种评估工具对随机抽取的500例住院患者进行压疮评估和皮肤完整性检查.计算各评估工具的灵敏度(Se)、特异度(Sp).结果 压疮发生率为2.8%;对于全部人群,Braden量表的临床效度较好(Se=0.8571,Sp=0.7160);对于汉族患者.Braden量表的临床效度较高(Se=0.8750,Sp=0.7438);对于少数民族患者,Waterlow量表具有较高的临床效度(Se=0.8333,Sp=0.7366).结论 临床初步评估压疮时,建议首选Braden量表,对于少数民族患者,辅以Waterlow量表.     

Treating Intracranial Hypertension in Patients with Severe Traumatic Brain Injury during Neurointensive Care

Abstract Despite the envisioned breakthrough prophesied for the end of the past century in healing brain injured patients, both clinicians and basic scientists are still struggling with this burden. In the past decades, intensive research has brought forward a plethora of different targets which—in part—have already been integrated in clinical routine directed at detailed monitoring, therapeutic interventions, and prevention of secondary deterioration. While intracellular targets remain obscure alterations on a larger scale as e. g., measured intracranial pressure (ICP), calculated cerebral perfusion pressure (CPP), and various imaging techniques are fundamental components of our present clinical understanding. At bedside, comprehension of pathophysiological loops and circuits of a given value (e. g., ICP) depends on individual knowledge, interpretation, and availability of additional diagnostic steps. As stated in the guidelines brought forward by the American Association of Neurological Surgeons and evaluated in various reports by the Cochrane Library we are still lacking prospective, randomized trials for the majority of the proposed diagnostic and therapeutic interventions. In this context, a recent meta-analysis even questioned the importance of ICP monitoring as we are lacking data from randomized controlled trials clarifying the role of ICP monitoring. The present review is to give an overview of various diagnostic and therapeutic possibilities based on reports published in the past 5 years to strengthen current approaches and nourish future well-designed investigations how to avoid and treat intracranial hypertension.     

临床护理路径在重型颅脑外伤病人抢救中的应用探讨

目的:在抢救重型颅脑外伤病人的急诊室抢救阶段和神经外科重症监护阶,采用临床护理路径,并对效果进行评价.方法:研究对象为我院收治病人,对照组192例,为2009年9月-2009年12月收治抢救的患者,实施常规抢救;试验组204例,为2010年1月-2010年6月收治抢救的患者,按快捷护理路径进行抢救.比较两组患者抢救时间及费用、住院时间及费用等各项指标.结果:试验组和对照组患者在抢救时间、抢救费用、住院时间指标上均有极显著性差异(P<0.01);试验组和对照组在并发症发生率统计是也存在显著差异(P<0.05).结论:快捷护理路径能够有效提高重型颅脑外伤病人抢救的效果,节省费用,值得推广.     

Risk Assessment for Pressure Ulcers: An Adaptation of the National Pressure Ulcer Advisory Panel Risk Factors to Spinal Cord Injured Patients

ABSTRACT

To estimate risk factors for pressure ulcers, we developed quantitative definitions for each of the nine general areas of risk outlined by the 1989 National Pressure Ulcer Advisory Panel (NPUAP) and evaluated each of these factors in a group of spinal cord injured patients by means of a retrospective chart review at a spinal cord injury referral center serving the New England area. All patients (n=364) admitted to the spinal cord injury service between January 1, 1989 and December 31, 1990 were studied.

We identified a pressure ulcer in 81 of 364 patients (22.3 percent). In the univariate analyses, pressure ulcers were associated with Frankel groups A to B with an odds ratio (OR) of 5.7 (95 percent confidence interval 2.8 to 11.9), low albumin with an OR of 4.9 (95 percent confidence interval 2.8 to 8.6), low hemoglobin with an OR of 2.5 (95 percent confidence interval 1.5 to 4.1), age ≥60 years with an OR of 1.9 (95 percent confidence interval 1.2 to 3.2) and three independent measures of co-morbidity: Cumulative Illness Rating Scale (CIRS) with an OR of 3.7 (95 percent confidence interval 2.1 to 6.3), Charlson Index with an OR of 2.2 (95 percent confidence interval 1.3 to 3.8), and International Classification of Diseases, Ninth Revision, Clinical Modification count with an OR of 4.2 (95 percent confidence interval 2.4 to 7.2). In the logistic regression model, low albumin, CIRS and Frankel grade A to B and history of pressure ulcers were predictors. This study demonstrates that the NPUAP criteria can be adapted and quantified for spinal cord injured patients who are at high risk for pressure ulcers.     

Risk Assessment Tool for Pressure Ulcer Development in Indian Surgical Wards

The aims of this paper were to compare the predictive validity of three pressure ulcer (PU) risk scales—the Norton scale, the Braden scale, and the Waterlow scale—and to choose the most appropriate calculator for predicting PU risk in surgical wards of India. This is an observational prospective cohort study in a tertiary educational hospital in New Delhi among 100 surgical ward patients from April to July 2011. The main outcomes measured included sensitivity, specificity, positive predictive value (PVP) and negative predictive value (PVN), and the area under the curve of the receiver operating characteristic (ROC) curve of the three PU risk assessment scales. Based on the cutoff points found most appropriate in this study, the sensitivity, specificity, PVP, and PVN were as follows: the Norton scale (cutoff, 16) had the values of 95.6, 93.5, 44.8, and 98.6, respectively; the Braden scale (cutoff, 17) had values of 100, 89.6, 42.5, and 100, respectively; and the Waterlow scale (cutoff, 11) had 91.3, 84.4, 38.8, and 97, respectively. According to the ROC curve, the Norton scale is the most appropriate tool. Factors such as physical condition, activity, mobility, body mass index (BMI), nutrition, friction, and shear are extremely significant in determining risk of PU development (p < 0.0001). The Norton scale is most effective in predicting PU risk in Indian surgical wards. BMI, mobility, activity, nutrition, friction, and shear are the most significant factors in Indian surgical ward settings with necessity for future comparison with established scales.     

洁悠神治疗重型颅脑损伤患者腹泻致肛周皮肤损伤

目的 探讨重型颅脑损伤患者腹泻致肛周皮肤损伤的治疗方法及效果.方法 将100例重型颅脑损伤腹泻致肛周皮肤损伤的患者随机分为观察组(52例)和对照组(48例),对照组皮损部位涂凡士林软膏处理,观察组采用洁悠神长效抗菌剂喷洒.结果 观察组疗效显著优于对照组,治愈时间显著缩短(均P＜0.01).结论 洁悠神辅助治疗重型颅脑损伤腹泻患者的肛周皮肤损害有效,且能缩短治疗时间,减轻患者痛苦.