基于破窗效应的干预模式对重型颅脑损伤术后患者营养状况及应激障碍程度的影响

Influence of intervention mode based on window-breaking effect on nutritional status and stress disorder of patients with severe craniocerebral injury after operation

目的分析基于破窗效应的干预模式对重型颅脑损伤术后患者营养状况及应激障碍程度的影响。方法选取2022年1~12月河南科技大学第一附属医院重症医学科收治的184例重型颅脑损伤患者作为研究对象,依据随机数表法分为对照组和观察组各92例。对照组患者采用常规护理,观察组患者在对照组的基础上联合基于破窗效应的干预模式,所有患者均护理至出院,并随访3个月。比较两组患者入院时及出院时的营养指标(白蛋白、总蛋白及血红蛋白)、格拉斯哥昏迷指数(GCS)、美国国立卫生研究院卒中量表(NIHSS)评分以及入院时及随访3个月时的创伤后应激障碍自评量表(社会功能损伤、警觉性增加、回避症状、反复重现体现、主观评定)评分,同时比较两组患者住院期间的并发症发生情况。结果入院时,两组患者的白蛋白、总蛋白及血红蛋白含量比较差异均无统计学意义(P>0.05);出院时,两组患者的白蛋白、总蛋白及血红蛋白含量均上升,且观察组患者的白蛋白、总蛋白及血红蛋白分别为(43.79±4.22)g/L、(69.03±5.73)g/L、(115.89±7.05)g/L,明显高于对照组的(39.17±4.60)g/L、(65.81±5.12)g/L、(108.74±6.44)g/L,差异均有统计学意义(P<0.05);入院时,两组患者的GCS、NIHSS评分比较差异均无统计学意义(P>0.05);出院时,两组患者的GCS评分均上升,NIHSS评分均下降,且观察组患者的GCS评分明显高于对照组,NIHSS评分明显低于对照组,差异均有统计学意义(P<0.05);入院时,两组患者的创伤后应激障碍自评量表中的各项评分比较差异均无统计学意义(P>0.05);随访3个月时,两组患者的创伤后应激障碍自评量表中的各项评分均下降,且观察组患者的社会功能损伤、警觉性增加、回避症状、反复重现体现、主观评定评分及总分分别为(2.31±0.34)分、(7.04±1.14)分、(10.11±1.26)分、(9.16±1.10)分、(1.28±0.15)分、(30.38±4.55)分,明显低于对照组的(3.42±0.46)分、(10.81±1.79)分、(14.08±1.39)分、(12.27±1.42)分、(2.24±0.26)分、(40.18±5.12)分,差异均有统计学意义(P<0.05);住院期间,观察组患者的并发症总发生率为11.96%,明显低于对照组的26.09%,差异有统计学意义(P<0.05)。结论基于破窗效应的干预模式能够改善重型颅脑损伤术后患者营养状况,减轻应激障碍和神经功能缺损程度,降低并发症风险,具有临床应用价值。

Objective To analyze the effect of intervention model based on window-breaking effect on nutritional status and stress disorder of patients with severe craniocerebral injury after operation.Methods A total of 184 patients with severe craniocerebral injury admitted to the Department of Critical Care Medicine,the First Affiliated Hospital of Henan University of Science and Technology from January 2022 to December 2022 were selected and divided into a control group and an observation group according to random number table method,with 92 patients in each group.Patients in the control group received routine nursing,and those in the observation group received intervention mode based on window-breaking effect in addition to routine nursing.All the patients were cared until discharge and followed up for 3 months.The nutritional indexes(albumin,total protein,and hemoglobin),Glasgow Coma Index(GCS),National Institutes of Health Stroke Scale(NIHSS)at admission and discharge,and post-traumatic stress disorder self-rating scale(social function damage,increased alertness,avoidance of symptoms,repeated manifestations,and subjective evaluation)at admission and after 3 months of follow-up were compared between the two groups,and the complications during hospitalization were also compared.Results At admission,there was no significant difference in albumin,total protein,and hemoglobin between the two groups(P>0.05);at discharge,albumin,total protein,and hemoglobin in both groups increased(P<0.05),and the levels in the observation group were(43.79±4.22)g/L,(69.03±5.73)g/L,and(115.89±7.05)g/L,which were significantly higher than(39.17±4.60)g/L,(65.81±5.12)g/L,and(108.74±6.44)g/L in the control group(P<0.05).At admission,there was no significant difference in GCS and NIHSS scores between the two groups(P>0.05).At discharge,the GCS score of the two groups increased,and the NIHSS score decreased;the GCS score of the observation group was significantly higher than that of the control group,and the NIHSS score was significantly lower than that of the control group;the differences were statistically significant(P<0.05).At admission,there was no significant difference in the scores of the self-rating scale of post-traumatic stress disorder between the two groups(P>0.05).After 3 months of follow-up,the the scores of self-rating scale of post-traumatic stress disorder in both groups significantly decreased;the social function damage,increased alertness,avoidance symptoms,repeated reappearance,subjective evaluation,and total score in the self-rating scale were(2.31±0.34)points,(7.04±1.14)points,(10.11±1.26)points,(9.16±1.10)points,and(1.28±0.15)points in the observation group,which were significantly lower than(3.42±0.46)points,(10.81±1.79)points,(14.08±1.39)points,(12.27±1.42)points,(2.24±0.26)points,and(40.18±5.12)points in the control group;the differences were statistically significant(P<0.05).The incidence of complications in the observation group was 11.96%,which was significantly lower than 26.09%in the control group(P<0.05).Conclusion The intervention model based on window-breaking effect can improve the nutritional status of patients with severe craniocerebral injury after operation,reduce the degree of stress disorder and neurological deficit,and reduce the risk of complications,which is worth popularizing.