Study on cumulative effects of biological craniocerebral trauma under repeated blast

Repeated blast impacts on personnel in explosive environments can exacerbate craniocerebral trauma.Most existing studies focus on the injury effects of a single blast,lacking in-depth analysis on the injury effects and cumulative effects of repeated blasts.Therefore,rats were used as the experimental samples to suffer from explosion blasts with different peak air overpressures(167 kPa~482 kPa)and varying number of repeated blasts.The cumulative effect of craniocerebral trauma was most pronounced for moderate repeated blast,showing approximately 95%increase of trauma severity with penta blast,and an approximately 85%increase of trauma severity with penta minor blast.The cumulative effect of craniocerebral trauma from severe,repeated blast has a smaller rate of change compared to the other two conditions.The severity of trauma from penta blast increased by approximately 69%compared to a single blast.Comprehensive physiological,pathological and biochemical analysis show that the degree of neurological trauma caused by repeated blasts is higher than that of single blasts,and the pathological trauma to brain tissue is more extensive and severe.The trauma degree remains unchanged after double blast,increases by one grade after triple or quadruple blast,and increases by two grades after penta blast.

Changes in platelet parameters and secondary brain injury in acute craniocerebral trauma

Changes in platelet parameters are important in secondary brain injury in acute craniocerebral trauma We selected 163 patients with craniocerebral trauma who were admitted within 24 hours with nonoperative therapy. Platelet parameters of 40 healthy subjects served as controls. Platelet number was decreased, while mean platelet volume and platelet distribution width values were increased, at 1 and 3 days after injury. Platelet number was lower and mean platelet volume and platelet distribution width were larger in patients with traumatic cerebral infarction and those in Glasgow Coma Scale score 〈 8 group. Platelet number was negatively correlated to volume of cerebral edema, but positively correlated to Glasgow Outcome Scale score. These data indicate that changes in platelet parameters may be utilized to indicate the state of central nervous system injury and patient prognosis .

Effects of Continuous Nursing Intervention on Postoperative Rehabilitation of Patients with Craniocerebral Trauma

Objective:To study and analyze the clinical effect of continuous nursing in the process of postoperative rehabilitation for patients with craniocerebral trauma.Methods:From August 2018 to July 2021,40 patients who came to our hospital for craniocerebral trauma treatment were randomly selected as clinical experimental research objects,and they were divided into continuous nursing group and routine nursing group.The rehabilitation of patients in the two groups before and after postoperative nursing was observed and counted.Results:Before nursing intervention,there was no significant difference in MMSE score and Fugl-Meyer score between the two groups,p>0.05.After nursing,the scores were scored again at 3 and 6 months after nursing.It was found that the two groups were improved,but the improvement range in the continuous nursing group was significantly higher than that in the routine nursing group,the difference was statistically significant(p<0.05).From the score of quality of life,the scores of physical pain,psychological function,mental health and social function in the continuous nursing group were better than those in the routine nursing group,the difference was statistically significant(p<0.05).Conclusion:Using continuous nursing measures for rehabilitation nursing of patients with craniocerebral trauma after discharge can significantly improve the quality of life of patients,restore the mental state and limb function of patients,and has significant clinical effect.

Craniocerebral trauma

210234 Regulating effects of the ERK1/2 signaling pathway on neurons apoptosis after diffuse brain injury in rats/Zhao Yaning(赵雅宁,Basic Med Dept,North Chin Coal Med Col,Tangshan 063000)…Chin J Neurosurg.-2010,26(1).

Craniocerebral trauma

209379 Calpain expression changes in response to hypothermia after traumatic brain injury/Wan Jieqing(万杰清,Dept Neurosurg,Renji Hosp,School Med,Shanghai Jiaotong Univ,Shanghai 200127)…∥Chin J Traum.-2009,25(6).-507～509Objective To determaine the effect of hypothermia on gene transcription and protein expression of calpain after traumatic brain injury(TBI).Methods Twenty-seven rats were randomly divided into three groups,ie,normal control group,normothermia TBI group and hypothermia TBI group.All rats with TBI suffered from a lateral fluid percussion injury(FPI)at the right parietal lobe.Hypothermia intervention[rectal temperature for(32±0.5)℃]was performed for four hours immediately after TBI in hypothermia TBI group.Fluorescence PCR and Western blot were utilized to semi-quantify gene transcription and protein expression of calpain and immunofluorescence used to observe protein distribution of Calpain.Results Compared with normothermia TBI group and normal control group,hypothermia TBI group showed increased calpain gene transcription at 12 and 24 hours respectively after FPI (P【0.05).However,the increase of calpain protein expression in hypothermia TBI group was inhibited more significantly by hypothermia at 6,12,24 and 72 hours after TBI,compared with normothermia TBI group(P【0.05).Conclusion Neuroprotection of hypothermia after TBI may somewhat be related to the decrease of calpain protein expression after its gene transcription.10 refs,1 fig,2 tabs.

