Clinical Effect of Intelligent Emergency Nursing Mode in Patients with Severe Traumatic Brain Injury

Objective: Severe traumatic brain injury (sTBI) is one of the common acute and critical diseases in neurosurgery. So we aim to explore the clinical effectiveness of an intelligent emergency care model in patients with severe traumatic brain injury. Methods: Eighty patients with severe traumatic brain injury (sTBI) who were treated in Zhuji People’s Hospital of Zhejiang Province from January 2019 to December 2021 were selected as the study subjects. The patients were divided into an observation group and a control group with 40 patients in each group according to the random number table method. Patients in the control group received conventional first-aid nursing mode intervention, and the intelligent emergency nursing mode was used for the observation group based on the control group. Comparisons were conducted between the two groups on the time of arrival to the emergency room, the time from the emergency room to the operating room, Glasgow Coma Scale (GCS) score before surgery, GCS score when leaving the Intensive Care Unit (ICU), the average length of ICU stay, the average length of hospital stay, the total hospital costs. Results: The time of arrival to the emergency room, the time from the emergency room to the operating room, the average length of ICU stay, the average length of hospital stay, and the total hospital costs in the observation group were significantly lower than those in the control group, and the differences were statistically significant (All P Conclusion: Intelligent emergency nursing mode can shorten the time of sTBI rescue, the length of ICU stay, and the average length of hospital stay, reduce the total hospitalization cost, improve the prognosis, with good efficacy, reduce the total cost of hospitalization, and improve the prognosis with better efficacy.

Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study

Objective To investigate the effects of propofol and sevoflurane on neurological recovery of traumatic brain injury(TBI)patients in the early postoperative stage.Methods We retrospectively analyzed the clinical data of TBI patients who underwent craniotomy or decompressive craniectomy.Generalized additive mixed model(GAMM)was used to analyze effects of propofol and sevoflurane on Glasgow Coma Scale(GCS)on postoperative days 1,3,and 7.Multivariate regression analysis was used to analyze effects of the two anesthetics on Glasgow Outcome Scale(GOS)at discharge.Results A total of 340 TBI patients were enrolled in this study.There were 110 TBI patients who underwent craniotomy including 75 in the propofol group and 35 in the sevoflurane group,and 134 patients who underwent decompressive craniectomy including 63 in the propofol group and 71 in the sevoflurane group.It showed no significant difference in GCS at admission between the propofol and the sevoflurane groups among craniotomy patients(β=0.75,95%CI:-0.55 to 2.05,P=0.260).However,elevation in GCS from baseline was 1.73 points(95%CI:-2.81 to-0.66,P=0.002)less in the sevoflurane group than that in the propofol group on postoperative day 1,2.03 points(95%CI:-3.14 to-0.91,P 0.001)less on day 3,and 1.31 points(95%CI:-2.43 to-0.19,P=0.022)less on day 7.The risk of unfavorable GOS(GOS 1,2,and 3)at discharge was higher in the sevoflurane group(OR=4.93,95%CI:1.05 to 23.03,P=0.043).No significant difference was observed among two-group decompressive craniectomy patients in GCS and GOS.Conclusions Compared to propofol,sevoflurane was associated with worse neurological recovery during the hospital stay in TBI patients undergoing craniotomy.This difference was not detected in TBI patients undergoing decompressive craniectomy.

Resuscitation therapy for traumatic brain injuryinduced coma in rats:mechanisms of median nerve electrical stimulation

In this study, rats were put into traumatic brain injury-induced coma and treated with median nerve electrical stimulation. We explored the wake-promoting effect, and possible mechanisms, of median nerve electrical stimulation. Electrical stimulation upregulated the expression levels of orexin-A and its receptor OX1R in the rat prefrontal cortex. Orexin-A expression gradually in-creased with increasing stimulation, while OX1R expression reached a peak at 12 hours and then decreased. In addition, after the OX1R antagonist, SB334867, was injected into the brain of rats after traumatic brain injury, fewer rats were restored to consciousness, and orexin-A and OXIR expression in the prefrontal cortex was downregulated. Our ifndings indicate that median nerve electrical stimulation induced an up-regulation of orexin-A and OX1R expression in the pre-frontal cortex of traumatic brain injury-induced coma rats, which may be a potential mechanism involved in the wake-promoting effects of median nerve electrical stimulation.

