集束化护理干预对降低止血带导致神经损伤的效果探讨

Effect of care bundle intervention on reducing nerve damage caused by tourniquets

目的探讨集束化护理干预对降低止血带导致神经损伤效果。方法 200例使用止血带行骨科四肢手术的患者,按随机数字表法分为观察组和对照组,各100例。对照组采用常规护理,观察组采用集束化护理干预。比较两组患者下肢痛觉、下肢肌力及肌电图异常情况及不同时间收缩压(SBP)、舒张压(DBP)、中心静脉压(CVP)水平。结果上止血带前及放止血带后,两组患者SBP、DBP及CVP水平比较差异均无统计学意义(P>0.05)。对照组患者下肢痛觉异常发生率为26.0%,下肢肌力异常发生率为10.0%,肌电图异常发生率为26.0%;观察组患者下肢痛觉异常为6.0%,下肢肌力异常发生率为3.0%,肌电图异常发生率为9.0%;观察组患者下肢痛觉异常、下肢肌力异常及肌电图异常发生率均低于对照组,差异有统计学意义(P<0.05)。结论使用止血带行骨科四肢手术的患者采用集束护理干预,可达到正确合理的使用目的,同时可以降低止血带所造成的神经损伤。

Objective To discuss the effect of care bundle intervention on reducing nerve damage caused by tourniquets. Methods A total of 200 cases of orthopaedic limb surgery with tourniquet were divided by random number table method into observation group and control group, with 100 cases in each group. The control group received conventional nursing, and the observation group received care bundle intervention. Comparison was made on status of abnormal pain sensation, muscle strength in lower limb and electromyogram, systolic blood pressure (SBP), diastolic blood pressure (DBP), central venous pressure (CVP) at different times between the two groups. Results Before and after tourniquet placement, there was no statistically significant difference in SBP, DBP and CVP between the two groups (P>0.05). The control group had incidence of abnormal pain sensation in lower limb as 26.0%, incidence of abnormal muscle strength in lower limb as 10.0% and incidence of abnormal electromyogram as 26.0%. The observation group had incidence of abnormal pain sensation in lower limb as 6.0%, incidence of abnormal muscle strength in lower limb as 3.0% and incidence of abnormal electromyogram as 9.0%. The observation group had lower incidence of abnormal pain sensation, muscle strength in lower limb and electromyogram than those of the control group, and their difference was statistically significant (P<0.05). Conclusion Care bundle intervention for patients undergoing orthopaedic limb surgery with tourniquet can promote the correct and reasonable using of tourniquet and reduce the nerve damage caused by tourniquet.