颅脑损伤患者生存质量与康复教育

1对象和方法1.1对象选择2000～2002年间在我院神经外科住院的颅脑损伤患者98例,男80例,女18例,平均年龄(38±10)岁。急性硬膜下血肿22例,急性硬膜外血肿19例,脑挫裂伤21例,颅内血肿36例,发病原因均为外伤所致。伤后6hGCS评分≤8分。其中气管切开20例。1.2方法1.2.1康复教育计划选择急性期后基本状况稳定、生命体征平稳、意识清楚,可与医护人员沟通者,由主治医师、责任医师、护师等根据患者的具体病情、文化程度、家属的状况制定康复教育计划,个别情况采用床边康复指导。1.2.2康复教育的内容(1)向患者介绍有关颅脑损伤疾病,治疗愈后的知识,…     

胃癌患者生存质量的评估

生存质量（Quality of Life,QOL)是临床肿瘤治疗效果评价的一个重要指标,目前与胃癌患者生存质量相关的国际标准尚未确定,本文就目前国际上胃癌患者QOL的测评量表予以评价。     

早期康复护理对颅脑外伤患者生活质量、运动功能的影响

目的 探讨早期康复护理在颅脑外伤患者中的应用效果。方法 选取2019年12月至2020年12月我院神经外科收治的108例颅脑外伤患者作为研究对象,按照随机数字表法将其分为对照组和试验组,各54例。对照组实施常规护理,试验组实施早期康复护理。比较两组的护理效果。结果 试验组的康复总有效率为94.44%,高于对照组的81.48%,差异具有统计学意义（P<0.05）。护理后,试验组的会话、命名、复述、听觉理解、阅读、书写评分高于对照组,差异具有统计学意义（P<0.05）。护理后,试验组的健康调查简表（SF-36）各维度评分高于对照组,差异具有统计学意义（P<0.05）。护理后,试验组的美国国立卫生研究院卒中量表（NIHSS）评分低于对照组,Wolf运动功能评价量表（WMFT）评分高于对照组,差异具有统计学意义（P<0.05）。结论 早期康复护理在颅脑外伤患者中的应用效果显著,可改善语言功能、神经功能、运动功能,提高生活质量,值得临床推广和应用。     

胃癌患者生存质量的评估

生存质量 ( Quality of Life, QOL) 是临床肿瘤治疗效果评价的一个重要指标 , 目前与胃癌患者生存质量相关的国际标准尚未确定 , 本文就目前国际上胃癌患者 QOL的测评量表予以评价 .     

优质护理对颅脑外伤患者生活质量的影响评价

目的探讨优质护理对颅脑外伤患者生活质量的影响。方法将100例颅脑外伤患者随机均分为对照组与观察组,对照组采用常规护理模式,观察组采用优质护理模式,比较患者护理前后心理状况、疼痛状况及生活质量。结果 (1)对照组护理前后焦虑自评量表(SAS)、抑郁自评量表(SDS)得分比较差异无统计学意义(P>0.05),观察组护理前后比较差异有统计学意义(P<0.05),观察组护理后SAS与SDS得分与对照组比较差异有统计学意义(P<0.05);(2)观察组护理后语言描述评分法(VRS)疼痛分级0～1级患者比例为84.0%,大于对照组的64.0%(P<0.05);(3)根据生活质量核心问卷(QLQ-C30)评价标准,护理后观察组患者生活质量优于对照组(P<0.05)。结论对颅脑外伤患者采取积极的优质护理措施能够显著提高患者生活质量。     

颅脑外伤后综合征对患者生活质量的影响

目的 对颅脑外伤后综合征患进行多项目评估,颅脑外伤后综合征对患生活质量的。方法 评估２４例颅脑外伤患的一般状况、运动功能和心理状况。统计出各种症状出现的比例并分析各因素间的相关关系。结果 超过一半的病例出现头痛、头晕、记忆力下降、抑郁,超过１／３病例出现焦虑和失眠。头痛与头晕、焦虑和抑郁、换眠与淡漠、换眠与抑郁、淡漠与抑郁、头晕与ＡＤＬ、抑郁ＡＤＬ、,抑郁与赔偿以及焦与赔偿之间的相关关系有显     