Wake-promoting effects of vagus nerve stimulation after traumatic brain injury: upregulation of orexin-A and orexin receptor type 1 expression in the prefrontal cortex

Orexins, produced in the lateral hypothalamus, are important neuropeptides that participate in the sleep/wake cycle, and their expres- sion coincides with the projection area of the vagus nerve in the brain. Vagus nerve stimulation has been shown to decrease the amounts of daytime sleep and rapid eye movement in epilepsy patients with traumatic brain injury. In the present study, we investigated whether vagus nerve stimulation promotes wakefulness and affects orexin expression. A rat model of traumatic brain injury was established using the free fall drop method. In the stimulated group, rats with traumatic brain injury received vagus nerve stimulation （frequency, 30 Hz, current, 1.0 mA; pulse width, 0.5 ms; total stimulation time, 15 minutes）. In the antagonist group, rats with traumatic brain injury were intracerebroventricularly injected with the orexin receptor type 1 （OXIR） antagonist SB334867 and received vagus nerve stimulation. Changes in consciousness were observed after stimulation in each group. Enzyme-linked immunosorbent assay, western blot assay and immunohistochemistry were used to assess the levels of orexin-A and OX1R expression in the prefrontal cortex. In the stimulated group, consciousness was substantially improved, orexin-A protein expression gradually increased within 24 hours after injury and OX1R expres- sion reached a peak at 12 hours, compared with rats subjected to traumatic brain injury only. In the antagonist group, the wake-promoting effect of vagus nerve stimulation was diminished, and orexin-A and OX1R expression were decreased, compared with that of the stim- ulated group. Taken together, our findings suggest that vagus nerve stimulation promotes the recovery of consciousness in comatose rats after traumatic brain injury. The upregulation of orexin-A and OXIR expression in the prefrontal cortex might be involved in the wake-promoting effects of vagus nerve stimulation.

Traumatic axonal injury of the cingulum in patients with mild traumatic brain injury: a diffusion tensor tractography study

The cingulum,connecting the orbitofrontal cortex to the medial temporal lobe,involves in diverse cognition functions including attention,memory,and motivation.To investigate the relationship between the cingulum injury and cognitive impairment in patients with chronic mild traumatic brain injury,we evaluated the integrity between the anterior cingulum and the basal forebrain using diffusion tensor tractography in 73 patients with chronic mild traumatic brain injury(39 males,34 females,age 43.29±11.42 years)and 40 healthy controls(22 males,18 females,age 40.11±16.81 years).The patients were divided into three subgroups based on the integrity between the anterior cingulum and the basal forebrain on diffusion tensor tractography:subgroup A(n=19 patients)– both sides of the anterior cingulum were intact;subgroup B(n=36 patients)– either side of the anterior cingulum was intact;and subgroup C(18 patients)– both sides of the anterior cingulum were discontinued.There were significant differences in total Memory Assessment Scale score between subgroups A and B and between subgroups A and C.There were no significant differences in diffusion tensor tractography parameters(fractional anisotropy,apparent diffusion coefficient,and fiber volume)between patients and controls.These findings suggest that the integrity between the anterior cingulum and the basal forebrain,but not diffusion tensor tractography parameter,can be used to predict the cognitive function of patients with chronic mild traumatic brain injury.This study was approved by Yeungnam University Hospital Institutional Review Board(approval No.YUMC-2014-01-425-010)on August 16,2017.

Structural and functional connectivity in traumatic brain injury

Traumatic brain injury survivors often experience cognitive deficits and neuropsychiatric symptoms.However,the neurobiological mechanisms underlying specific impairments are not fully understood.Advances in neuroimaging techniques（such as diffusion tensor imaging and functional MRI）have given us new insights on structural and functional connectivity patterns of the human brain in both health and disease.The connectome derived from connectivity maps reflects the entire constellation of distributed brain networks.Using these powerful neuroimaging approaches,changes at the microstructural level can be detected through regional and global properties of neuronal networks.Here we will review recent developments in the study of brain network abnormalities in traumatic brain injury,mainly focusing on structural and functional connectivity.Some connectomic studies have provided interesting insights into the neurological dysfunction that occurs following traumatic brain injury.These techniques could eventually be helpful in developing imaging biomarkers of cognitive and neurobehavioral sequelae,as well as predicting outcome and prognosis.

