颈椎前路术后硬膜外血肿的临床护理

Clinical Observation and Nursing Care on Post-operative Epidural Hematoma with Anterior Cervical Approaches

目的：探讨颈椎前路术后硬膜外血肿患者的临床护理要点。方法：回顾分析我院2001年1月-2013年6月1682例行颈椎前路手术病例,共12例（0.71%）发生术后血肿并行急诊手术。其中男8例,女4例;年龄38~69岁,平均52.5岁。护理措施包括：1）术前按规范行评估、宣教及训练;2）术后严密观察生命体征和神经功能,强调及时医护、医患沟通;3）术后正确给药、重视心理护理并给予康复训练指导。结果：12例患者急诊行原入路探查、血肿清除术后症状即刻或逐渐改善。随访6~24个月（平均12个月）,脊髓神经功能评价采用ASIA分级,其中手术前B级1例、C级5例、D级6例,末次随访时C级2例、D级5例、E级5例。结论：对于颈椎前路患者,严密观察生命体征和神经功能、及时医护沟通、早期发现术后硬膜外血肿并尽快再次手术清除血肿,是及时抢救患者生命、恢复神经功能的关键。另外,采取积极有效的护理措施和康复训练可有效地降低致残率,提高神经功能的恢复。

Objective：To investigate the nursing care for patients suffering post-operative epidural hematoma with anterior cervical approaches.Methods：All 1682 patients received surgeries with anterior cervical approaches from January 2001 to June 2013.Twelve cases（0.71%,male 9cases,female 6cases,mean age 52.5years）suffered from post-operative epidural hematoma and treated with emergency surgeries.The nursing interventions included：1）Evaluate the condition of patients,and give propaganda,education and training to the patients before the surgery;2）Observe the vital signs and nerve function intensively after the surgery,and pay attention to the communication between doctors,nurses and patients;3）Use medicine correctly,give mental nursing and rehabilitation training.Results：All the cases were given surgeries with the same approach to remove the hematoma.Symptoms had alleviated right after the surgery or gradually.All patients were followed up for 6~24months（mean time 12months）.ASIA classification was used to evaluate the nerve function of the patients.There were 6cases in D,5cases in C and 1case in B before the surgery.At the last follow-up there were 2cases in C,5cases in D and 5cases in E after the surgery.Conclusion：It is very important to observe the vital signs and nerve function of patients with post-operative epidural hematoma.It is crucial to discover the symptoms and inform the doctors in time.Besides,effective nursing interventions and rehabilitation training can decrease disability rate and enhance the recovery of nerve function.