认知教育对颅脑损伤患者生存质量延伸性的影响

目的 评估认知教育对颅脑损伤患的日常生活能力、肢体功能状态的变化，了解认知教育对颅脑损伤患的近期与远期影响。方法 住院期间对145例颅脑损伤患采取认知教育，并于认知教育前、认知教育后出院后1个月、6个月、1年分别进行社区延伸性追踪访视、评估。结果 人知教育后，患日常生活能力、肢体功能状态均有显进步且呈持续状态，达到统计学上显性。结论 认知教育对提高病人应对能力、增加有关疾病知识、提高疾病治疗的依从性的作用显。     

改善颅脑损伤患者长期生活质量的研究进展

本文介绍了颅脑损伤患者生活质量状况的研究进展,对流行病学概况、常用生活质量评价量表、生活质量状况及相关因素、干预对策等方面进行了综述,为提高颅脑损伤患者长期生活质量提供依据。     

颅脑损伤后神经症患者生活质量影响因素分析

目的:分析颅脑损伤后神经症患者生活质量影响因素及干预效应,以期为颅脑损伤的康复治疗提供帮助。方法:通过对276例颅脑损伤康复期患者生活质量因素进行总结分析,所得资料均进行单因素分析和多元逐步回归分析。结果:单因素分析显示,年龄、性别、伤情、文化程度、社会、心理因素等影响患者生活质量。多因素分析,则显示伤情(P=0.0121)、社会因素(P=0.0326)、心理因素(P=0.0063),均有显著意义(P<0.05)。结论:伤情、社会因素、心理因素是影响生活质量的重要因素,其中社会、心理因素为促发因素。充分认识这些因素,并进行干预措施,可提高其生活质量。     

早期康复训练对重型颅脑损伤患者生活质量的影响

目的：探讨早期康复训练对重型颅脑损伤患者肢体功能及生活自理能力的影响。方法：将120患者随机分为早期康复纽、延期康复组和对照组各40例,三组均接受神经外科常规治疗,早期康复组于发病后7d内进行康复训练,延期康复组于发病后7～30d内进行康复训练。结果：早期康复组和延期康复组及对照组（P〈0．01）,早期康复组显效率明显优于延期康复组（P〈0．05）。结论：康复训练时重型颅脑损伤患者肢体功能恢复有效,能有效提高生活自理能力,早期介入康复效果更明显。     

Coping strategies in individuals after traumatic brain injury: associations with health-related quality of life

Abstract

Purpose: This study investigates coping strategies after traumatic brain injury (TBI) and their associations with health-related quality of life (HRQoL). Methods: Participants were 141 adults followed up 3 months to 15 years after TBI of all severity degrees. Coping was assessed by the Freiburg Questionnaire of Coping with Illness (FQCI) and HRQoL by the Quality of Life after Brain Injury (QOLIBRI) scale and the Short Form-36 Health Survey (SF-36). Coping dimensions were extracted by principal component analysis. Multiple linear regression analysis was used to identify predictors of coping strategies. Results: Two factors for coping after TBI were extracted: Action/Distraction and Trivialisation/Resignation. The Trivialisation/Resignation strategy was negatively correlated with all aspects of HRQoL, while relationships with the Action/Distraction strategy were positive and significant for two domains. These two factors also showed significant associations with anxiety, depression, recovery, cognitive status, mood states and trauma severity. Multiple regression analysis identified recovery status as a predictor for the maladaptive Trivialisation/Resignation strategy. Conclusion: Two coping factors were identified, which were differentially associated with HRQoL. Maladaptive coping strategies play a particularly important role, and less reliance on such strategies is associated with better HRQoL; use of adaptive strategies should correspondingly be fostered.

• Implications for Rehabilitation

• This study highlights the relationship of coping strategies and HRQoL after TBI.