Traumatic brain injury:A case-based review

BACKGROUND:Traumatic brain injuries are common and costly to hospital systems.Most of the guidelines on management of traumatic brain injuries are taken from the Brain Trauma Foundation Guidelines.This is a review of the current literature discussing the evolving practice of traumatic brain injury.DATA SOURCES:A literature search using multiple databases was performed for articles published through September 2012 with concentration on meta-analyses,systematic reviews,and randomized controlled trials.RESULTS:The focus of care should be to minimize secondary brain injury by surgically decompressing certain hematomas,maintain systolic blood pressure above 90 mmHg,oxygen saturations above 93%,euthermia,intracranial pressures below 20 mmHg,and cerebral perfusion pressure between 60-80 mmHg.CONCLUSION:Much is still unknown about the management of traumatic brain injury.The current practice guidelines have not yet been sufficiently validated,however equipoise is a major issue when conducting randomized control trials among patients with traumatic brain injury.

Outcome of Surgically Treated Acute Traumatic Epidural Hematomas Based on the Glasgow Coma Scale

This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural hematomas. The mean age of patients was 29.56 years and 63.04% of the patients were between 21 and 30 years of age. Forty-tree out of 46 (93.47%) of the patients were males. Road traffic crash was the main mode of injury. The severity of the traumatic brain injury was classified according to the Glasgow coma scale score at admission. The injury was mild or moderate in 35 (76.08%) cases and severe in 11. Eight patients (17.39%) presented with pupillary abnormalities. The computed tomography scanning of the head has objectivized the epidural hematoma in all patients and has shown a mass effect with midline shift in all but one case (45/46). The most frequent surgical procedure done was craniotomy. Six (13.04%) patients died (GOS 1), but 38 (82.60%) recovered fully (GOS 5) and two (04.34%) were disabled but independent (GOS 4). The Glasgow coma score at admission was very predictive for good or poor outcome, since all patients but one who died and all survivors who were disabled were comatose at admission (GCS ≤ 8).

Arousal effect and potential mechanism of dopamine-mediated acupuncture on traumatic brain injury

Traumatic brain injury(TBI)is a brain injury caused by direct external forces,and its prognosis depends on the extent of the damage and the changes in level of consciousness.Timely awakening from a coma is the first thorny problem to be solved in TBI treatment.Therefore,there is a need for the development of safe and effective methods for timely awakening after TBI coma.Dopamine(DA)and its receptors in the nervous system are involved in the regulation of wakefulness.The amount and activity of dopaminergic neurons can affect cellular function and neuroinflammatory response,and are also significant for the awakening process after TBI.The current common awakening therapy for TBI may also be related to the activation of dopaminergic neurons.Acupuncture plays a beneficial role in timely awakening,recovery of conscious level,and functional rehabilitation after TBI.The mechanism may be related to the targeted regulation of DA and its receptors via acupuncture.Among acupuncture first aid therapies,acupuncture at hand 12 Jing-Well points,with its advantages of simple operation and ultra-early intervention,has shown great promise in timely awakening following TBI and triggering a series of subsequent nerve repair effects in the treatment of TBI.We here present a review that provides a new perspective for the timely awakening from TBI-induced coma,with a focus on the role of DA in the regulation of wakefulness and the efficacy and potential mechanism of DA systems in the treatment of TBI by acupuncture.

