Application effect for a care bundle in optimizing nursing of patients with severe craniocerebral injury

BACKGROUND Severe craniocerebral injury(STBI)is a critical physical trauma caused by a sudden external force acting on the head.The condition is complex and changeable,and disability and mortality rates are high.Although the life of STBI patients can be saved through treatment,the sequelae of consciousness,speech,cognitive impairment,stiffness,spasm,pain and abnormal behavior in the early rehabilitation stage can be a heavy burden to a family.In the past,routine nursing was often used to treat/manage STBI;however,problems,such as improper cooperation and untimely communication,reduced therapeutic effectiveness.AIM To investigate the effect of a proposed care bundle to optimize the first aid process and assess its effectiveness on the early rehabilitation nursing of patients with STBI.METHODS From January 2019 to December 2020,126 STBI patients were admitted to the emergency department of Chongqing Emergency Medical Center.These patients were retrospectively selected as the research participants in the current study.The study participants were then divided into a control group(61 cases)and a study group(65 cases).The control group was treated with routine nursing.The study group adopted the proposed care bundle.The National Institutes of Health Stroke Scale/Score and Glasgow Coma Scale(GCS)were used to evaluate neurological function before and after emergency treatment.After 3 mo of rehabilitation,experimental outcomes were assessed.These included the GCS,Barthel Index,complication rate,muscle strength grade and satisfaction.RESULTS There was no significant difference in gender,age,cause of injury and GCS between the two groups.After emergency,the National Institutes of Health Stroke Scale/Score of the study group(10.23±3.26)was lower than that of the control group(14.79±3.14).The GCS score of the study group(12.48±2.38)was higher than that of the control group(9.32±2.01).The arrival time of consultation in the study group was 20.56±19.12,and the retention time in the emergency room was 45.12±10.21,which were significantly shorter than those in the control group.After 3 mo of rehabilitation management,the GCS and Barthel Index of the study group were 14.56±3.75 and 58.14±12.14,respectively,which were significantly higher than those of the control group.The incidence of complications in the study group(15.38%)was significantly lower than that in the control group(32.79%).The proportion of muscle strength≥grade III in the study group(89.23%)was significantly higher than that in the control group(50.82%).The satisfaction of patients in the study group was significantly higher than that in the control group.CONCLUSION Care bundles are used to optimize the nursing process.During first-aid,care bundles can effectively improve the rescue effect and improve neurological function of STBI patients as well as shorten the treatment time.In early rehabilitation,they can effectively improve the consciousness of STBI patients,improve the activities of daily living,reduce the risk of complications,accelerate the recovery of muscle strength and improve their satisfaction.

院前院内一体化急救护理模式在多发伤患者抢救中的效果评价

目的 探究院前院内一体化急救护理模式在急诊科抢救多发伤患者的临床效果。方法 选取2018年6月—2020年6月医院多发伤患者93例为研究对象,采用组间基本资料匹配的原则分为观察组(52例)和对照组(41例)。观察组实施院前院内一体化急救护理模式,对照组采用常规急救护理模式,比较两组患者入院时及入ICU时血乳酸值和血红蛋白值、院前急救反应时间、就诊到达时间、评估时间、急诊抢救室救治时间、核血备血时间、到达手术室或重症监护室时间、患者或家属对护理工作的满意度。结果 观察组院前急救反应时间、就诊到达时间、评估时间、急诊抢救室救治时间、核血备血时间、到达手术室或重症监护室时间均短于对照组,组间比较差异均有统计学意义(P<0.05);入ICU时观察组乳酸值低于对照组,血红蛋白值高于对照组,组间比较差异有统计学意义(P<0.05);观察组患者或家属对护理工作的满意程度高于对照组,组间比较差异具有统计学意义(P<0.05)。结论 院前院内一体化急救护理模式提高了多发伤患者的救治效果和满意程度。

严重多发伤患者的早期救治和护理

目的患者的早期救治和护理方法。方法回顾性分析急诊室收治的70例严重多发伤患者的临床资料,全部患者均接受早期救治护理,包括疏通呼吸道、吸氧、控制出血、抗感染、保暖、抗休克、病情监测、预防并发症等。结果本组患者中,4例患者死亡,66例患者病情得到有效控制和救治,抢救成功率为94.29%;抢救成功患者中,3~15个月内死亡4例、痊愈50例、残疾12例。结论对严重多发伤患者实施有效的早期救治护理,可显著提高抢救成功率,进一步争取更多的治疗时间。

早期预警系统对急诊颅脑损伤患者救治成功率的影响

目的:探究早期预警系统对急诊颅脑损伤患者救治成功率的影响。方法:从医院收治的急诊颅脑损伤患者中抽取72例,随机分为对照组和观察组,两组患者均由急诊科医生采用哥拉斯昏迷评分系统进行病情评估,观察组患者在此基础上加用早期预警系统评估患者的潜在风险。对两组救治情况进行比较。结果:观察组患者的抢救成功率为97.22%,对照组为77.78%,差异具有统计学意义(P<0.05);与对照组相比,观察组患者就诊时间短、并发症发生率低、满意度高,差异具有统计学意义(P<0.05)。结论:早期预警系统有助于提高急诊颅脑损伤患者的救治成功率,改善预后效果,减少并发症的发生风险,对于急诊颅脑损伤患者具有极高的应用价值。