• For the assessment of HRQoL a novel disease-specific instrument was applied, that provides in detail TBI-relevant aspects of well-being and HRQoL.

• Individuals after TBI use two main sets of coping strategies that are differentially associated with HRQoL (and clinical variables). One is adaptive and the other maladaptive for HRQoL after TBI.

• Maladaptive and adaptive coping strategies used by the individual should be identified and considered in rehabilitation efforts to improve HRQoL after TBI.

     

康复护理干预对颅脑外伤病人生活质量影响的临床研究

[目的]研究康复护理干预对颅脑外伤病人生活质量的影响。[方法]将60例重型颅脑外伤病人随机分为对照组和干预组各30例,对照组病人进行急诊对症手术治疗,并给予脱水、抗感染、支持治疗疗及常规护理,干预组在对照组的基础上对病人行早期康复护理。比较两组病人治疗前后日常生活能力(ADL)评定及躯体运动能力Fugl-Meyer运动功能变化。[结果]干预组进行康复护理后ADL、Fugl-Meyer评分与对照组比较,差异有统计学意义(P<0.01)。[结论]康复护理干预可改善重型颅脑损伤病人的日常生活能力及躯体运动能力。     

Review article: Prehospital fluid management in traumatic brain injury

The early management of patients who have sustained traumatic brain injury is aimed at preventing secondary brain injury through avoidance of cerebral hypoxia and hypoperfusion. Especially in hypotensive patients, it has been postulated that hypertonic crystalloids and colloids might support mean arterial pressure more effectively by expanding intravascular volume without causing problematic cerebral oedema. We conducted a systematic review to investigate if hypertonic saline or colloids result in better outcomes than isotonic crystalloid solutions, as well as to determine the safety of minimal volume resuscitation, or delayed versus immediate fluid resuscitation during prehospital care for patients with traumatic brain injury. We identified nine randomized controlled trials and one cohort study examined the effects of hypertonic solutions (with or without colloid added) for prehospital fluid resuscitation. None has reported better survival and functional outcomes over the use of isotonic crystalloids. The only trial of restrictive resuscitation strategies was underpowered to demonstrate its safety compared with aggressive early fluid resuscitation in head injured patients, and maintenance of cerebral perfusion remains the top priority.     

Stress and coping among families of patients with traumatic brain injury: a review of the literature

Aims and objectives. This literature review aims to structure the available information on the psychological reactions of family members confronted with traumatic brain injury. The stress–coping theory and the systems theory provide the theoretical framework for this review. Method. Literature review. Results. The level of stress experienced by the family members of patients who have traumatic brain injury is such that professional intervention is appropriate, even after 10–15 years. Not the severity of the injury but the nature of the injuries determines the level of stress. Partners experience more stress than parents. Children have specific difficulties. Young families with little social support, financial, psychiatric and/or medical problems are the most vulnerable. Coping with traumatic brain injury can be described in phases. The better family members can cope with the situation, the better the patient's recovery. There are functional and non‐functional coping mechanisms and coping is influenced by such factors as gender, social and professional support and the possibility to have reciprocal communication or an affective relation with the patient. Relevance to clinical practice. Support from professionals reduces the stress being experienced and encourages people to cope effectively. Conflicts with professional carers should be avoided. Every attempt should be made to develop models of long‐term support and care that alleviate sources of burden on relatives. Further research is necessary to develop such models.     