有创颅内压监测下控制性阶梯式减压在重型颅脑损伤中的应用

目的:探讨有创颅内压监测下控制性阶梯式减压法治疗重型颅脑损伤者的应用价值。方法:选取2022年7月—2023年7月肇庆市第一人民医院收治的82例重型颅脑外伤者作为研究对象,将其分为对照组和试验组,每组各41例。患者均未行手术治疗,且处于急性期。对照组常规监测生命体征变化情况,试验组行脑室型有创颅内压监测探头植入术。比较两组颅内压、并发症发生率(迟发血肿、术后脑梗塞)、死亡率、格拉斯哥昏迷评分法(Glasgow Coma Scale,GCS)评分及预后情况。结果:术后6 h、12 h、24 h,对照组颅内压指标高于试验组,差异有统计学意义(P<0.05)。对照组术后并发症发生率高于试验组,差异有统计学意义(P<0.05)。术后24 h、72 h、7 d,两组GCS评分比较,差异无统计学意义(P>0.05)。术后3个月,对照组恢复良好率低于试验组,差异有统计学意义(P<0.05)。结论:有创颅内压监测下控制性阶梯式减压疗法应用于重型颅脑损伤患者中效果理想,可改善患者颅内压指标,降低术后并发症发生率及死亡率,患者可更快恢复意识,改善预后。

基于哈贝马斯交往行为理论的沟通模式在急诊脑外伤患者中的应用

目的探讨基于哈贝马斯交往行为理论的沟通模式在急诊脑外伤患者中的应用效果。方法回顾性分析2021年1月—2022年12月在西安交通大学第一附属医院进行救治的106例脑外伤患者的临床资料,根据护理干预方法不同分为观察组和对照组,每组53例。对照组患者采用常规脑外伤急救护理干预,观察组患者采用基于哈贝马斯交往行为理论的沟通模式进行干预。比较2组患者的确诊时间、手术准备时间、住院时间等急诊救治效果指标及家属护理满意度,同时比较2组患者的神经功能缺损状况、日常生活能力等指标以及并发症发生情况。结果干预前,2组患者美国国立卫生研究院卒中量表(NIHSS)评分比较,差异无统计学意义(P>0.05);干预后,观察组患者的NIHSS评分低于对照组,日常生活能力量表(ADL)评分高于对照组,差异均有统计学意义(P<0.05)。干预前,2组患者神经行为认知状态检查(NCSE)量表及格拉斯哥昏迷评分量表(GCS)评分比较,差异均无统计学意义(P>0.05);干预后,观察组患者的NCSE和GCS评分均高于对照组,差异均有统计学意义(P<0.05)。观察组患者的确诊时间、手术准备时间、住院时间均短于对照组,差异均有统计学意义(P<0.05)。观察组患者家属对护理人员沟通能力、健康宣教水平、操作技能、服务态度4项护理满意度评分均高于对照组,差异均有统计学意义(P<0.05)。观察组与对照组患者术后并发症发生率分别为5.67%和15.09%,差异无统计学意义(χ^(2)=2.536,P=0.111)。结论基于哈贝马斯交往行为理论的沟通模式应用于急诊脑外伤患者护理中,有助于减轻患者神经功能受损程度,改善患者神经认知功能,提升急诊救治效率和家属护理满意度。

外周血FDP/Fib值联合GCS评分对创伤性脑损伤患者预后的预测价值

目的:探讨外周血纤维蛋白降解产物/纤维蛋白原(FDP/Fib)比值联合格拉斯哥昏迷评分(GCS)对创伤性脑损伤(TBI)患者预后的预测价值。方法:选取80例中重度TBI患者为研究对象,根据28 d预后分为死亡组(n=26)与存活组(n=54)。比较两组患者临床特征[年龄、性别、创伤机制、血压、心率和呼吸频率、GCS评分、创伤严重程度评分(ISS)]和实验室指标[血白细胞计数、血小板计数、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体(D-D)、纤维蛋白原(Fib)、纤维蛋白降解产物(FDP)、FDP/Fib值];Pearson相关系数分析外周血FDP/Fib值与ISS、GCS评分的相关性;多元Logistic回归分析中重度TBI患者28 d死亡的独立预测因子;采用受试者工作特征(ROC)曲线评估外周血FDP/Fib值、GCS评分及二者联合对预后的预测价值。结果:死亡组GCS评分、APTT和Fib低于存活组(P<0.001);ISS评分、PT、D-D、FDP、FDP/Fib值高于存活组(P<0.05)。Pearson相关系数分析显示,外周血FDP/Fib值与ISS评分正相关(P<0.05);与GCS评分负相关(P<0.05)。多元Logistic回归分析显示,GCS评分(OR=1.344)和FDP/Fib值(OR=1.145)是中重度TBI患者28 d死亡的独立预测因子(P<0.05)。ROC曲线分析显示,外周血FDP/Fib值、GCS评分及二者联合预测TBI预后的曲线下面积(AUC)分别为0.854、0.890、0.948,二者联合预测价值最高(P<0.001)。结论:外周血FDP/Fib值与TBI患者病情程度相关,联合GCS评分对TBI患者的预后有较好的预测价值。

