NBASS-APS在重症颅脑损伤患儿术后镇痛护理中的应用

Application of NBASS-APS in postoperative analgesic care for children with severe craniocerebral injury

目的探讨以护士为基础,以麻醉医师和专科医师共同督导的急性疼痛服务模式(NBASS-APS)在重症颅脑损伤患儿术后镇痛护理中的应用效果。方法选取2018年1月—2020年6月驻马店某医院收治的68例重型颅脑损伤患儿为研究对象,根据抽签随机分组法分为实验组和对照组,各34例。对照组患儿给予常规护理,实验组患儿给予NBASS-APS模式护理,2组患儿均持续护理4周。比较2组患儿术后疼痛情况及并发症发生情况,比较2组患儿术后3 d体征指标,比较2组患儿入院时、护理2周及护理4周时运动功能量表(Fugl-Meyer)评分。结果实验组术后轻度疼痛患儿占比高于对照组,中度疼痛、重度疼痛患儿占比均低于对照组,差异均有统计学意义(P<0.05)。实验组患儿术后3 d平均动脉压、颅内压、心率、颈静脉氧饱和度均低于对照组,差异均有统计学意义(P<0.05)。入院时,2组患儿Fugl-Meyer评分比较,差异无统计学意义(P>0.05);护理2周、护理4周时,2组患儿Fugl-Meyer评分均高于入院时,且实验组高于对照组,差异均有统计学意义(P<0.05)。实验组患儿术后并发症发生率为11.76%,低于对照组的35.29%,差异有统计学意义(P<0.05)。结论NBASS-APS应用于重症颅脑损伤患儿术后护理中可有效缓解其术后疼痛、维持生命体征平稳,促进运动功能恢复,降低术后并发症发生率,可在临床上推广使用。

Objective To explore the effect of the nurse-based,anesthesiologist and specialist-supervised acute pain services(NBASS-APS)in postoperative analgesic care for children with severe craniocerebral injury.Methods Sixty-eight children with severe craniocerebral injury admitted to a hospital in Zhumadian from January 2018 to June 2020 were selected as subjects and divided into experimental and control groups according to the random lottery grouping method,with 34 cases in each group.The children in the control group received conventional care,and the children in the experimental group received NBASS-APS care,and subjects in both groups were continuously cared for 4 weeks.The postoperative pain and complications were compared between the two groups,the postoperative signs were compared between the two groups at 3 d,and the Fugl-Meyer motor function assessment(FMA)scores were compared between the two groups at the time of admission,2 weeks and 4 weeks of care.Results The percentage of children with mild postoperative pain in the experimental group was higher than that in the control group,and the percentage of children with moderate and severe pain were lower than that in the control group,and the differences were statistically significant(P<0.05).The mean arterial pressure,intracranial pressure,heart rate and jugular venous oxygen saturation of children in the experimental group were all lower than those in the control group at 3 d after surgery,and the differences were statistically significant(P<0.05).The difference between the Fugl-Meyer scores of the two groups at the time of admission was not statistically significant(P>0.05);the Fugl-Meyer scores of the two groups at 2 weeks and 4 weeks of care were higher than those at the time of admission,and the experimental group had higher scores than the control group,with statistically significant differences(P<0.05).The incidence of postoperative complications in the children in the experimental group was 11.76%,which was lower than that in the control group(35.29%),with statistically significant differences(P<0.05).Conclusion The application of NBASS-APS in children with severe craniocerebral injury can effectively relieve their postoperative pain,improve physical signs,promote the recovery of motor function,and reduce the incidence of postoperative complications,which can be promoted in clinical practice.