恢复期脑外伤患者日常生活活动能力的预测模型研究

摘要目的：分析影响住院康复的脑外伤患者出院时日常生活活动（activity of daily living, ADL）能力和住院期间ADL能力改善程度的因素,并建立预测模型。方法：回顾性收集2017年9月—2020年9月在北京博爱医院神经康复科住院的220例脑外伤患者资料数据,按3∶1随机分为训练集和验证集,对所有变量进行描述性分析。分别以训练集出院时Barthel指数（Barthel index, BI）和出入院BI差值为结局指标,先通过单因素分析筛选有显著性意义的影响因素,然后采用多因素逻辑回归分析建立预测模型,采用受试者工作特征曲线（receiver operating characteristic, ROC）、校准曲线和Hosmer-Lemeshow检验评价模型在训练集和验证集中的区分度和校准度。结果：通过多因素Logistic回归建立了两个预测模型：①入院时病程、入院时Fugl-Meyer平衡功能评分（Fugl-Meyer balance, FMB）、入院时BI是患者出院时BI的显著影响因素,以出院时BI为结局的预测模型在训练集和验证集中曲线下面积分别为0.957（95%CI：0.930—0.983）和0.917（95%CI：0.839—0.994）,模型区分度较好,Hosmer-Lemeshow检验结果分别为P=0.196和P=0.551,模型校准度较好。模型的灵敏度、特异度、约登指数分别为91.4%（95%CI：0.833—0.959）、83.3%（95%CI：0.723—0.907）、0.747。②入院时病程、住院天数、年龄显著影响出入院BI差值,建立的预测模型在训练集和验证集中曲线下面积分别为0.773（95%CI：0.702—0.844）和0.747（95%CI：0.613—0.881）,Hosmer-Lemeshow检验结果分别为P=0.721和P=0.274,模型区分度和校准度良好。模型的灵敏度、特异度、约登指数分别为77.2%（95%CI：0.670—0.850）、64.4%（95%CI：0.522—0.750）、0.416。结论：建立的两个预测模型将帮助康复医生根据脑外伤患者入院时状况初步判断出院时的功能独立水平和住院期间的功能改善程度,为康复医疗工作提供参考。     

Glucose variability negatively impacts long-term functional outcome in patients with traumatic brain injury

Purpose

Significant glycemic excursions (so-called glucose variability) affect the outcome of generic critically ill patients but has not been well studied in patients with traumatic brain injury (TBI). The purpose of this study was to evaluate the impact of glucose variability on long-term functional outcome of patients with TBI.

Material and Methods

A noncomputerized tight glucose control protocol was used in our intensivist model surgical intensive care unit. The relationship between the glucose variability and long-term (a median of 6 months after injury) functional outcome defined by extended Glasgow Outcome Scale (GOSE) was analyzed using ordinal logistic regression models. Glucose variability was defined by SD and percentage of excursion (POE) from the preset range glucose level.

Results

A total of 109 patients with TBI under tight glucose control had long-term GOSE evaluated. In univariable analysis, there was a significant association between lower GOSE score and higher mean glucose, higher SD, POE more than 60, POE 80 to 150, and single episode of glucose less than 60 mg/dL but not POE 80 to 110. After adjusting for possible confounding variables in multivariable ordinal logistic regression models, higher SD, POE more than 60, POE 80 to 150, and single episode of glucose less than 60 mg/dL were significantly associated with lower GOSE score.

Conclusions

Glucose variability was significantly associated with poorer long-term functional outcome in patients with TBI as measured by the GOSE score. Well-designed protocols to minimize glucose variability may be key in improving long-term functional outcome.     

创伤性颅脑损伤康复治疗患者相关因素的回顾性分析

目的了解接受康复治疗的创伤性颅脑损伤(TBI)患者的一般情况、康复治疗时间、并发症等情况。方法回顾性分析北京博爱医院神经康复科1993年9月~2004年7月入院的所有TBI病例。结果共有280例TBI住院患者,平均发病年龄(33.1±11.4)岁,男女比为4.28∶1,职业构成以机关干部为主(占34.6%),报销方式也以公费医疗最多(占71.1%)。受伤原因以交通事故为主(占66.4%)。入院时距离受伤日期10 d~6年,平均288 d,在伤后3月内入院行康复治疗者占25.0%。继发癫痫者占15.7%,住院期间发现有脑积水者占18.9%。结论目前我国因TBI住院康复治疗的群体主要为城市男性居民、享受公费医疗待遇者;TBI急性期和亚急性期的康复流程体系也有待建立和完善。