腰大池引流流量控制护理干预在术后颅内感染患者中的应用效果分析

Analysis of application effect of nursing intervention of flow control during lumbar cistern drainage in patients with postoperative intracranial infection

目的 观察腰大池引流时流量控制护理干预方案在术后颅内感染患者中的应用效果.方法 选择在湖州市第一人民医院进行开颅术后颅内感染的74例患者作为研究对象,根据收治时间分为对照组(2017年1月至2018年12月)和观察组(2019年1月至2020年12月).两组患者均进行腰大池引流治疗,同时对照组37例进行基础护理,未进行流量控制;观察组37例在对照组基础上基于流量控制理论进行护理干预.检测两组引流24 h脑脊液中炎症细胞因子〔包括白细胞介素(IL-1β、IL-4、IL-6、IL-8、IL-10、IL-12、IL-13、IL-15)、 肿瘤坏死因子-α(TNF-α)、γ-干扰素(IFN-γ)、单核细胞趋化蛋白-1(MCP-1)〕水平,比较干预后两组的临床相关指标〔包括格拉斯哥预后评分(GOS)、住院时间〕和并发症发生情况.结果 观察组IL-1β、IL-4、IL-6、IL-8、IL-10、IL-12、IL-13、IL-15、TNF-α、IFN-γ均低于对照组〔IL-1β(μg/L):0.62±0.08比1.10±0.17,IL-4(μg/L):0.74±0.25比1.35±0.36,IL-6(μg/L):55.62±10.85比385.74±69.59,IL-8(μg/L):0.30±0.04比2.41±0.25,IL-10(μg/L):31.46±5.57比52.18±7.90,IL-12(μg/L):0.74±0.21比1.59±0.28,IL-13(μg/L):0.56±0.11比1.62±0.25,IL-15(μg/L):0.89±0.21比1.78±0.43,TNF-α(μg/L):4.82±1.56比24.79±5.92,IFN-γ(μg/L):2.80±0.66比15.27±2.72〕,并发症发生率低于对照组〔5.41%(2/37)比27.03%(10/37)〕,差异均有统计学意义(均P<0.05);两组的体温、MCP-1进行比较差异无统计学意义〔体温(℃):36.50±0.15比36.54±0.20,MCP-1(μg/L):1098.60±211.89比1100.25±212.46,均P>0.05〕;观察组GOS评分、住院时间均优于对照组〔GOS(分):4.14±0.56比3.45±0.47,住院时间(d):11.90±2.60比13.26±2.84,均P<0.05〕.结论 对开颅术后颅内感染患者实施腰大池引流流量控制理论的护理干预,能够降低脑脊液细胞炎症因子水平和并发症发生率,可获得更好的康复效果.

Objective To observe the effect of applying nursing intervention program of flow control during lumbar cistern drainage treatment for patients with postoperative intracranial in feet ion.Methods A total of 74 post operative patients with intracranial infection after craniotomy in Huzhou First People's Hospital were selected as the research subjects,and according to different admission time,they were divided into a control group(January 2017 to December 2018)and an observation group(January 2019 to December 2020).Both groups received lumbar cistern drainage treatment,while 37 cases in the control group received basic nursing without flow control;37 cases in the observation group received nursing intervention based on the theory of flow control and the basic nursing in the control group.The levels of inflammatory cytokines[including interleukins(IL-1β,IL-4,IL-6,IL-8,IL-10,IL-12,IL-13,IL-15),tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ)and monocyte chemoattractant protein-1(MCP-1)]were detected in the 24-hour cerebrospinal fluid of the two groups;the clinically relevant indicators[including Glasgow outcome score(GOS)and length of hospital stay]and the incidence of complications were observed and compared between the two groups after intervention.Results The levels of IL-1β,IL-4,IL-6,IL-8,IL-10,IL-12,IL-13,IL-15,TNF-α,IFN-γin the observation group were lower than those in the control group[IL-1 P(μg/L):0.62±0.08 vs.1.10±0.17,IL-4(μg/L):0.74±0.25 vs.1.35±0.36,IL-6(μg/L):55.62±10.85 vs.385.74±69.59,IL-8(μg/L):0.30±0.04 vs.2.41±0.25,IL-10(μg/L):31.46±5.57 vs.52.18±7.90,IL-12(μg/L):0.74±0.21 vs.1.59±0.2&IL-13(μg/L):0.56±0.11 vs.1.62±0.25,IL-15(μg/L):0.89±0.21 vs.1.78±0.43,TNF-α(μg/L):4.82±1.56 vs.24.79±5.92,IFN-γ(μg/L):2.80±0.66 vs.15.27±2.72];the incidence of complications was lower than that of the control group[5.41%(2/37)vs.27.03%(10/37)],the difference being statistically significant(all P<0.05);there were no statistical significant differences in body temperature and MCP-1 level Between the two groups[body temperature(℃):36.50±0.15 vs.36.54±0.20,MCP-1(μg/L):1098.60±211.89 vs.1100.25±212.46,both P>0.05];the GOS score and the length of hospital stay in the observation group were better than those in the control group[GOS(scores):4.14±0.56 vs.3.45±0.47,the length of hospital stay(days):11.90±2.60 vs.13.26±2.84,Both P<0.05].Conclusions Nursing intervention based on lumbar cistern drainage flow control theory and applied for postoperative patients with intracranial infection after craniotomy can reduce the levels of various inflammatory cytokines in cerebrospinal fluid and the incidence of complications,thus it can achieve better recovery effects.