早期高压氧联合正中神经电刺激治疗重型颅脑损伤的疗效及对患者血流动力学、昏迷程度和神经功能的影响

目的探讨早期高压氧联合正中神经电刺激治疗重型颅脑损伤的疗效及对患者血流动力学、昏迷程度、神经功能的影响。方法选择2020年3月至2021年10月西部战区总医院收治的78例重型颅脑损伤患者为研究对象,采用随机数字表法将患者分为对照组和观察组,每组39例。2组患者均行纠正水电解质和酸碱平衡、营养支持、抗感染、去骨瓣减压术等基础治疗,在此基础上,对照组患者给予早期高压氧治疗,观察组在对照组治疗基础上给予正中神经电刺激治疗。比较2组患者的临床疗效;治疗前和治疗后,采用双通道经颅多普勒超声检测2组患者大脑中动脉收缩期峰值血流速度(Vs)、平均血流速度(Vm)、搏动指数(PI)等血流动力学指标,格拉斯哥昏迷指数(GCS)评分评估2组患者的昏迷程度,美国国立卫生研究院卒中量表(NIHSS)评分评估2组患者的神经功能缺损情况,酶联免疫吸附法检测血清中枢神经特异性蛋白(S100-β)、神经胶质纤维酸性蛋白(GFAP)及髓鞘碱性蛋白(MBP)水平;记录2组患者治疗期间并发症发生情况,并比较并发症发生率。结果对照组和观察组患者的总有效率分别为79.49%(31/39)、92.31%(36/39);观察组患者的总有效率显著高于对照组(χ^(2)=8.971,P<0.05)。治疗前2组患者的Vm、Vs、PI比较差异均无统计学意义(P>0.05)。治疗后,2组患者的Vm、Vs显著高于治疗前,PI显著低于治疗前(P<0.05);且观察组患者的Vm、Vs显著高于对照组,PI显著低于对照组(P<0.05)。治疗前,2组患者的GCS、NIHSS评分比较差异均无统计学意义(P>0.05)。治疗后,2组患者的GCS评分显著高于治疗前,NIHSS评分显著低于治疗前(P<0.05);且观察组患者的GCS评分显著高于对照组,NIHSS评分显著低于对照组(P<0.05)。治疗前2组患者的S100-β、GFAP、MBP水平比较差异无统计学意义(P>0.05)。治疗后,2组患者的S100-β、GFAP、MBP水平显著低于治疗前(P<0.05),且观察组患者的S100-β、GFAP、MBP水平显著低于对照组(P<0.05)。治疗过程中,对照组和观察组患者并发症发生率分别为23.08%(9/39)、20.51%(8/39),2组患者并发症发生率比较差异无统计学意义(χ^(2)=2.328,P>0.05)。结论早期高压氧联合正中神经电刺激治疗重型颅脑损伤的疗效较好,可以有效改善患者的血流动力学水平,减轻患者昏迷程度,提高患者神经功能,促使患者早日恢复意识,且不增加并发生症发生风险。

