以限制性液体管理为主的综合护理在ICU重型颅脑损伤患者中的应用效果

Application effect of comprehensive nursing based on restrictive fluid management in ICU patients with severe craniocerebral injuries

目的探讨以限制性液体管理为主的综合护理在重症监护病房(ICU)重型颅脑损伤患者中的应用价值。方法选取2020年3月至2022年3月徐州医科大学附属医院ICU收治的200例重型颅脑损伤患者为研究对象进行前瞻性随机对照研究,将患者按照随机数字表法分为对照组和观察组,各100例。2组患者均接受常规治疗和护理,对照组行积极性液体管理治疗,观察组行以限制性液体管理为主的综合护理。比较2组的液体平衡量、康复情况、预后、凝血功能指标水平及并发症发生率。结果护理1 d后2组的液体平衡均为正平衡,且观察组的液体正平衡量少于对照组(P<0.05);护理3 d和7 d后2组的液体平衡均为负平衡,观察组的负平衡量均多于同期对照组(P均<0.05)。护理2 d后2组的凝血酶原时间、活化部分凝血活酶时间、凝血酶时间、D-二聚体和纤维蛋白原均优于入住ICU时,且观察组均比对照组更优,对比均有统计学差异(P均<0.05)。相较于对照组,观察组的ICU住院时间和机械通气时间均更短,并发症总发生率更低,护理7 d后的格拉斯哥昏迷(GCS)评分更高(P均<0.05)。结论以限制性液体管理为主的综合护理能够减少ICU重型颅脑损伤患者并发症的发生,改善其凝血功能、液体平衡量和预后,缩短康复时间。

Objective To investigate the application value of comprehensive nursing based on the restrictive fluid management in patients with severe craniocerebral injuries in the intensive care unit(ICU).Methods Two hundred patients with severe craniocerebral injuries at the Affiliated Hospital of Xuzhou Medical University from March 2020 to March 2022 were selected as the research subjects.A prospective randomized controlled study was conducted,and the patients were allocated into control and observation groups by using a random number table.Both groups contained 100 patients and received routine treatment and nursing.The control group received active fluid management,while the observation group received comprehensive nursing based on restrictive fluid management.The fluid balance,rehabilitation,prognosis,coagulation function indicators,and incidence of complications were compared between the two groups.Results After 1 day of nursing,the fluid balance of both groups was positive,and the amount of positive fluid balance in the observation group was less than that in the control group(P<0.05).After 3 and 7 days of nursing,the fluid balance of both groups was negative,and the amount of negative fluid balance in the observation group was greater than that in the control group(both P<0.05).After 2 days of nursing,the levels of prothrombin time,activated partial thromboplastin time,thrombin time,D-dimer,and fibrinogen of both groups were better than those at the time of admission to the ICU,and the observation group was better than the control group(all P<0.05).Compared with the control group,the observation group had shorter ICU hospitalization time and mechanical ventilation time,lower overall incidence of complications,and higher Glasgow Coma Scale(GCS)scores after 7 days of nursing(all P<0.05).Conclusion Comprehensive nursing based on the restrictive fluid management can reduce the complications in ICU patients with severe craniocerebral injuries,improve their coagulation function,fluid balance and prognosis,and shorten the recovery time.