循环支持对神经外科危重症患者循环功能和神经功能的影响研究

Study of the Effect of Circulatory Support on Circulatory Function and Neurological Function in Critically Ill Neurosurgical Patients

目的:研究循环支持的干预方法及在神经外科危重症患者护理中的应用价值。方法:将某院神经外科收治的90例危重症患者随机分为C组和C+D+Y组各45例,C组患者按照危重症患者常规模式予以护理,C+D+Y组患者在C组的基础上联合开展循环支持护理(包括循环监测、维持电解质平衡、建立呼吸道防御屏障、减轻心脏负荷、维持体液和营养代谢等)。于护理干预前后,分别检测两组患者循环功能指标[心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)]和血清神经损伤相关因子[神经特异性蛋白(S100β)、神经肽Y(NPY)、神经元特异性烯醇化酶(NSE)],并随访统计两组患者预后情况。结果:干预后,C+D+Y组患者HR低于C组(P<0.05),MAP、CVP均高于C组(P<0.05);C+D+Y组患者血清S100β、NPY、NSE均低于C组(P<0.05)。C+D+Y组患者临床预后良好率为64.44%,高于C组的44.44%(P<0.05)。结论:通过神经外科危重症患者循环支持护理可有效改善患者循环功能,减轻神经功能损伤程度,使患者获得良好预后。

Objective:To study the intervention method of circulatory support and its application value in the nursing of critically ill patients in neurosurgery.Methods:A total of 90 critically ill patients admitted to a hospital were randomly divided into C group(n=45)and C+D+Y group(n=45).Patients in group C were nursed according to the usual mode of critically ill patients,and on the basis of group C,patients in group C+D+Y received circulatory support nursing(including circulatory monitoring,maintenance of electrolyte balance,establishment of respiratory barrier,reduction of cardiac load,maintenance of body fluid and nutrient metabolism,etc.).Before and after the nursing intervention,circulatory function indexes[heart rate(HR),mean arterial pressure(MAP),central venous pressure(CVP)]and serum nerve injury related factors[eurospecific proteins(S100β),neuropeptide Y(NPY),neuronspecific enolase(NSE)]were detected and the prognosis in the two group were followed up and counted.Results:After intervention,HR in C+D+Y group was lower than that in C group(P<0.05),and MAP and CVP were higher than those in C group(P<0.05).Serum S100β,NPY and NSE in C+D+Y group were lower than those in C group(P<0.05).The rate of good clinical prognosis in C+D+Y group was 64.44%,which was higher than 44.44%in C group(P<0.05).Conclusion:Circulatory support nursing for critically ill neurosurgical patients can effectively improve the patients'circulatory function,reduce the degree of neurological impairment,and promote the patients to obtain a good prognosis.