基于危机管理理论的全方位急诊护理对创伤性颅脑损伤患者的影响

目的:探究基于危机管理理论的全方位急诊护理对创伤性颅脑损伤患者的影响。方法:回顾性选取2023年1—12月厦门大学附属第一医院急诊科收治的100例创伤性颅脑损伤患者。根据不同护理方法将其分为观察组和对照组,各50例。对照组实施常规急诊护理,观察组在对照组基础上实施基于危机管理理论的全方位急诊护理。比较两组时间指标、并发症、相关指标。结果:观察组确诊时间、急诊科抢救时间、急诊转送至手术时间均早于对照组,住院时间短于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。出院时,两组格拉斯哥昏迷评分法(GCS)评分、卡式功能状态量表(KPS)评分均升高,美国国立卫生研究院卒中量表(NIHSS)评分降低,观察组GCS评分、KPS评分均高于对照组,NIHSS评分低于对照组,差异有统计学意义(P<0.05)。结论:基于危机管理理论的全方位急诊护理可提高抢救效果,还可保证患者的健康安全。

以赋能理论为框架的多维护理干预对去骨瓣减压干预重症颅脑损伤患者术后恢复情况、生活质量的影响

目的探讨在赋能理论指导下的多维度护理对进行去骨瓣减压干预治疗的重症颅脑损伤患者的术后恢复情况以及生活质量产生的影响。方法我院选取88例干预时间在2022年3月至2023年11月之间使用去骨瓣减压干预治疗的重症颅脑损伤患者,使用双盲法对患者分组,每组44例患者,对照组接受基础护理,研究组在接受基础护理后增加赋能理论指导的多维度护理,比较两组干预前、干预后3 d、干预后7 d的疼痛情况[视觉模拟评分法(VAS)],比较两组干预前后的心理情况[焦虑自评量表(SAS)、抑郁自评量表(SDS)],比较两组干预前及干预后1个月的上肢功能情况[上肢运动功能评测表(Fugl-Meyer)]、睡眠情况[匹兹堡睡眠质量指数(PSQI)]以及患者的生活质量[生活质量调查表(SF-36)]。结果在患者疼痛情况的比较中,两组干预后不同时间的VAS评分较干预前下降(P<0.05),研究组干预后3 d(t=3.683,P<0.001)、干预后7 d的VAS评分(t=13.376,P<0.001)低于对照组。在心理情况的比较中,两组干预后的不良情绪得分较干预前下降(P<0.05),且研究组的SDS评分(t=6.249,P<0.001)、SAS评分(t=5.269,P<0.001)低于对照组。在患者上肢功能和睡眠情况的比较中,两组干预后1个月的Fugl-Meyer评分高于干预前(P<0.05),且研究组的评分高于对照组(t=4.279,P<0.001)。在睡眠情况的比较中,两组干预后的PSQI评分低于干预前,且研究组低于对照组(t=3.659,P<0.001)。在生活质量的比较中,两组干预后SF-36评分高于干预前,且研究组高于对照组(t=3.753,P<0.001)。结论以赋能理论为框架的多维度护理用于去骨瓣减压干预的重症颅脑损伤患者中,可减少患者疼痛,改善其心理情况,促进患者上肢功能和睡眠质量的恢复,提高其生活质量。

危机理论指导下的创伤急救护理对颅脑外伤患者急救时间、神经功能及生命体征的影响

目的:探讨危机理论指导下的创伤急救护理对颅脑外伤患者急救时间、神经功能和生命体征的影响。方法:选择2020年9月—2023年9月在连云港市中医院接受颅脑外伤急救治疗的102例患者作为研究对象,根据随机数表法将患者分为对照组和观察组,各51例。对照组接受常规急救护理,观察组在对照组基础上接受危机理论指导下的创伤急救护理。比较两组急救时间(有效抢救时间、确诊时间和急诊至手术时间)、神经功能[美国国立卫生研究院脑卒中量表(National Institutes of Health stroke scale,NIHSS)评分和格拉斯哥昏迷指数(Glasgow coma scale,GCS)]、生命体征(呼吸频率、心率、收缩压和舒张压)及并发症(缺血性痉挛、电解质紊乱和肢体功能障碍)发生情况。结果:观察组有效抢救时间、确诊时间、急诊至手术时间短于对照组,差异有统计学意义(P<0.05);观察组护理后NIHSS评分低于对照组,GCS评分高于对照组,差异有统计学意义(P<0.05);观察组护理后呼吸频率、心率、收缩压、舒张压低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:危机理论指导下的创伤急救护理可有效缩短颅脑外伤患者急救时间,改善神经功能和生命体征,降低并发症发生率。