Correlation of serum CNP and IGF-Ⅱ contents with brain injury and inflammatory response in patients with craniocerebral trauma

Objective:To study the correlation of serum C-type natriuretic peptide (CNP) and insulin-like growth factor-Ⅱ (IGF-Ⅱ) contents with brain injury and inflammatory response in patients with craniocerebral trauma.Methods: Patients with craniocerebral trauma who were treated in the First Affiliated Hospital of Xi'an Jiaotong University between March 2015 and July 2017 were included in the case group of the study, and the healthy volunteers who received physical examination during the same period were included in the control group. The contents of CNP, IGF-Ⅱ, nerve markers and pro-inflammatory cytokines in serum as well as the expression of inflammatory signaling molecules in peripheral blood were measured.Results: CNP and IGF-Ⅱ contents in serum of case group were significantly lower than those of control group whereas UCH-L1, GFAP, S100B, Tau, MIP-1α, IL-1β, IL-6, IL-8 and TNF-α contents in serum as well as JAK2, STAT3, MEK and ERK1/2 mRNA expression in peripheral blood were significantly higher than those of control group;CNP and IGF-Ⅱ contents in serum of case group were negatively correlated with UCH-L1, GFAP, S100B, Tau, MIP-1α, IL-1β, IL-6, IL-8 and TNF-α contents in serum as well as JAK2, STAT3, MEK and ERK1/2 mRNA expression in peripheral blood.Conclusion: The decrease of serum CNP and IGF-Ⅱ in patients with craniocerebral trauma is closely related to the aggravation of brain injury and the over-activation of inflammatory response.

Effects of propofol anesthesia on oxidative stress, neurological function and inflammatory cytokines in patients with craniocerebral trauma

Objective: To investigate the effect of propofol anesthesia on oxidative stress, neurological function and inflammatory cytokines in patients with craniocerebral trauma. Methods: A total of 102 patients with craniocerebral trauma who underwent surgery in our hospital from December 2014 to January 2017 were randomly divided into control group and observation group, each contained 51 cases. The control group was given 1%-2% of sevoflurane and 0.1-0.2 μg/kg/min of remifentanil and 20-30 μg/kg/h of vecuronium for anesthesia maintenance. The observation group was given propofol 4-6 mg/kg/h, remifentanil 0.1-0.2 μg/kg/min and vecuronium 20-30 μg/kg/h for anesthesia maintenance. The levels of oxidative stress, neurological function, and inflammatory factors were assessed in both groups. Results:Compared with before treatment, the levels of SOD and HO-1 in the two groups were significantly increased and the levels of MDA were significantly decreased, the difference was significant, and the levels of SOD and HO-1 in the observation group were significantly higher than control group, the level of MDA was significantly lower than that of the control group, the difference was significant. Compared with before treatment, the levels of NSE, GFAP and Tau level were significantly decreased in the two groups after treatment, and level in observation group was lower than control group, the difference was statistically significant. Compared with before treatment, the levels of IL-6, TNF-α and CRP in the two groups after treatment were significantly lower than those in the control group, the difference was statistically significant. Conclusion: Propofol anesthesia can significantly reduce the oxidative stress injury, inhibit the inflammatory reaction and protect the neurological function of patients. The effect is better than isoflurane anesthesia, and it is worthy of clinical application.

Relationship of Nogo-A gene expression in serum and cerebrospinal fluid with nerve injury and inflammatory factor levels in patients with craniocerebral trauma

