不完全性脊髓损伤患者的个体化分阶段护理

Individual staged nursing on patients with incomplete spinal cord injury

目的 :探讨个体化分阶段护理模式对不完全性脊髓损伤(ISCI)患者的护理效果,为临床护理工作提供参考。方法:将我院2015年2月~2016年4月收治的60例ISCI患者随机分为对照组与观察组。对照组中女性10例,男性20例;年龄19~57岁,平均42.16±4.27岁;ASIA分级B级9例、C级10例、D级11例,脊髓损伤发生于颈段5例,胸段10例,腰段15例。观察组中女性8例,男性22例,年龄21~55岁,平均45.23±6.72岁;ASIA分级B级10例、C级8例、D级12例,脊髓损伤发生于颈段6例,胸段9例,腰段15例。两组在性别、年龄、脊髓损伤节段及ASIA分级等情况无统计学差异。观察组予个体化分阶段护理,包括对个性化分阶段的心理康复、功能锻炼与呼吸道、肠道、泌尿系管理,对照组住院期间给予常规护理。治疗前及治疗后(90d时)依次采用Zung氏抑郁自评量表(SDS)、康复效果评定表(ISNCSCI-2013)、改良Barthel指数量表分别对两组患者的心理健康状态(SDS评分)、运动和感觉功能及日常生活能力进行评估,并比较两组患者治疗过程中并发症的发生率。结果:观察组SDS评分治疗前61.51±2.3分,治疗后40.11±2.1分;对照组治疗前62.22±2.9分,治疗后50.50±3.1分。观察组运动功能评分治疗前47.8±10.2分,治疗后68.4±13.2分;对照组治疗前47.4±11.3分,治疗后60.1±13.5分。观察组感觉功能评分治疗前87.2±14.5分,治疗后102.5±19.3分;对照组治疗前88.3±14.7分,治疗后94.1±18.3分。观察组日常生活能力评分治疗前55.4±8.7分,治疗后78.1±9.5分;对照组治疗前55.2±9.2分,治疗后69.6±11.4分。观察组在心理健康状态、运动和感觉功能恢复情况及日常生活能力优于对照组(P<0.05)。观察组的肺部感染(6.67%)、泌尿系感染(3.33%)、便秘并发症发生率(10%)低于对照组(分别为13.33%、16.67%及23.33%)(P<0.05)。结论 :个体化分阶段护理模式对于不完全性脊髓损伤患者心理健康、功能康复及其减少并发症具有优势,值得应用推广。

Objectives： To explore the effect of individual staged nursing on incomplete spinal cord injury（ISCI） patients, and to provide reference for clinical nursing work in the future. Methods： 60 patients with ISCI were selected as the samples in our hospital, and all cases were randomly divided into control group and observation group. In the control group, there were 10 females and 20 males, the cases aged from 19 to 57 years old, with an average age of 45.23±6.72. Based on ASIA scale, 9 cases were in grade B, 10 cases in grade C, and 11 cases in grade D. Cervical spinal cord injury occurred in 5 cases, thoracic spinal cord injury was in 10 cases, and lumbar spinal cord injury was in 15 cases. Two groups had no statistical differences with regard to the sex ratio, age, ASIA grade and so on. The observation group was given individual staged nursing, including personalized staged psychological rehabilitation, functional exercise, and respiratory tract, intestinal, urinary system management. The control group was given routine nursing practice during hospitalization. Before and after treatment（90d）, Zung self-rating depression scale（SDS）, rehabilitation effect evaluation form（ISNCSCI-2013）, and modified Barthel index scale were used to assess the mental health status, motion perception, and daily living ability. The incidences of complications during treatment in the two groups were compared. Results： The functional rehabilitation scores of two groups showed significant differences before and after the nursing（P〈0.05）. In the observation group, the SDS score was 61.51±2.3 before treatment and 40.11±2.1 after treatment; in the control group, it was 62.22±2.9 before treatment and 50.50±3.1 after treatment. In the observation group, the motion score was 47.8±10.2 before treatment and 68.4±13.2 after treatment; in the control group, it was 47.4±11.3 before treatment and 60.1±13.5 after treatment. In the observation group, the perception score was 87.2±14.5 before treatment and 102.5±19.3 after treatment; in the control group, it was 88.3±14.7 before treatment and 94.1±18.3 after treatment. In the observation group, the daily living ability score was 55.4±8.7 before treatment and 78.1±9.5 after treatment; in the control group, it was 55.2±9.2 before treatment and 69.6±11.4 after treatment. The mental health , motion perception recovery, and daily living ability of the observation group were better than those of the control group（P〈0.05）. The incidences of pulmonary infection （6.67%）, urinary tract infection （3.33%） and constipation （10%） in the observation group were lower than those （13.33%, 16.17% and 23.33% respectively） in the control group（P〈0.05）. Conclusions： Individual staged nursing can significantly decrease the occurrence of complications, improving physiological function and psychological rehabilitation.