预见性护理联合精细化护理管理模式在重型颅脑损伤中的应用效果(1)
[摘要] 目的 探讨预见性护理联合精细化护理管理模式对重型颅脑损伤患者的护理效果。 方法 前瞻性纳入80例因重型颅脑损伤入我院神经外科的患者，随机分为干预组与对照组，各40例。干预组实施预见性护理联合精细化护理管理措施；对照组实施常规护理。比较两组患者的并发症发生率、依从性及生存质量。 结果 干预组患者呼吸道感染、消化道溃疡、下肢深静脉血栓、便秘发生率、死亡率明显低于对照组，差异有统计学意义(P<0.05)；干预组依从性Frankl量表评分、生存质量WHOQOL-BREF量表评分高于对照组，差异有统计学意义(P<0.05)。结论 预见性护理联合精细化护理干预能有效减少能有效减少重型颅脑损伤患者并发症发生率及死亡率，提高患者依从性和生存质量。
[关键词] 预见性护理；精细化管理；重型颅脑损伤
[中图分类号] R651.1+5 [文献标识码] A [文章编号] 1674-4721(2016)02(c)-0192-03
[Abstract] Objective To explore the nursing effects of predictive nursing combined with refinement nursing management in patients with severe craniocerebral injury. Methods 80 patients with severe craniocerebral injury in our hospital were selected prospectively.Patients were randomly divided into intervention group and control group，and each group was 40 cases.Patients in intervention group were given predictive nursing combined with refinement nursing management，and patients in control group were given routine nursing.The incidence rate of complications，compliance and life quality in two groups were compared. Results The respiratory infection，peptic ulcer，deep venous thrombosis，incidence rate of constipation and death rate in intervention group were obvious lower than that of control group，and the difference was statistical significance (P<0.05).The compliance Frankl score and life quality WHOQOL-BREF score in intervention group were obvious higher than that of control group，and the difference was statistical significance (P<0.05). Conclusion Predictive nursing combined with refinement nursing management can effective reduce the incidence rate of complications and death rate in patients with severe craniocerebral injury，enhance compliance and life quality of patients.
[Key words] Predictive nursing；Refinement management；Severe craniocerebral injury
重型颅脑损伤是神经外科常见急症，具有病情重、住院周期长、死亡率高的特点。在诊治过程中，患者由于创伤及手术打击，处于高应激状态，易出现各种并发症[1-3]。临床护士作为每日接触病人最频繁的护理人员，早期发现病情变化将有助于疾病的预后[4]。预见性护理即是在日常临床护理工作中，通过对疾病病理、生理过程的了解，同时观察患者的日常生命体征及一般状况，采取预防性的护理措施，尽量降低并发症的发生率[5-6]，而精细化护理管理则是在具体的临床护理措施中，优化护理路径，使护理措施具体化，两者结合将有助于护理效果的改善[7-8]。本院针对重型颅脑损伤患者的特点，在疾病治疗的基础上，采取了预见性护理联合精细化护理管理模式，提高了临床护理效果，现报道如下。
1 资料与方法
1.1 一般资料
前瞻性纳入2013年12月～2015年1月因重型颅脑损伤入我院神经外科的患者共80例，随机分为干预组与对照组，各40例。纳入标准：①外伤后24 h，GCS评分≤8分；②CT提示颅骨骨折、颅内血肿、脑挫裂伤或弥漫性轴索损伤。排除标准：①存在脑梗、脑出血等原发性疾病；②多发伤、复合伤的患者；③并存恶性肿瘤、慢性心肺功能不全、慢性肝肾功能不全的患者；④已发生脑疝患者及24 h出入院患者。