Objective:To study the relationship of Nogo-A gene expression in serum and cerebrospinal fluid with nerve injury and inflammatory factor levels in patients with craniocerebral trauma. Methods:82 patients with craniocerebral trauma who were treated in our hospital between January 2015 and February 2017 were collected as observation group, and 58 normal subjects who received internal hemorrhoids surgery under lumbar anesthesia in our hospital during the same period were collected as control group. Fluorescence quantitative PCR method was used to detect Nogo-A gene expression in serum and cerebrospinal fluid of both groups, and enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of nerve injury indexes and inflammatory factors in two groups. Pearson test was used to assess the relationship of Nogo-A gene expression in serum and cerebrospinal fluid with disease severity in patients with craniocerebral trauma.Results: Nogo-A mRNA expression in the serum and cerebrospinal fluid of observation group were higher than those of the control group;serum IGF-Ⅱ level was lower than that of control group while NSE, MBP and S100B levels were higher than those of control group;serum HSP-70, PCT, IL-1β, IL-6 and CRP levels were higher than those of control group. Pearson test showed that Nogo-A gene expression in serum and cerebrospinal fluid of patients with craniocerebral trauma were directly correlated with the nerve injury degree and inflammatory factor levels.Conclusions: Nogo-A gene is highly expressed in patients with craniocerebral trauma, and its expression is directly correlated with the nerve injury and systemic inflammatory response.

Effect of propofol and isoflurane general anesthesia on nerve injury in patients with craniocerebral trauma after emergency surgery

Objective: To study the effect of propofol and isoflurane general anesthesia on nerve injury in patients with craniocerebral trauma after emergency surgery. Methods: Patients with craniocerebral trauma who accepted emergency surgery in Dangyang People's Hospital between May 2015 and February 2017 were selected and randomly divided into propofol group and isoflurane group who received propofol + fentanyl + vecuronium bromide as well as isoflurane + fentanyl + vecuronium bromide anesthesia respectively. Serum levels of nerve injury markers, excitatory amino acids, inhibitory amino acids and oxidative stress indicators were detected before operation, immediately after operation and 12 h after operation. Results:Immediately after operation and 12 h after operation, serum NSE, GFAP, NGB, Tau, GLU, ASP, 8-iso-PGF2 and MDA levels of both groups of patients were significantly lower than those before operation while GABA, ALA, HO-1, NQO-1 and SOD levels were significantly higher than those before operation, and serum NSE, GFAP, NGB, Tau, GLU, ASP, 8-iso-PGF2 and MDA levels of propofol group immediately after operation and 12 h after operation were significantly lower than those of isoflurane group while GABA, ALA, HO-1, NQO-1 and SOD levels were significantly higher than those of isoflurane group. Conclusion: Propofol for emergency surgery of patients with craniocerebral trauma is more effective than isoflurane in alleviating nerve injury degree, correcting the excitatory and inhibitory amino acid disorder, and inhibiting oxidative stress reaction.

RELATIONSHIP BETWEEN THE COURSE OF THE DISEASE AND P_300 OF PATIENTS WITH CLOSED CRANIOCEREBRAL TRAUMA

目的:研究闭合性颅脑外伤患者病程与P300之间的关系,并探讨作P300测定的最佳时间。方法:应用Medicid-03E脑诱发电位仪测定518例闭合性颅脑外伤患者的视觉刺激诱发的P300波之潜伏期和波幅。结果:病人组P300波潜伏期较正常对照组明显延长,波幅也明显降低。结论:P300波的变化可作为判断闭合性颅脑外伤患者脑认知功能变化的一项客观指标。

Cranial ultrasound in perioperative period of acute severe traumatic brain injury

Objective To observe the value of cranial ultrasound for perioperative patients with acute severe traumatic brain injury(sTBI).Methods Data of 55 sTBI patients who underwent craniotomy were retrospectively analyzed.The patients were divided into observation group(n=15)and control group(n=40)according to received perioperative cranial ultrasound or not.The general data and surgical data were compared between groups,and ultrasonic data of observation group were analyzed.Results The proportions of good prognosis 1 and 6 months after operation in observation group were both higher than those in control group,while the incidence of cerebral infarction in observation group was lower than that in control group(all P<0.05).No significant difference of general data nor other surgical data was found between groups(all P>0.05).Acute encephalocele occurred in 1 case in observation group during operation,and cranial ultrasound accurately showed the contralateral secondary epidural hematoma.Increased intracranial pressure in different degrees were found in all 15 cases(15/15,100%)in observation group after operation with transcranial color coded Doppler(TCCD)or transcranial Doppler(TCD),while cerebral vascular spasm was observed in 5 cases(5/15,33.33%),among them 4 cases(4/5,80.00%)were diagnosed cerebral infarction based on CT examination.Conclusion Cranial ultrasound could be used to evaluate changes of sTBI in perioperative period and guide adjusting treatment strategy in time,being valuable for reducing risk of postoperative cerebral infarction and improving prognosis.

