危机管理渗透式风险预控急救护理联合良肢位训练对重症脑卒中抢救及后期康复的效果研究

Study on the effect of crisis management infiltration risk pre control emergency nursing combined with good limb position training on the rescue and late rehabilitation of severe stroke

目的研究危机管理渗透式风险预控急救联合良肢位训练在重症脑卒中抢救及后期康复效果。方法①筛选宜兴市人民医院2016年1月-2019年1月间收治的90例临床资料完整的重症脑卒中患者纳为研究对象,按照患者就诊顺序,将其分为观察组(2017年6月后就诊,危机管理渗透式风险预控急救护理,n=40)与对照组(2017年6月之前就诊,常规抢救,n=50),比较两组抢救效果。②急救完成后,采用随机数字表法将观察组患者分为第一组(n=20)与第二组(n=20),其中第一组病情稳定后接受良肢位训练,第二组接受常规术后康复训练,连续干预3周后,比较两组干预效果。结果①观察组发病至到院时间、转入专科治疗时间均显著短于对照组(P<0.05),观察组院外气管插管率、院外开通静脉通道率及院外吸氧率均显著高于对照组(P<0.05);观察组抢救过程中危机事件发生率显著低于对照组(P<0.05);两组入院3 d后,急性生理学及慢性健康状况评分系统(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分均较同组出院时显著下降(P<0.05),格拉斯哥昏迷量表评分(Glasgow Coma Scale,GCS)均较同组入院时显著上升(P<0.05),且观察组入院3 d后,APACHEⅡ评分显著低于对照组,GCS评分显著高于对照组(P<0.05);②康复训练干预3周后,两组运动功能得分均较同组干预前显著上升(P<0.05),且第一组干预3周后,运动功能得分均显著高于第二组(P<0.05);第一组肩关节脱位、患足跖屈内翻、肢体痉挛及异常运动模式发生率均低于第二组,其中两组肩关节脱位及肢体痉挛发生率差异显著(P<0.05)。结论危机管理渗透式风险预控急救护理能有效优化急救护理质量,提高重症脑卒中救治效果,而联合良肢位训练,可有效减少患者肢体痉挛、异常运动模式等并发症,提高患者运动功能。

Objective To study the effect of crisis management infiltration risk pre control emergency treatment com‐bined with good limb position training in the rescue and late rehabilitation of severe stroke.Methods①90 cases of se‐vere stroke patients with complete clinical data in our hospital from January 2016 to January 2019 were selected as the research objects,and they were divided into the observation group(treated after June 2017,crisis management osmotic risk pre control emergency care,n=40)and the control group(treated before June 2017,routine rescue,n=50).②After emergency treatment,the patients in the observation group were randomly divided into group 1(n=20)and group 2(n=20).The patients in group 1 received good limb position training after stable condition,and the two groups received rou‐tine postoperative rehabilitation training.After 3 weeks of continuous intervention,the intervention effects of the two groups were compared.Results①the time from onset to hospital and transfer to special treatment in the observation group were significantly shorter than those in the control group(P<0.05),the rate of tracheal intubation,the rate of open‐ing venous passage and the rate of oxygen inhalation before hospital in the observation group were significantly higher than those in the control group(P<0.05);the incidence of crisis events in the observation group was significantly lower than that in the control group(P<0.05);Apache was significantly lower in the observation group than that in the control group 3 days after admission Compared with the same group,the scores ofⅡdecreased significantly(P<0.05),GCS scores increased significantly(P<0.05),and Apache scores of observation group were significantly higher than those of the same group at admission(P<0.05)After 3 weeks of rehabilitation training intervention,the motor function scores of the two groups were significantly increased(P<0.05),and the motor function scores of group 1 were significantly higher than those of group 2(P<0.05);the incidences of shoulder joint dislocation,plantar flexion and varus,limb spasm and abnormal movement mode in group 1 were significantly higher than those in group 2(P<0.05).The incidence of shoulder joint dislocation and limb spasm between the two groups was significantly different(P<0.05).Conclusion crisis manage‐ment infiltration risk pre control emergency nursing can effectively optimize the quality of emergency care and improve the treatment effect of severe stroke.Combined with good limb position training,it can effectively reduce the complica‐tions such as limb spasm and abnormal movement mode,and improve the motor function of patients.