分级监控管理联合精细化护理在重症颅脑损伤术后的应用

Application of hierarchical monitoring management and refined nursing in postoperative treatment of severe craniocerebral injury

目的探讨分级监控管理+精细化护理模式对重症颅脑损伤术后昏迷患者压力性损伤发生率的影响。方法选取本院2017年7月至2019年7月收治的重症颅脑损伤术后昏迷患者62例,按入院顺序不同分为常规组和联合组,各31例。常规组实施常规护理干预,联合组基于常规组实施分级监控管理+精细化护理模式。对比两组术后康复指标[机械通气时间、重症监护室(ICU)治疗时间、住院天数]、压力性损伤发生率、家属对护理工作满意度及干预前后股、腘静脉血流速度。结果联合组机械通气时间、ICU治疗时间、住院天数短于常规组(均P<0.05);联合组干预1周后股、腘静脉血流速度快于常规组(均P<0.05);联合组压力性损伤发生率低于常规组[6.45%(2/31)比25.81%(8/31),P<0.05];联合组出院时家属对护理工作满意度高于常规组[93.55%(29/31)比70.97%(22/31),P<0.05]。结论分级监控管理+精细化护理模式应用于重症颅脑损伤术后昏迷患者,能显著加快血流速度,降低压力性损伤发生率,缩短术后恢复时间,提高家属对护理工作的满意度。

Objective To investigate the effect of graded surveillance management and refined nursing mode on the incidence of stress injury in patients with coma after operation for severe craniocerebral injury.Methods 62 patients with coma after operation for severe craniocerebral injury treated in our hospital from July,2017 to July,2019 were selected,and were divided into a routine group and a combination group according to the admission order,with 31 cases in each group.The routine group implemented routine nursing intervention;in addition,the combination group group implemented hierarchical monitoring management and refined nursing mode.The postoperative rehabilitation indicators[mechanical ventilation time,intensive care unit(ICU)treatment time,and hospitalization days],the incidences of stress injury,family members'satisfaction to nursing work,and blood flow velocities of the femoral and iliac veins before and after the intervention were compared between the two groups.Results The mechanical ventilation time,ICU treatment time,and hospitalization days were shorter in the combination group than in the control group(all P<0.05).The blood flow velocities of the femoral and iliac veins were faster in the combination group than in the control group(both P<0.05).The incidence of stress injury was lower in the combination group than in the control group[6.45%(2/31)vs.25.81%(8/31)P<0.05].The satisfaction of the family members to the nursing work was higher in the combination group than in the control group[93.55%(29/31)vs.70.97%(22/31),P<0.05].Conclusion Hierarchical monitoring management+refined nursing mode can be applied to patients with coma after surgery for severe craniocerebral injury,and can significantly accelerate their blood flow velocity,reduce the incidence of stress injury,shorten the postoperative recovery time,and improve the satisfaction of family members.