脊髓神经功能快速评估流程构建及应用

Establishment and application of a rapid assessment process for spinal cord neurological function

目的评价脊髓神经功能快速评估流程在临床护理工作中的应用效果。方法根据脊髓对肌的节段性支配分布,结合脊髓损伤神经学分类标准及临床工作特点,制定脊髓神经功能快速评估流程,并应用于2017年(实施后)收治的1763例脊柱脊髓疾病术后患者脊髓神经功能评估。收集患者评估结果并与2016年(实施前)患者资料比较,同时选取12名参与脊髓神经功能快速评估流程的护士进行个人深入访谈。结果实施前脊柱脊髓术后患者神经功能障碍或异常发生率为0.49%(9/1824),其中6例被及时发现,处理后8例神经功能恢复;实施后神经功能障碍或异常发生率为0.40%(7/1763),7例均被及时发现,处理后神经功能均恢复。访谈护士认为脊髓神经功能快速评估流程快速省时、便于及时发现病情变化、护士容易掌握、患者及家属参与性高。结论脊髓神经功能快速评估流程的构建与应用,有利于及时发现神经功能变化,促进患者神经功能的恢复。可作为脊柱术后常规专科护理监测项目。

Objective To evaluate the application effect of a rapid assessment process for spinal cord neurological function in clinical nursing. Methods According to the segmental innervation distribution of spinal cord,and combining with the neurologic classification standard of spinal cord injury and the characteristics of clinical work,a rapid assessment process for spinal cord neurological function was developed,which was then used to assess spinal cord neurological function for 1 763 spine or spinal cord disease patients after surgery in 2017 (after intervention).The assessment result was compared with the information of the patients underwent surgery in 2016 (before intervention),and personal in-depth interviews were conducted among 12 nurses who had participated in the rapid assessment process for spinal cord neurological function. Results Before the intervention,the rate of neurological function impairement or abnormal for the spine or spinal cord disease patients after surgery was 0.49%(9/1824),6 of the patients were detected timely,and the neurological function of 8 patients recovered after resolving.After the intervention,the rate of neurological function impairement or abnormal was 0.40%(7/1763),7 patients were detected timely,and the neurological function of all the patients recovered after resolving.The interviewed nurses thought the rapid assessment process was fast and time-saving,convenient for timely detection of disease changes,easy for nurses to grasp,and high participation of patients and family members. Conclusion Establishment and application of the rapid assessment process for spinal cord neurological function is conducive to detecting neurological function change timely and improving the recovery of neurological function.It can be used as a routine monitoring project of specialized nursing after spinal surgery.