NO代谢产物在中重型颅脑损伤患者中的变化探析及与ICP和GCS评分的关系研究

探讨NO代谢产物在中重型颅脑损伤患者中的变化及其与颅内压(ICP)和格拉斯哥昏迷(GCS)评分的关系。选择中南大学湘雅二医院桂林医院2018年1月—2022年12月收治的132例中重型颅脑损伤患者为研究对象,根据Fisher CT分级将患者分为1~2级组和3~4级组;根据预后将患者分为预后良好组和预后差组。测量患者ICP并检测各组NO代谢产物;采用GCS评分进行评估,比较各组的NO代谢产物、ICP及GSC评分,对中重型颅脑损伤患者预后进行多因素Logistic回归分析,对患者NO代谢产物与ICP和GCS评分进行相关性分析。研究发现,NO代谢产物在中重型颅脑损伤患者中呈高表达,与ICP和GCS评分存在相关性,三者均与患者预后存在紧密的联系。

血清胆碱酯酶联合GCS评分对重型闭合性颅脑损伤预后的评估价值

目的探讨入院时血清胆碱酯酶(cholinesterase,ChE)联合格拉斯哥昏迷评分(Glasgow coma scale,GCS)对重型闭合性颅脑损伤病人28d院内预后的预测价值。方法回顾性分析87例重型闭合性颅脑损伤病例资料,根据28d院内的生存情况分为存活组(n=64)与死亡组(n=23)。比较两组病人基线资料、GCS评分、ChE以及急性生理学和慢性健康评估Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分。采用多因素Logistic回归,分析重型闭合性颅脑损伤病人28d院内预后的影响因素。绘制受试者工作特征曲线(receiver operating characteristic,ROC),确定最佳临界值,分析ChE联合GCS评分评估重型闭合性颅脑损伤病人28d院内预后的价值。结果存活组ChE水平、GCS评分及血红蛋白均显著高于死亡组,而血糖、D-二聚体、凝血酶原时间及APACHEⅡ评分显著低于死亡组(均P<0.05)。多因素Logistic回归分析显示:ChE、GCS评分及APACHEⅡ评分是重型闭合性颅脑损伤病人28d院内出现死亡的影响因素(均P<0.05)。ROC曲线分析显示:ChE联合GCS评分曲线下面积大于两者单独预测时的曲线下面积。结论入院时ChE、GCS评分均对重型闭合性颅脑损伤病人预后具有预测价值,两者联合价值更高。

医疗失效模式与效应分析在颅脑创伤急诊手术护理风险管理中的应用

目的探讨医疗失效模式与效应分析(HFMEA)在颅脑创伤(TBI)急诊手术护理风险管理中的应用效果。方法以HFMEA模型为理论框架,对TBI急诊手术流程进行分析,并绘制流程图,分析潜在的风险因素。针对高危失效模式采取相应管理方案,其中2022年11月—2023年4月的80例患者接受HFMEA实施前的常规管理(对照组),2023年5—10月的80例患者接受HFMEA实施后的管理(观察组)。比较2组手术效率(术前等待时间、手术准备时间、麻醉诱导时间、术后交接时间)、手术室不良事件发生率(物品准备不全、手术铺巾污染、术中器械不足或不良、护理记录单书写错误、交接信息传递错误或缺项)、围术期并发症发生率(术中低体温、压力性损伤、术中生命体征异常波动、切口感染、肺部感染)以及手术医生对当台护士(巡回护士、器械护士)的满意度。结果观察组术前等待时间、手术准备时间、麻醉诱导时间、术后交接时间均短于对照组,差异有统计学意义(P<0.01)。观察组手术室不良事件发生率为16.25%,低于对照组的46.25%,差异有统计学意义(P<0.01)。观察组并发症发生率为8.75%,低于对照组的26.25%,差异有统计学意义(P<0.01)。观察组手术医生对当台护士满意度高于对照组手术医生,差异有统计学意义(P<0.05)。结论将HFMEA模型应用于TBI急诊手术患者手术护理管理中可有效提高手术效率,降低护理不良事件及并发症发生率,提高手术医生对手术室护士的满意度。

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

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。