刘晓燕;刘建风;张侠;

• 1:郑州大学第二附属医院

摘要(Abstract)：

目的探讨多感官促醒护理模式对高血压脑出血术后昏迷患者觉醒意识及神经功能的影响。方法收集郑州大学第二附属医院2016-01—2018-12治疗的高血压脑出血术后昏迷患者130例,随机分为常规护理组和多感官促醒护理组。比较2组患者护理干预前后昏迷情况、生理状态、脑功能恢复情况、平均苏醒时间、并发症发生率。结果干预前及干预1周,常规护理组和多感官促醒护理组GCS评分、DFS评分、脑功能评分比较差异无统计学意义(P>0.05);干预2周和干预4周,常规护理组和多感官促醒护理组GCS评分和脑功能评分均较干预前明显升高,DFS评分明显降低,差异有统计学意义(P<0.05)。干预2周和干预4周,多感官促醒护理组GCS评分和脑功能评分均较常规护理组明显升高(分别为2周:9.42±1.43 vs 7.82±1.34,5.99±1.23 vs 3.59±0.63;4周:10.96±2.48 vs 8.95±1.46,9.72±1.48 vs 5.96±1.03),DFS评分较常规护理组明显降低(分别为2周:11.04±1.97 vs 14.98±2.39;4周:6.25±1.32 vs 9.82±2.03),差异均有统计学意义(P<0.05);多感官促醒护理组平均苏醒时间为(19.89±1.96)d,常规护理组平均苏醒时间为(29.08±2.87)d,多感官促醒护理组平均苏醒时间明显短于常规护理组,差异有统计学意义(t=-21.117,P<0.05)。多感官促醒护理组并发症发生率明显低于常规护理组(4.4%vs17.7%),差异有统计学意义(χ²=5.997,P<0.05)。结论多感官促醒护理干预通过听觉、嗅觉、视觉、触觉等多重感官刺激,促进高血压脑出血术后昏迷患者脑神经功能恢复,尽快苏醒,降低并发症发生率,且该方法简单易行。

关键词(KeyWords)： 高血压脑出血;多感官促醒护理;神经功能;觉醒意识

Abstract:

Keywords:

基金项目(Foundation): 2018年河南省科技厅科技攻关项目(编号：182102311215)

作者(Authors): 刘晓燕;刘建风;张侠;

