重型颅脑外伤病人应用快捷护理路径急救的效果研究

A syudy on effect of carrying out first-aid by applying shortcut nursing path for patients with severe traumatic brain injury

[目的]探讨重型颅脑外伤病人在急诊室抢救阶段和神经外科重症监护阶段,应用快捷护理路径的临床效果。[方法]采用非同期队列对照研究,门诊急救阶段收集2005年12月—2006年6月在门诊抢救的重型颅脑外伤病人32例为对照组,按常规进行抢救,2006年7月—2007年1月在门诊抢救的重型颅脑外伤病人34例为试验组,按快捷护理路径进行抢救;神经外科重症监护住院阶段是以上两组病人经门诊抢救后存活病人转至神经外科住院或急诊手术后转至神经外科治疗病人,对照组按护理常规进行护理,试验组按快捷护理路径进行护理,对两组病人不同阶段的抢救时间及费用、住院时间及费用、并发症发生情况等指标进行比较。[结果]①两组病人在门诊急救阶段和神经外科重症监护住院阶段年龄、性别、格拉斯哥昏迷评分(GCS)、伤情评分(ISS)差异均无统计学意义;②两组病人急诊抢救时间及急诊抢救费用、平均住院时间差异均具有统计学意义(P<0.001);③两组病人重症监护住院7 d时GCS评分、平均住院费用差异无统计学意义;④两组病人肺部感染及尿路感染并发症发生率差异有统计学意义(P<0.05)。[结论]重型颅脑外伤病人在急救中应用快捷护理路径后,急诊抢救阶段抢救时间明显缩短,抢救费用降低;在神经外科重症监护室住院期间肺部感染和尿路感染发生率明显降低。

Objective： To probe into clinical effect of applying shortcut nursing path for severe traumatic brain injury （STBI） patients at the first - aid stage in emergency room and in intensive care unit of neurosurgical department. Methods- By adopting non- synchronization cohort control study, 32 cases with STBI in the first- aid stage in outpatient clinic or emergency room were collected from December of 2005 to June of 2006 as control group. They were rescued as in routine. from July of 2006 to January of 2007 as And another 34 cases were collected test group. Survival cases of the two groups after first - aid in outpatient clinic transferred into neurosurgical department or intensive care unit of neurosurgical department after undergoing emergency operation. Patients of test group were given nursing care by applying shortcut nursing path. And indexes including the time and expense of first - aid, the duration and cost of hospitalization, and the incidence of complications in different stages of the two group cases were compared. Results： ①There were no statistical significant differences in terms of age, gender, Glasgow coma scoring （GCS）, and injury severity scale （ISS） in outpatient clinic first - aid stage and during hospitalization in intensive care unit of neurosurgical department between the two group cases. ②In terms of the time and expenses of first - aid and the average hospitalization time, there were statistical significant differences between the two groups （ P 〈 0. 001 ）. ③ There were no statistical significant differences in terms of GC8 on the 7th day staying in intensive care unit and the average hospitalization expense between the two group cases. ④There were statistical significant differences in terms of the incidences of pulmonary infection and urinary tract infection between the two groups （ P 〈 0.05 ）. Conclusions： After applying shortcut nursing path in first - aid of STBI cases, both the time and the cost of rescuing of them were decreased in the first - aid stage. In the hospitalized stage in neurosurgical department, the incidence rates of either pulmonary infection or urinary tract infection were significantly decreased. And the average hospitalization cost of patients decreased as well.