脑室外引流联合Ommaya囊引流治疗脑室出血患者的护理体会

Nursing experience on the patients with introventricular hemorrhage during external ventricular drainage combined with the Ommaya reservoirs implantation

目的 探讨脑室穿刺外引流联合Ommaya囊植入治疗高血压性脑室出血患者的护理体会.方法 2010年1月～2012年12月采用脑室穿刺外引流联合Ommaya囊植入治疗高血压性脑室出血患者38例,同时选取同期49例患者作为对照组,所有患者术后积极护理,并予早期康复治疗.结果 脑室穿刺外引流联合Ommaya囊植入术术后感染发生率7.89％,单纯脑室外引流术术后感染发生率24.49％,差异有统计学意义（P＜0.05）.所有患者术后3个月随访,按GOS预后标准评价疗效,联合引流组预后良好23例,中度残疾9例,重度残疾3例,植物生存2例,死亡1例,外引流组预后良好26例,中度残疾11例,重度残疾6例,植物生存4例,死亡2例,两组比较差异无统计学意义（P＞0.05）.结论 对脑室内出血患者及时行脑室外引流术,同时在护理上进行有效的术前和术后护理干预,严密观察意识、瞳孔及生命体征变化,维持有效的引流,密切观察引流液的性状,做好Om-maya囊护理,能有效减少并发症,从而提高患者的生存率及生存质量.

Objective To discuss the nursing experience during external ventricular drainage in combination with the ommaya reservoirs implantation for the patients with hypertensive introventricular hemorrhage. Methods All 38 patients with hypertensive intraventricular hemorrhage underwent external ventricular drainage combinedwith the Ommaya reservoirs implantation and 49 patients with hypertensive intraventricular hemorrhage underwent external ventricular drainage were retrospectively analyzed from Jan.2010 to Dec.2012,who all received positive nursing and early rehabilitation. Results The patients underwent external ventricular drainage combined with the Ommaya reservoirs implantation was 7.89% incidence of postoperative infection, simple ventricular drainage 24.49% incidence of postoperative infection, difference between the two groups was statistical significance （P 〈 0.05）. Postoperative follow-up for 3 months, all patients according to GOS standard evaluation of curative effect, prognosis joint drainage of 23 cases with good prognosis, moderate disability 9 cases, severe disability of 3 cases, plant survival of 2 cases, 1 case died, while the external ventricular drainage group of 26 cases with good prognosis, moderate disability in 11 cases, 6 cases of severe disability, plant survival 4 cases, 2 cases died, difference between the two groups had no statistical significance （P 〉 0.05）. Conclusion External ventricular drainage for the patients with hypertensive intraventricular hemorrhage in time, and nursing for effective preoperative and postoperative nursing intervention at the same time, close observation consciousness, pupil and vital signs of change, maintain effective drainage, observe drainage fluid properties, completes the Ommaya capsule care, can reduce complication and improve survival rate and quality of life.