动脉瘤性蛛网膜下腔出血患者迟发性缺血性神经功能障碍的临床特点及护理

Clinical Features and Nursing Interventions of Patients with Delayed Ischemic Neurological Dysfunction after Aneurysmal Subarachnoid Hemorrhage

总结42例动脉瘤性蛛网膜下腔出血后迟发性缺血性神经功能障碍(DIND)的临床特点及护理对策。认为动脉瘤性蛛网膜下腔出血患者延迟性缺血性神经功能障碍的主要临床特点为紧张焦虑等心理障碍、颅内压增高、血液黏稠度增高、脑血管痉挛、动脉瘤再破裂,以及中枢性高热、水电解质平衡失调、肺部感染等并发症。应采取有针对性的护理措施,护理重点包括:加强心理护理;避免诱发脑血管痉挛及动脉瘤再破裂的诱因,并警惕两者先兆症状的观察及变化,控制患者血压;注重动态分析患者颅内压监护仪、红细胞压积、经颅多普勒、颅脑CT等检查结果,着重观察监测指标异常的患者,发现异常情况及时报告医生处理;并发症预防与护理。全组治疗结果根据Glasgow预后评分:Ⅰ级17例,Ⅱ级11例,Ⅲ级4例,Ⅳ级2例,Ⅴ级8例;病死率19%。

To summed up the clinical features and nursing interventions of 42 patients with delayed ischemic neurological dysfunction （DIND） after aneurysmal subarachnoid hemorrhage （aSAH）. The clinical features of DIND included psychological disorders, complicated psychical factors, elevated intracranial pressure, increased blood viscosity, cerebral vasospasm, aneurysmal re- rapture and complications such as central high fever, water electrolyte imbalance and lung infection. To improve clinical efficacy, some distinctive nursing interventions should be implemented. These measures included valuing psychological nursing to prevent the cause of cerebral vasospasm and aneurysmal re-rupture; paying attention to the warning symptoms and controlling patients＇ blood pressure, monitoring closely and analyzing dynamicly the results of intracranial pressure, hematocrit, transcranial Doppler （TCD） and brain CT. The abnormal data should be reported to the doctor at once and precaution and nursing were inevitable for other complications. The clinical efficacy was evaluated by Glasgow Outcome Scale （GOS） and the results were as follow： 17 cases had GOS scores 1, 11 had 2, 4 had 3, 2 had 4, 8 had 5 and the mortality was 19%.