失效模式与效应分析模式下的护理管理在重症颅脑损伤患者中的应用分析

Analysis of the Application of Nursing Management under Failure Mode and Effect Analysis Mode in Patients with Severe Traumatic Brain Injury

目的:分析失效模式与效应分析(failure mode and effect analysis,FMEA)模式下的护理管理在重症颅脑损伤(severe traumatic brain injury,STBI)患者中的应用。方法:选取2020年1月—2022年12月新余市人民医院收治的112例STBI患者为研究对象。以患者入院时间为分组依据,2020年1月—2021年6月入院的患者纳入对照组(n=50),2021年7月—2022年12月入院的患者纳入观察组(n=62)。对照组采取常规护理干预,观察组采取基于FMEA模式下的护理干预。比较两组意识、预后、凝血功能、营养学指标及并发症发生率。结果:护理前,两组格拉斯哥昏迷量表(Glasgow coma scale,GCS)、卡式功能状态(Karnofsky performance status,KPS)评分比较,差异均无统计学意义(P>0.05);护理后,两组GCS、KPS评分均较护理前升高,且观察组均高于对照组,差异均有统计学意义(P<0.05)。护理前,两组凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)及D-二聚体(D-dimer,D-D)比较,差异均无统计学意义(P>0.05);护理后,两组FIB均较护理前升高,且观察组高于对照组,两组PT均较护理前缩短,D-D均较护理前降低,且观察组均优于对照组,差异均有统计学意义(P<0.05)。护理前,两组前白蛋白(prealbumin,PA)、白蛋白(albumin,ALB)比较,差异均无统计学意义(P>0.05);护理后,两组ALB、PA均较护理前升高,且观察组均高于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率为12.90%,低于对照组的38.00%,差异有统计学意义(P=0.013)。结论:对STBI患者在进行积极有效的抢救治疗措施后,采取FMEA模式下的护理管理能极大地改善患者预后,并预防各类并发症的发生。

Objective:To analyze the application of nursing management under failure mode and effect analysis(FMEA)mode in patients with severe traumatic brain injury(STBI).Method:A total of 112 patients with STBI admitted to Xinyu People's Hospital from January 2020 to December 2022 were selected as the study objects.Patients were grouped according to time of admission,patients admitted from January 2020 to June 2021 were included in the control group(n=50),patients admitted from July 2021 to December 2022 were included in the observation group(n=62).The control group received routine nursing intervention,while the observation group received nursing intervention based on FMEA mode.Consciousness,prognosis,coagulation function,nutritional index and incidence of complications were compared between the two groups.Result:Before nursing,there were no statistical significances in scores of Glasgow coma scale(GCS)and Karnofsky performance status(KPS)between the two groups(P>0.05);after nursing,scores of GCS and KPS in the two groups were increased compared to those before nursing,and those in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).Before nursing,there were no statistically significant differences in prothrombin time(PT),fibrinogen(FIB)and D-dimer(D-D)between the two groups(P>0.05);after nursing,FIB in the two groups were increased compared to those before nursing,and that in the observation group was higher than that in the control group;PT were shorter and D-D were lower in the two groups than those before nursing,and those in the observation group were better than those in the control group,the differences were statistically significant(P<0.05).Before nursing,there were no statistically significant differences in prealbumin(PA)and albumin(ALB)between the two groups(P>0.05);after nursing,ALB and PA in both groups were higher than those before nursing,and those in observation group were higher than those in the control group,the differences were statistically significant(P<0.05).The incidence of complications was 12.90%in the observation group,lower than 38.00%in the control group,the difference was statistically significant(P=0.013).Conclusion:After active and effective rescue and treatment measures for patients with STBI,nursing management under FMEA mode can greatly improve the prognosis of patients and prevent the occurrence of various complications.