基于深度教学理念在眼战伤早期急救护理教学中的应用研究

目的探讨深度教学理念引导下的眼战伤早期急救护理教学应用效果。方法64名参加眼战伤早期急救护理培训的眼科护士被分为两组,对照组26人,观察组38人。对照组理论部分采用清单式自主学习,操作技能采用传统示教法;观察组基于深度教学的理念,从促进理解、启发反思、沉浸式体验3个维度进行教学设计并实施理论和实践教学。对比分析两组护士一般资料和实施前、后理论成绩,操作成绩及护士核心能力得分情况。采用SPSS 22.0进行t检验和卡方检验。结果两组护士在年龄、眼科工作年限、学历、职称等一般资料上差异无统计学意义。实施前两组护士理论成绩、操作成绩和护士核心能力得分比较差异均无统计学意义;实施后观察组护士理论成绩[(90.13±5.87)vs.(81.73±4.68),P<0.001],两项操作成绩[(95.63±2.81)vs.(87.31±4.51),P<0.001];[(96.24±2.74)vs.(89.08±4.50),P<0.001]均优于对照组;观察组护士核心能力量表的评判性思维得分[(34.00±1.93)vs.(30.58±3.01),P<0.001]和临床护理能力得分[(32.13±1.65)vs.(28.35±2.28),P<0.001]优于对照组。结论基于深度教学理念的教学模式有助于提升眼科护士关于眼战伤早期急救的相关知识、急救技能、临床反思及护理能力,利于提高军队临床护士的思想觉悟和练兵备战意识。

应当以眼科急症来处理外伤性视神经病变

近年来外伤性视神经病变（TON）有增多的趋势。TON视功能损伤严重，预后较差。TON的早期诊断和早期治疗能获得较高的视力改善率。TON治疗成功的关键是抓住时机，以眼科急症来尽早处理TON病例，进行快速准确的临床诊断；尽快完成必要的辅助检查，包括计算机断层扫描（CT）和视觉电生理检查，以便判断是否有手术指征；尽早给予合理治疗。

改良早期预警评分系统在急诊多发伤患者救治中的应用效果

目的:探讨改良早期预警评分系统在急诊多发伤患者救治中的应用效果。方法:采用便利抽样法,选择2018年1月—2019年12月长治医学院附属和平医院急诊科收治的126例多发伤患者为研究对象,按照时间顺序分为对照组和干预组,各63例。对照组给予传统的多发伤常规急救和监护方案,干预组在对照组的基础上应用改良早期预警评分系统。比较两组患者的急救成功率、病情恶化程度。结果:实施改良早期预警评分系统后,干预组患者的急救成功率高于对照组,病情恶化程度低于对照组,差异均有统计学意义(P<0.05)。结论:改良早期预警评分系统在急诊多发伤患者中的应用效果显著,能改善患者的救治成功率,降低病情恶化程度。

四肢血管损伤的急诊救治体会

目的:探讨四肢血管损伤的早期诊断、急诊处理与手术方法。方法:本组患者共37例,门(急)诊根据外伤史及体征确诊26例,其中7例经彩色多普勒检查确诊,4例经血管造影确诊。接诊后行气囊止血带止血12例,肱动脉损伤压迫腋窝及上臂止血点2例,股动脉损伤压迫腹股沟处止血点4例。以无菌纱布块加压包扎止血3例。对闭合性损伤暂不行止血带止血。所有患者经手术探查均证实为大血管损伤。3例一期行截肢术,其余行血管修复手术。股动脉损伤或伴股静脉损伤5例均行股动静脉修复,腘动脉损伤或伴静脉损伤10例均行腘动脉修复,修复腘静脉4例,胫前后动静脉损伤仅修复动脉。肱动静脉损伤均行肱动脉修复,桡动静脉损伤8例均行桡动脉修复。结果:门诊确诊率70%。气囊止血带使用率在开放性损伤病例中达39%。动静脉损伤(受伤至通血)时间:<6h15例,6～8h11例,9～12h4例,>12h3例。未通血4例。术后72h内共5例患者出现血管危象,行局部烤灯照射,热敷后2例消除,3例探查改行静脉移植修复后血供恢复。7例术后2～3周复查超声多普勒探测均提示血流正常。随访6～12个月,均未见肢体缺血表现,远端动脉搏动良好。6例遗留缺血性肌挛缩,4例截肢,截肢率11%。结论:四肢血管损伤的救治原则是早期快速诊断,早期正确止血,早期修复血管,早期治疗并发症。