护士和家属实施感觉刺激对重型创伤性颅脑损伤昏迷患者促醒作用的比较

Comparing effects of sensory stimulation by nurses and family members on unconscious patients with severe traumatic brain injury

目的评价由护士和家属分别提供的感觉刺激对重型创伤性颅脑损伤昏迷患者促醒作用的临床效果。方法将南通大学附属医院神经外科ICU病房于2016年5月-2017年5月收治的92例重型创伤性颅脑损伤昏迷患者,采用随机数字表法均分为两组。对照组由主管护士施行感觉刺激,观察组由家庭照顾者施行感觉刺激。比较两组患者施行感觉刺激干预前后的格拉斯哥昏迷量表(GCS)评分、西方神经感觉刺激参数量表(WNSSP)评分、RLA认知评分以及脑电图检查评估情况。结果施行感觉刺激干预前,两组患者各项评分差异均无统计学意义(P>0.05)。施行感觉刺激干预2周后,对照组和观察组GCS[(7.28±1.86),(9.78±2.01)分]、WNSSP[(13.23±10.07),(47.48±14.32)分]和RLA认知评分[(2.15±0.98),(3.20±1.30)分]的差异均有统计学意义(P<0.05)。但干预后对照组和观察组脑电图评级(17.39%,30.43%)差异无统计学意义(P>0.05)。结论实施感觉刺激可促进重型创伤性颅脑损伤昏迷患者意识和基础认知感觉功能的恢复,且家庭照顾者实施感觉刺激的促醒效果优于主管护士实施感觉刺激的促醒效果,前者更有利于促进患者的康复治疗。

Objective To evaluate the clinical effects of sensory stimulation provided by nurses and family members respectively on waking up unconscious patients with severe traumatic brain injury. Methods A total of 92 unconscious patients with severe traumatic brain injury admitted in the Intensive Care Unit,Neurosurgery Department,Affiliated Hospital of Nantong University between May 2016 and May 2017 were selected and divided into two groups according to the random number table.Patients in the control group received sensory stimulation by nurses,while patients in the observation group received sensory stimulation by family members.The Glasgow Coma Scale (GCS),Western Neuro Sensory Stimulation Profile (WNSSP),Rancho Los Amigos Scale (RLA)and electroencephalogram examination (EEG)scores were compared between the two groups before and after the intervention.Results There was no statistical difference in the scores between the two groups before the sensory stimulation (P >0.05).Two weeks post the intervention,there were statistical differences between the control group and the observation group in GCS [(7.28±1.86)vs.(9.78±2.01)], WNSSP [(13.23±10.07)vs.(47.48±14.32)]and RLA [(2.15±0.98)vs.(3.20±1.30)]scores (P <0.05), but there was no statistical difference in EEG between the two groups (17.39% vs.30.43%,P >0.05). Conclusions Sensory stimulation can enable the unconscious patients with severe traumatic brain injury to regain consciousness,cognitive and sensory functions.The sensory stimulation provided by earegivers is better than that by responsible nurses,and the former is better in accelerating the patients'rehabilitation.