干预组40例，其中男28例，女12例；平均年龄(37.5±9.5)岁，入院时GCS评分为(6.1±1.3)分；其中诊断为硬膜外血肿15例、硬膜下血肿9例、脑室出血7例、颅骨骨折8例、脑挫裂伤1例；致伤原因包括车祸伤16例、高坠伤19例、重物砸伤5例。对照组40例，其中男29例，女11例；平均年龄(36.7±10.2)岁；入院GCS评分为(6.6±1.1)分；其中诊断为硬膜外血肿15例、硬膜下血肿8例、脑室出血5例、颅骨骨折10例、脑挫裂伤2；致伤原因包括车祸伤27例、高坠伤13例，两组患者一般资料比较差异无统计学意义(P>0.05)，具有可比性。, http://www.100md.com(邹依然 杨佳)
[关键词] 预见性护理；精细化管理；重型颅脑损伤
[中图分类号] R651.1+5 [文献标识码] A [文章编号] 1674-4721(2016)02(c)-0192-03
[Abstract] Objective To explore the nursing effects of predictive nursing combined with refinement nursing management in patients with severe craniocerebral injury. Methods 80 patients with severe craniocerebral injury in our hospital were selected prospectively.Patients were randomly divided into intervention group and control group，and each group was 40 cases.Patients in intervention group were given predictive nursing combined with refinement nursing management，and patients in control group were given routine nursing.The incidence rate of complications，compliance and life quality in two groups were compared. Results The respiratory infection，peptic ulcer，deep venous thrombosis，incidence rate of constipation and death rate in intervention group were obvious lower than that of control group，and the difference was statistical significance (P<0.05).The compliance Frankl score and life quality WHOQOL-BREF score in intervention group were obvious higher than that of control group，and the difference was statistical significance (P<0.05). Conclusion Predictive nursing combined with refinement nursing management can effective reduce the incidence rate of complications and death rate in patients with severe craniocerebral injury，enhance compliance and life quality of patients.
[Key words] Predictive nursing；Refinement management；Severe craniocerebral injury
重型颅脑损伤是神经外科常见急症，具有病情重、住院周期长、死亡率高的特点。在诊治过程中，患者由于创伤及手术打击，处于高应激状态，易出现各种并发症[1-3]。临床护士作为每日接触病人最频繁的护理人员，早期发现病情变化将有助于疾病的预后[4]。预见性护理即是在日常临床护理工作中，通过对疾病病理、生理过程的了解，同时观察患者的日常生命体征及一般状况，采取预防性的护理措施，尽量降低并发症的发生率[5-6]，而精细化护理管理则是在具体的临床护理措施中，优化护理路径，使护理措施具体化，两者结合将有助于护理效果的改善[7-8]。本院针对重型颅脑损伤患者的特点，在疾病治疗的基础上，采取了预见性护理联合精细化护理管理模式，提高了临床护理效果，现报道如下。
1 资料与方法
1.1 一般资料
前瞻性纳入2013年12月～2015年1月因重型颅脑损伤入我院神经外科的患者共80例，随机分为干预组与对照组，各40例。纳入标准：①外伤后24 h，GCS评分≤8分；②CT提示颅骨骨折、颅内血肿、脑挫裂伤或弥漫性轴索损伤。排除标准：①存在脑梗、脑出血等原发性疾病；②多发伤、复合伤的患者；③并存恶性肿瘤、慢性心肺功能不全、慢性肝肾功能不全的患者；④已发生脑疝患者及24 h出入院患者。
干预组40例，其中男28例，女12例；平均年龄(37.5±9.5)岁，入院时GCS评分为(6.1±1.3)分；其中诊断为硬膜外血肿15例、硬膜下血肿9例、脑室出血7例、颅骨骨折8例、脑挫裂伤1例；致伤原因包括车祸伤16例、高坠伤19例、重物砸伤5例。对照组40例，其中男29例，女11例；平均年龄(36.7±10.2)岁；入院GCS评分为(6.6±1.1)分；其中诊断为硬膜外血肿15例、硬膜下血肿8例、脑室出血5例、颅骨骨折10例、脑挫裂伤2；致伤原因包括车祸伤27例、高坠伤13例，两组患者一般资料比较差异无统计学意义(P>0.05)，具有可比性。, http://www.100md.com(邹依然 杨佳)