Brain arousal dysfunction induced by severe craniocerebral trauma treated with acupuncture

Objective To observe the early rehabilitation effects of acupuncture on brain arousal in patients with severe craniocerebral injury. Methods One hundred and two patients with severe craniocerebral injury were randomly divided into an acupuncture group and an electrical stimulation （ES） group with 51 cases in each group. In addition to conventional treatment and nursing in neurosurgery, acupuncture at Shuigou （水沟 GV 26）, Neiguan （内关PC 6） and Sanyingjiao （三阴交 SP 6）, as the main aeupoints, were applied for the cases in acupuncture group, and functional electrical stimulation （FES） was applied at selected muscles in the affected upper limb for the cases in ES group. The awaken rate, time for arousal and clinical therapeutic effects were compared between the two groups after 30 days of treatments. Results The awaken rate was 82.4%（42/51） in acupuncture group, which was significantly higher than 56.9%（29/51） in ES group （P〈0.01）, and the arousal time was significantly shorter and therapeutic effects were better in acupuncture group than those in ES group （both P〈0.01）. Conclusion On the basis of conventional treatment, early application of acupuncture provides better effects on restoration of arousal function of the brain in patients with severe craniocerebral injury than functional electrical stimulation.

Clinical analysis of craniocerebral trauma complicated with thoracoabdominal injuries in 2165 cases

Objective: To explore the optimal treatment for craniocerebral trauma complicated with thoraco-abdominal injuries. Methods: A total of 2 165 cases of craniocerebral trauma complicated with thoraco-abdominal injuries admitted to our hospital between July 1993 and June 2003 were retrospectively studied. Among them, 382 cases sustained severe craniocerebral trauma (in which 167 were complicated with shock), 733 thoracic injuries, 645 abdominal injuries and 787 thoraco-abdominal injuries. On admittance, 294 cases had developed shock. With the prime goal of saving life, respiratory and circulatory systems and encephalothilipsis were especially treated and monitored. Priority in management was directed to severe or open injures rather than to moderate or closed injures. For cases with cerebral hernia due to intracranial hematoma and severe shock due to blood loss, cerebral hernia and shock were treated concurrently. Results: After treatment, 2024 ( 93.49%) cases survived and the other 141 ( 6.51%) died. Among patients who had severe craniocerebral injury with shock and those without, 78 ( 46.71%) and 53 ( 24.56%) died, respectively. For patients who had underwent craniocerebral and thoraco-abdominal operations concurrently and those who had not, the death rates were 58.49%- 65.96% and 28.57% respectively, indicating a significant difference (P< 0.05). Conclusions: Treatment for hematoma hernia, shock and disturbed respiration is the key in the management of multiple trauma of craniocerebral, thoracic or abdominal injuries, especially when two or three conditions occurred simultaneously. Unless it is necessary, operations at two different parts at the same time is not recommended. It is preferred to start two concurrent operations at different time.

Clinical Observation of Hemodynamic and Cerebral Protective Effects of Different Doses of Dexmedetomidine in Patients with Traumatic Brain Injury

Background: Patients with craniocerebral trauma may suffer ischemic brain injury and neurological dysfunction due to immune inflammation and neuroendocrine reactions. Dexmedetomidine (Dex) is one of the commonly used anesthetic drugs in clinic. Studies have shown Dex has the function of protecting brain nerves and inhibiting inflammation. However, there are few studies on the effects of different doses of dexmedetomidine on patients undergoing surgery. The purpose of this study is to observe the effects of different doses of Dex on hemodynamics and brain protection in patients undergoing brain trauma surgery. Materials and Methods: Eighty patients with craniocerebral trauma surgery were randomly divided into study group (group A, n = 40) and control group (group B, n = 40) by random number table method. Dex pump volume was 0.5 μg/kg/h in group A and 1.0 μg/kg/h in group B. Heart rate (HR) and mean arterial pressure (MAP) were recorded before anesthesia induction (T0), immediately after endotracheal intubation (T1) and at the end of operation (T2). The serum levels of central nervous system specific protein (S-100β) and neuron specific enolase (NSE) were measured and compared between the two groups at T0 and T2. Results: HR and MAP in group A were significantly higher than those in group B at T2, and the difference was statistically significant (P P β and NSE in both groups at T2 were lower than those at T0, and the concentrations of S-100β and NSE in group A were significantly lower than those in group B at T2 (P Conclusions: 0.5 μg/kg dose of Dex is stable in hemodynamics and has a better protective effect on brain function in patients with traumatic brain injury.

