顽固难治性癫痫的手术的临床观察及护理策略

目的：探讨顽固难治性癫痫的外科手术的临床观察及护理策略,总结护理经验。方法：回顾性分析了21例顽固难治性癫痫患者资料,依据临床表现、影像学资料、视频脑电图及认知功能评估,进行全身了解,并制定个性化手术方案,术后继续服用丙戊酸钠片(德巴金)或左乙拉西坦片(开浦兰),得理多等药物。通过病情评估,心理护理,医学知识宣教,安全管理,分析护理过程,总结病患的观察要点和护理策略。手术方式：选择性杏仁核和海马(边缘系统)切除；病灶+标准前颞叶切除；软脑膜下横切(MST)或热灼术,迷走神经刺激术(VNS),立体定向微创脑电监测技术。术前给予心理疏导；肺功能训练,雾化吸入。术后加强安全防护,密切观察病情变化,稳定病人情绪,防止癫痫复发,积极康复护理。结果：本组21例无1例手术死亡及严重并发症。术前患者均存在认知损害,病灶及致痫灶均定位准确。手术前评估病患及家属的依从性,协助医生消除病患和家属的疑虑,并相互取得充分信任,以便更好地配合治疗和康复。术后护理重点是并发症的观察,抗癫痫药物的使用,手术切口的护理,出院后指导用药和定期复查。结论：术前综合评估和准确定位,术中皮层电极应用,选择合适的手术方式,正确的术后护理治疗顽固难治性癫痫能获得满意效果,对病患实施精细化,个体化和连续性的优质专业护理以及康复指导,提高手术治疗的效果,改善病患的生活质量,促进早日康复。

Clinical observation and nursing strategy of surgical treatment of intractable epilepsy

Objective: To explore the clinical observation and nursing strategy of surgical treatment of intractable epilepsy, and summarize the nursing experience. Methods: the data of 21 patients with intractable epilepsy were retrospectively analyzed. According to the clinical manifestations, imaging data, video EEG and cognitive function evaluation, the patients were given general understanding, and individualized operation plan was made. After operation, they continued to take sodium valproate tablets (debakin) or levetiracetam tablets (Kaplan), and deridol. Through disease assessment, psychological nursing, medical knowledge education, safety management, analysis of the nursing process, summarize the patient''s observation points and nursing strategies. Methods: selective amygdala and hippocampus (limbic system) resection; Lesion + standard anterior temporal lobectomy; Methods: the patients were divided into three groups: subdural transection (MST) or cauterization, vagus nerve stimulation (VNS), stereotactic minimally invasive EEG monitoring. Psychological counseling was given before operation; Lung function training, aerosol inhalation. After the operation, we should strengthen the safety protection, closely observe the changes of the patient''s condition, stabilize the patient''s mood, prevent the recurrence of epilepsy, and take active rehabilitation nursing. Results: there was no operative death or serious complication in 21 cases. All patients had cognitive impairment before operation, and the location of focus and epileptogenic focus was accurate. To evaluate the compliance of patients and their families before operation, to help doctors eliminate the doubts of patients and their families, and to gain mutual trust, so as to better cooperate with the treatment and rehabilitation. The key points of postoperative nursing are the observation of complications, the use of antiepileptic drugs, the nursing of surgical incision, the guidance of medication and regular review after discharge. Conclusion: preoperative comprehensive evaluation and accurate positioning, intraoperative application of cortical electrodes, selection of appropriate surgical methods and correct postoperative nursing can achieve satisfactory results in the treatment of intractable epilepsy. The implementation of fine, individualized and continuous high-quality professional nursing and rehabilitation guidance can improve the effect of surgical treatment, improve the quality of life of patients and promote early recovery.