重型颅脑损伤患者的急救阶段监护与干预

目的：探讨重型颅脑损伤患者在急诊室抢救阶段实施监护与干预的临床效果。方法：2007年1~12月我院收治重型颅脑损伤患者34例,急诊室抢救阶段均按快捷护理路径进行抢救,施行急救阶段的监护,作为监护组。选取本院未开展急救阶段的监护的2006年重症颅脑损伤患者30例作为对照组。采用格拉斯哥昏迷评分（GCS）、格拉斯哥预后评分（GOS）和远期生活质量评估判断抢救效果。结果：两组患者转入临床途径1周后GCS均较入院时有明显改善,其中,监护组好转率为97.06%,对照组好转率为56.67%,两者间差异有统计学意义（P〈0.01）。格拉斯哥预后评分（GOS）情况：监护组恢复良好为47.06%,轻度残疾为41.14%,近期预后明显优于对照组（P〈0.05）。两组患者随访1年发现,监护组远期生活质量显著优于对照组（P〈0.05）。急救阶段实施监护与干预可以缩短门诊抢救时间、住院时间,降低门诊抢救费用。结论：急救阶段实施监护与干预可以明显提高重型颅脑损伤的抢救效果,改善患者预后。

Relationship of guardianship and intervention between the prognosis of severe head injuries during emergency stage

Objective： To investigate the effects of guardianship and intervention in patients with severe head injuries during emergency stage.Methods：Thirty-four cases with severe head injuries were selected as guardianship group, who were treated with guardianship and intervention during emergency stage. Thirty cases took routine emergency treatment as control group. Glasgow coma score（GCS）, the prognosis was judged dependent on Glasgow outcome score （GOS） and longterm quality life evaluation. Results：All patients＇ GCSs improved greatly, while it was more obvious in those of guardianship group than those of control group （P〈0.01）, improvement rate was 97.06% ： 56.67%, one week later. GOSs showed that the short-term prognosis of patients in guardianship group were better than those in control group （P〈0.05）. And long- term prognosis of patients in guardianship group surpassed those in control group（P〈0.05）, during one year follow-up. Conclusion： Guardianship and intervention can improve greatly the prognosis of severe head injuries during emergency stage.