Effectiveness of an early operating room start time in managing pediatric trauma

BACKGROUND The timing of operative treatment for pediatric supracondylar humerus fractures(SCHF)and femoral shaft fractures(FSF)remains controversial.Many fractures previously considered to be surgical emergencies,such as SCHF and open fractures,are now commonly being treated the following day.When presented with an urgent fracture overnight needing operative treatment,the on-call surgeon must choose whether to mobilize resources for a late-night case or to add the case to an elective schedule of the following day.AIM To describe the effect of a program allowing an early operating room(OR)start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight.METHODS Starting in October 2017,patients were eligible for the early slot in the OR at the discretion of the surgeon if they were admitted after 21:00 the previous night and before 05:00.We compared demographics and timing of treatment of SCHF and FSF treated one year before and after implementation as well as the survey responses from the surgical team.RESULTS Of the 44 SCHF meeting inclusion criteria,16 received treatment before imple mentation while 28 were treated after.After implementation,the mean wait time for surgery decreased by 4.8 h or 35.4%(13.4 h vs 8.7 h;P=0.001).There were no significant differences in the operative duration,time in the post anesthesia care unit,and wait time for discharge.Survey results demonstrated decreased popularity of the program among nurses and anesthesiologists relative to surgeons.Whereas 57%of the surgeons believed that the program was effective,only 9%of anesthesiologists and 16%of nurses agreed.The program was ultimately discontinued given the dissatisfaction.CONCLUSION Our findings demonstrate significantly reduced wait times for surgery for uncomplicated SCHF presenting overnight while discussing the importance of shared decision-making with the stakeholders.Although the program produced promising results,it also created new conflicts within the OR staff that led to its discontinuation at our institution.Future implementations of such programs should involve stakeholders early in the planning process to better address the needs of the OR staff.

鼻内镜下Draf Ⅱ-Ⅲ型额窦开放手术在颅脑外伤术后反复额窦感染并窦道形成中的应用

目的探讨鼻内镜下DrafⅡ-Ⅲ型额窦开放手术在颅脑外伤术后反复额窦感染并窦道形成中的应用。方法8例颅脑外伤术后反复额窦感染的患者,主要表现为头痛、额部反复感染、流脓、窦道形成,发病时间平均43.25个月。患者在鼻内镜下行DrafⅡ-Ⅲ型额窦开放术,其中DrafⅡa型2例,DrafⅡb型5例,DrafⅢ型1例,术中扩大开放额窦口,见额窦内有骨蜡堵塞额窦口,取出骨蜡,额窦引流通畅。全部患者未做面部切口。结果术后8例患者额部感染明显减轻,治愈出院,术中、术后未发生脑脊液鼻漏或颅内感染。出院后,于1、3、6、12个月进行门诊随访复查,见额窦口保持通畅,额部未再发生感染,瘘口逐渐愈合。结论鼻内镜下采用DrafⅡ-Ⅲ型额窦开放术式,是处理颅脑外伤术后额窦反复感染并窦道形成的有效手术方式。

颅脑创伤患者早期并发心脏收缩功能不全存在较多影响因素

目的:研究颅脑创伤患者早期并发心脏收缩功能不全相关因素。方法:收集123例单纯性颅脑创伤(iTBI)患者的临床资料,均行超声心动图检测,根据检测结果将患者分为心脏收缩功能正常组(100例)及心脏收缩功能不全组(23例)。比较2组患者的临床资料,采用Logistic回归分析影响患者并发心脏收缩功能不全的相关因素,绘制受试者工作特征(ROC)曲线评估各指标对iTBI患者并发心功能不全的预测价值。结果:与心脏收缩功能正常组比较,心脏收缩功能不全组入院时格拉斯哥昏迷(GCS)评分更低;而入院时心率、收缩压及血清hs-cTnT水平更高(P均<0.05)。多因素Logistic回归分析显示,入院时心率、GCS评分、血清hs-cTnT是iTBI患者并发心脏收缩功能不全的影响因素(P均<0.05)。经ROC曲线分析入院时血清hs-cTnT水平预测iTBI患者并发心脏收缩功能不全的曲线下面积、灵敏度、特异性及约登指数高于入院时心率和GCS评分预测(P均<0.05)。结论:iTBI患者早期并发心脏收缩功能不全相关因素包括入院时心率、GCS评分、血清hs-cTnT水平,其中入院时血清hs-cTnT水平预测iTBI患者早期并发心脏收缩功能不全的效能较高。

