风险管理早期干预对急性脑梗死介入治疗患者神经功能与日常生活能力的影响

Effect of early intervention based on risk management on neurological function and activities of daily living in patients with acute cerebral infarction undergoing interventional therapy

目的观察基于风险管理的早期干预护理对急性脑梗死(ACI)介入治疗患者神经功能、日常生活能力的影响。方法选取2020年1月至2023年9月在江汉大学附属湖北省第三人民医院接受介入治疗的86例ACI患者为研究对象,其中男47例,女39例,年龄(56.85±5.62)岁,前、后循环闭塞各43例。采用随机数字表法分为对照组和观察组,各43例,对照组采用常规护理,观察组采用基于风险管理的早期干预护理模式,均干预至出院后1个月。评估两组干预前后神经功能、自我护理能力、日常生活能力、跌倒风险、护理满意度[采用美国国立卫生研究院卒中量表(NIHSS)、自我护理能力测定量表(ESCA)、改良巴氏量表(MBI)、汉化版跌倒效能量表(FES)分别评估患者的神经功能、自我护理能力、日常生活能力、跌倒风险,利用自制护理满意度量表收集护理满意率],记录护理期间及出院后随访3个月内并发症发生情况。结果出院后1个月,观察组NIHSS评分为(7.84±3.29)分,低于对照组的(10.28±4.63)分(t=2.817,P<0.05);ESCA的4个项目评分、MBI、FES评分、护理满意率依次为(27.64±3.72)分、(15.04±3.55)分、(19.72±4.56)分、(62.63±7.33)分、(70.11±5.05)分、(48.28±5.05)分、97.67%(42/43),均高于对照组[(24.16±2.15)分、(12.06±2.84)分、(14.74±3.59)分、(56.29±6.75)分、(64.27±5.43)分、(42.16±5.43)分、83.73%(36/43)](t=5.311、4.298、5.627、4.171、5.164、5.412,χ^(2)=4.962,均P<0.05)。观察组并发症总发生率为6.98%(3/43),低于对照组的23.26%(10/43),差异有统计学意义(χ^(2)=4.441,P<0.05)。结论基于风险管理的早期干预护理可促进ACI介入治疗患者神经功能恢复,提高自我护理能力、日常生活能力,降低跌倒事件发生风险及并发症发生率,提高护理满意度。

Objective To observe the effect of early intervention nursing based on risk management on neurological function and activities of daily living in patients with acute cerebral infarction(ACI)undergoing interventional therapy.Methods A total of 86 patients with ACI who underwent interventional therapy in Hubei Province Third People's Hospital,Jianghan University from January 2020 to September 2023 were selected as the research objects,including 47 males and 39 females who were(56.85±5.62)years old.Among them,there were 43 cases with anterior circulation occlusion and 43 cases with posterior circulation occlusion.The patients were divided into a control group and an observation group using the random number table method,with 43 cases in each group.The control group received routine nursing,while the observation group received early intervention nursing based on risk management.Both groups received intervention till 1 month after discharge.The neurological function[National Institutes of Health Stroke Scale(NIHSS)],self-care ability[Exercise of Self-Care Agency(ESCA)],activities of daily living[modified Barthel index(MBI)],fall risk[Chinese version Falls Efficacy Scale(FES)],nursing satisfaction(self-made nursing satisfaction scale),and incidences of complications during nursing and follow-up within 3 months after discharge in the two groups were evaluated.Results One month after discharge,the score of NIHSS in the observation group was lower than that in the control group[(7.84±3.29)vs.(10.28±4.63);t=2.817;P<0.05];the scores of the 4 items of ESCA,MBI,and FES and nursing satisfaction rate in the observation group were higher than those in the control group[(27.64±3.72)vs.(24.16±2.15),(15.04±3.55)vs.(12.06±2.84),(19.72±4.56)vs.(14.74±3.59),(62.63±7.33)vs.(56.29±6.75),(70.11±5.05)vs.(64.27±5.43),(48.28±5.05)vs.(42.16±5.43),and 97.67%(42/43)vs.83.73%(36/43);t=5.311,4.298,5.627,4.172,5.164,and 5.412;χ^(2)=4.962;all P<0.05].The total incidence of complications in the observation group was lower than that in the control group[6.98%(3/43)vs.23.26%(10/43)],with a statistical difference(χ^(2)=4.441;P<0.05).Conclusion Early intervention nursing based on risk management can promote neurological function recovery in patients with ACI undergoing interventional therapy,improve their self-care ability and activities of daily living,reduce the risks of complications and falls,and improve the satisfaction with nursing.