颅脑损伤昏迷病人院前救护程序改进的效果观察

Effect of the Improved Pre-hospitalization Emergency Nursing Process in Caring Coma Patients From Craniocerebral Trauma

目的探讨改良颅脑损伤昏迷病人院前急救护理程序的效果。方法按颅脑损伤昏迷病人救护车出诊先后顺序编号,单号为观察组60例,双号为对照组59例。观察组实施改良的救护程序:第1步先进行快速护理诊断,根据GCS昏迷评分标准确定昏迷等级;第2步保持呼吸道和静脉通道有效开放;第3步测定瞳孔、脉搏、血压、呼吸、血氧饱和度,为进一步采取急救措施提供依据;第4步,应对措施处于预启动状态,包括心肺复苏、抗休克、伤口处理、头部CT检查和术前准备,形成院前救护-CT室-手术室的绿色通道。对照组实施常规急救护理流程。比较两组接到"120"呼救电话至气管插管、头部CT检查、入手术室时间,两组术后3 d内意识进展情况、并发症发生率和死亡率。结果与对照组比较,观察组接到呼救电话至入手术室时间、至头部CT检查时间、至气管插管/气管切开时间均较对照组提前(P<0.05);术后3 d内意识好转、意识恢复率提高(P<0.05或P<0.01),2周内并发症的发生率和死亡率明显降低(P<0.05或P<0.01)。结论改良院前救护程序能有效缩短颅脑损伤昏迷病人的院前急救时间,是减少并发症及死亡率的有效急救护理措施。

Objective To study the effect of the improved pre-hospitalization emergency nursing process in caring coma patients from craniocerebral trauma. Methods 199 coma patients from craniocerebral trauma were divided into two groups according to their registration number： those with odd number in the observation group （n=60） and those with even number in the control group （n=59）. Improved pre-hospitalization emergency nursing process was conducted in the observation group： First, fast nursing diagnosis was adopted to clarify the classifications of coma according to GCS. Second, respiratory tract and veins were kept smooth and open. Third, pupils, pulse, blood pressure and blood oxygen saturation were observed and tested. Fourth, the coping strategy was ready including preoperative preparation of eardiopulmonary resuscitation, anti-shock, wounds treatment, brain CT examination to establish a green passage of pre-hospitalization emergency rescue - CT Room - Operation Room. For the controls, routine emergency nursing process was conducted. The time from answering “120” to tracheal intubation, brain CT examination till entering the operation room, the development of consciousness 3 days after operation, complication rate and mortality were compared between the two groups. Results The time from answering “120” to tracheal intubation, brain CT examination till entering the operation room in the observation group was significantly shorter than the control group （P〈0.05）. The consciousness development rate and consciousness reversion rate 3 days after operation were better （P〈0.05 or P〈0.01）. The complication rate and mortality two weeks after operation were significantly lower as well （P〈0.05 or P〈0.01）. Conclusion Developed pre-hospitalization emergency nursing process is able to effectively shorten the time for pre-hospitalization emergency rescue of coma patients from craniocerebral trauma, thus effectively reducing the complication rate and mortality.