颅脑外伤患者术后中枢神经系统感染的危险因素及病原菌特点分析

目的明确颅脑外伤患者术后发生颅内感染的危险因素、病原菌的分布特点及耐药性分析。方法回顾性分析2016年1月至2022年12月在首都医科大学附属北京天坛医院神经外科行手术治疗的颅脑外伤患者的临床资料,依据术后是否发生中枢神经系统感染分为感染组(335例)和非感染组(770例)。分析导致术后中枢神经系统感染发生的危险因素;通过分析感染组患者脑脊液的细菌培养及鉴定结果,了解病原菌的分布特点及耐药性。结果手术持续时间≥3 h、术中出血量≥400 mL、二次手术、有切口脑脊液漏、引流管留置时间≥3 d、重症监护室(ICU)滞留时间≥7 d、合并糖尿病、血清降钙素原升高、快速C反应蛋白升高是发生术后中枢神经系统感染的危险因素(P<0.05)。脑脊液送检标本共培养出细菌107株,其中革兰阳性菌46株,革兰阴性菌61株。常见革兰阳性菌对万古霉素、利奈唑胺、替加环素均敏感,革兰阴性菌大多为多重耐药菌。结论手术持续时间长、术中出血量大、再次手术、有切口脑脊液漏、引流管留置时间长、ICU滞留时间长、合并糖尿病是颅脑外伤患者术后中枢神经系统感染的危险因素,需注意对相关危险因素进行防控,尽可能减少术后中枢神经系统感染事件的发生。此外革兰阴性菌感染比率逐渐上升,应根据细菌培养结果及时调整抗菌药物使用,制定更有针对性的抗感染治疗方案。

开放性手外伤术后感染危险因素及预测分析

目的探讨开放性手外伤术后感染危险因素并进一步分析相关因素风险预测临床效能。方法回顾性纳入2020年6月至2023年6月于本院行手术治疗开放性手外伤患者共106例,根据术后有无感染出现分组,比较感染组和无感染组临床特征资料,采用Logistics回归模型多因素分析评估开放性手外伤术后感染独立危险因素,描绘ROC曲线分析上述独立危险因素用于开放性手外伤术后感染风险预测临床效能。结果本研究纳入于本院行手术治疗开放性手外伤患者106例中出现术后感染11例,发生率为10.38%。单因素分析结果显示,年龄、吸烟、合并糖尿病、有无手术创面污染、受伤至手术时间、ASA评分、手术时间及是否行负压引流均可能与开放性手外伤术后感染发生有关(P<0.05)。Logistic回归模型多因素分析结果显示,年龄≥60岁、合并糖尿病、受伤至手术时间≥6 h、手术创面污染及未行负压引流均是开放性手外伤术后感染发生独立危险因素(P<0.05)。ROC曲线分析结果显示,年龄、是否合并糖尿病、受伤至手术时间、有无手术创面污染及有无行负压引流均可用于开放性手外伤术后感染发生风险预测,且上述指标联合预测效能显著优于单一指标(P<0.05)。结论开放性手外伤术后感染发生与年龄、是否合并糖尿病、受伤至手术时间、有无手术创面污染及有无行负压引流关系密切;而上述指标联合在预测开放性手外伤术后感染发生风险方面显示出更优临床效能。

ICU护士对重型颅脑损伤患者目标体温管理知信行问卷的编制及信效度检验

目的编制ICU护士对重型颅脑损伤(severe traumatic brain injury,STBI)患者目标体温管理(target tem-perature management,TTM)知信行(knowledge,attitude and practice,KAP)问卷并检验其信效度。方法以知信行理论为框架,通过文献分析及小组讨论初步构建问卷条目池,再通过德尔菲法和预调查确定问卷初稿。采用便利抽样法,于2022年10月选取甘肃省4所医院240名ICU护士进行调查,进行问卷信效度检验。结果ICU护士对重型颅脑损伤患者目标体温管理知信行问卷共包含3个维度,32个条目。问卷整体内容效度指数为0.955,条目内容效度指数为0.800~1.000。探索性因子分析提取4个公因子,累积方差贡献率为58.889%,问卷整体Cronbach’sα系数为0.862,重测信度为0.890;知识、态度及行为维度的Cronbach’sα系数分别为0.713、0.925及0.924,重测信度分别为0.801、0.943及0.950。结论ICU护士对重型颅脑损伤患者目标体温管理知信行问卷具有良好的信效度,可作为ICU护士对重型颅脑损伤患者目标体温管理知信行水平的测评工具。