参考文献(References)：

• [1]GAVITO-HIGUERA J,KHATRI R,QURESHI I A,et al Aggressive blood pressure treatment of hypertensive intracerebral hemorrhage may lead to global cerebral hypoperfusion:Case report and imaging perspective[J].World JRadiol,2017,9(12):448-453.DOI:10.4329/wjr.v9.i12.448.
• [2]CHUI J,NIAZI B,VENKATRAGHAVAN L.Postoperative hemodynamic management in patients undergoing resection of cerebral arteriovenous malformations:A retrospective study[J].J Clin Neurosci,2020,72:151-157.DOI:10.1016/j.jocn.2019.12.039.
• [3]ZHANG X Q.The effect of wake-promoting nursing on coma time and prognosis of severe craniocerebral operation patients[J].Int J Nursing,2014,33(1):6-8.DOI:10.3760/cma.j.issn.1673-4351.2014.01.003.
• [4]WANG G,ZHENG J L.Appl ication of prospective nursing intervention in early nursing of hypertensive cerebral hemorrhage patients with hemiplegia[J].Chin Nursing Res,2017,31(2):223-225.DOI:10.3969/j.issn.1009-6493.2017.02.028.
• [5]PROESCHOLDT M A,SCHEBESCH K M,BRAWANSKIA,et al.Continuous intraarterial nimodipine infusion in patients with severe refractory cerebral vasospasm after aneurysmal subaraehnoid hemorrhage:a feasibility study and outcome results[J].Acta neurochirurgica,2015,157(12):2041-2050.
• [6]COLVIN Z,FENG M,PAN A,et al.Duration of labor induction in nulliparous women with hypertensive disorders of pregnancy and maternal and neonatal outcomes[J].JMatern Fetal Neonatal Med,2020 Nov 12:1-8.DOI:10.1080/14767058.2020.1844658.
• [7]DING L P,LI X Y,GONG L F,et al.Risk factors and prevention of nosocomial infections in elderly patients with hypertensive intracerebral hemorrhage[J].Chin JNosocomiol,2017,27(19):4443-4445.DOI:10.11816/cn.ni.2017-170650.
• [8]DING W L,XIANG Y S,LIAO J C,et al.Early tracheostomy is associated with better prognosis in patients with brainstem hemorrhage[J].J Integr Neurosci,2020,19(3):437-442.DOI:10.31083/j.jin.2020.03.25.
• [9]MURTHY S B,CHO S M,GUPTA A,et al.A Pooled Analysis of Diffusion-Weighted Imaging Lesions in Patients With Acute Intracerebral Hemorrhage[J].JAMANeurol,2020,77(11):1-9.DOI:10.1001/jamaneurol.2020.2349.
• [10]DE OLIVEIRA MANOEL A L.Surgery for spontaneous intracerebral hemorrhage[J].Crit Care,2020,24(1):45.DOI:10.1186/s13054-020-2749-2.
• [11]WANG Q,WANG T,LIU Y W,et al.The Monitoring and Application of Transcranial Doppler Ultrasound in Patients with Severe Neurovascular Diseases[J].Sichuan Da Xue Xue Bao Yi Xue Ban,2020,51(4):578-581.DOI:10.12182/20200760606.
• [12]ZHAO X H,ZHANG S Z,FENG J,et al.Efficacy of neuroendoscopic surgery versus craniotomy for supratentorial hypertensive intracerebral hemorrhage:A metaanalysis of randomized controlled trials[J].Brain Behav,2019,9(12):e01471.DOI:10.1002/brb3.1471.
• [13]薛春.综合性护理干预对高血压脑出血患者促醒效果和生存质量的影响[J].中国实用神经疾病杂志,2016,19(8):133-134.
• [14]HOSMANN A,WANG W T,DODIER P,et al.The Impact of Intra-Arterial Papaverine-Hydrochloride on Cerebral Metabolism and Oxygenation for Treatment of Delayed-Onset Post-Subarachnoid Hemorrhage Vasospasm[J].Neurosurgery,2020,87(4):712-719.DOI:10.1093/neuros/nyz500.
• [15]LIN J,PIRAN P,LERARIO M P,et al.Differences in Admission Blood Pressure Among Causes of Intracerebral Hemorrhage[J].Stroke,2020,51(2):644-647.DOI:10.1161/STROKEAHA.119.028009.
• [16]LI C,POWDER P.The effect of multi-sensory awake nursing mode on the consciousness and prognosis of the patients with cerebral coma[J].J Nurses,2019,34(7):630-634.
• [17]SRIPONTAN S.Good Outcome in a Patient with Massive Pontine Hemorrhage[J].Asian J Neurosurg,2019,14(3):992-995.DOI:10.4103/ajns.AJNS_295_18.
