风险护理在神经外科重症手术管理中的应用及对患者并发症的影响

目的 探讨风险护理在控制性阶梯式颅内减压手术治疗重型颅脑损伤中的效果。 方法 选取2018年3月—2019年3月台州市第一人民医院收治的96例重型颅脑损伤患者,采用随机数字表法分为2组,每组48例。对照组进行常规护理,观察组在对照组基础上进行风险护理。比较2组患者风险事件发生率、6个月预后状况、手术结果、并发症发生率、颅内压、谵妄评定量表(delirium rating scale, DRS)及美国国立卫生院卒中量表(NIH stroke scale, NIHSS)评分。 结果 观察组术后风险事件发生率为10.4%(5/48),低于对照组的33.3%(16/48),χ2=7.375,P<0.05;观察组预后良好率为81.3%(39/48),优于对照组的62.5%(30/48),χ2=4.174,P<0.05;观察组手术时间、住院天数、手术出血量低于对照组(均P<0.05);观察组术后院内并发症发生率为6.3%(3/48),低于对照组的20.8%(10/48),χ2=4.360,P<0.05;观察组治疗后颅内压、DRS及NIHSS评分低于对照组(均P<0.05)。 结论 对重型颅脑损伤患者,进行风险护理,护理效果理想,可降低风险事件和并发症发生率,提高治疗安全性。同时,可改善患者颅内压,降低DRS及NIHSS评分,改善患者预后,促进病情恢复。 

The application of risk nursing in the management of severe operation in Department of neurosurgery and its influence on the complications

Objective To explore the effect of risk nursing in the treatment of severe craniocerebral injury by controlled step intracranial decompression. Methods A total of 92 patients with severe craniocerebral injury from March 2018 to March 2019 were randomly divided into two groups. The control group received routine nursing and the observation group received risk nursing based on the control group. The incidence of risk events, prognosis after 6 months, surgical results, complications, intracranial pressure, delirium rating scale(DRS) and NIH stroke scale(NIHSS) scores were compared between the two groups. Results The incidence of postoperative risk events in the observation group was 10.4%(5/48), which was lower than that in the control group(33.3%, 16/48), χ2=7.375, P<0.05. The good prognosis rate in the observation group was 81.3%(39/48), which was better than that in the control group(62.5%, 30/48), χ2=4.174, P<0.05. The operation time, hospitalization days and bleeding volume in the observation group were lower than those in the control group(all P<0.05). The complication rate was 6.3%(3/48), which was lower than that of the control group(20.8%, 10/48), χ2=4.360, P<0.05. The intracranial pressure, DRS and NIHSS scores of the observation group were lower than those of the control group(all P<0.05). Conclusion For patients with severe craniocerebral injury, risk nursing can reduce the incidence of risk events and complications and improve the safety of treatment. Meanwhile, intracranial pressure can be improved, DRS and NIHSS scores can be reduced, prognosis of patients can be improved, and recovery of patients can be accelerated.