• [18]XIAO T,WAN J,QU H,et al.Endoscopic Surgery versus Minimal Puncture Drainage Surgery for Treatment of Supratentorial Intracerebral Hemorrhage[J].Turk Neurosurg,2020,30(4):565-572.DOI:10.5137/1019-5149.JTN.27977-19.2.
• [19]SUN S,LI Y,ZHANG H,et al.Neuroendoscopic Surgery versus Craniotomy for Supratentorial Hypertensive Intracerebral Hemorrhage:A Systematic Review and Meta-Analysis[J].World Neurosurg,2020,134:477-488.DOI:10.1016/j.wneu.2019.10.115.
• [20]CUCCI M D,BENKEN S T.Blood pressure variability in the management of hypertensive emergency:A narrative review[J].J Clin Hypertens(Greenwich),2019,21(11):1684-1692.DOI:10.1111/jch.13694.
• [21]SUWATCHARANGKOON S,DE MARCHIS G M,WITSCH J,et al.Medical Treatment Failure for Symptomatic Vasospasm After Subarachnoid Hemorrhage Threatens Long-Term Outcome[J].Stroke,2019,50(7):1696-1702.DOI:10.1161/STROKEAHA.118.022536.
• [22]ZIAI W C,THOMPSON C B,MAYO S,et al.Intracranial Hypertension and Cerebral Perfusion Pressure Insults in Adult Hypertensive Intraventricular Hemorrhage:Occurrence and Associations With Outcome[J].Crit Care Med,2019,47(8):1125-1134.DOI:10.1097/CCM.0000000000003848.
• [23]LIU X,ZHANG P,GUO C,et al.Effect of rehabilitation therapy and nursing intervention on postoperative recovery of patients with hypertensive intracerebral hemorrhage[J].Exp Ther Med,2019,17(6):4598-4604.DOI:10.3892/etm.2019.7486.
• [24]MOULLAALI T J,WANG X,MARTIN R H,et al.Statistical analysis plan for pooled individual patient data from two landmark randomized trials(INTERACT2 and ATACH-II)of intensive blood pressure lowering treatment in acute intracerebral hemorrhage[J].Int J Stroke,2019,14(3):321-328.DOI:10.1177/1747493018813695.
• [25]SOTIRIADIS A,PETOUSIS S,THILAGANATHAN B,et al.Maternal and perinatal outcomes after elective induction of labor at 39 weeks in uncomplicated singleton pregnancy:a meta-analysis[J].Ultrasound Obstet Gynecol,2019,53(1):26-35.DOI:10.1002/uog.20140.
• [26]YAMAGUCHI Y,KOGA M,SATO S,et al.Early Achievement of Blood Pressure Lowering and Hematoma Growth in Acute Intracerebral Hemorrhage:Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement-Intracerebral Hemorrhage Study[J].Cerebrovasc Dis,2018,46(3/4):118-124.DOI:10.1159/000492728.
• [27]ZHANG J,LU S,WANG S,et al.Comparison and analysis of the efficacy and safety of minimally invasive surgery and craniotomy in the treatment of hypertensive intracerebral hemorrhage[J].Pak J Med Sci,2018,34(3):578-582.DOI:10.12669/pjms.343.14625.
• [28]KATSURAGI S,TANAKA H,HASEGAWA J,et al.Analysis of preventability of hypertensive disorder in pregnancy-related maternal death using the nationwide registration system of maternal deaths in Japan[J].J Matern Fetal Neonatal Med,2019,32(20):3420-3426.DOI:10.1080/14767058.2018.1465549.
• [29]RIVERA-LARA L,MURTHY SB,NEKOOVAGHT-TAKS,et al.Influence of Bleeding Pattern on Ischemic Lesions After Spontaneous Hypertensive Intracerebral Hemorrhage with Intraventricular Hemorrhage[J].Neurocrit Care,2018,29(2):180-188.DOI:10.1007/s12028-018-0516-x.
• [30]ZHANG Y,SHI F,WANG C,et al.Analysis of clinical effect of humanized nursing mode on patients with hypertensive cerebral hemorrhage[J].Panminerva Med,2020 Sep 2.DOI:10.23736/S0031-0808.20.04072-0.
• [31]BRODERICK M,ROSIGNOLI L,LUNAGARIYA A,et al.Hypertension is a Leading Cause of Nontraumatic Intracerebral Hemorrhage in Young Adults[J].J Stroke Cerebrovasc Dis,2020,29(5):104719.DOI:10.1016/j.jstrokecerebrovasdis.2020.104719.
• [32]FORMAN R,SLOTA K,AHMAD F,et al.Intracerebral Hemorrhage Outcomes in the Very Elderly[J].J Stroke Cerebrovasc Dis,2020,29(5):104695.DOI:10.1016/j.jstrokecerebrovasdis.2020.104695.
• [33]SONG G F,LI X,FENG Y,et al.Acupuncture combined Bobath approach for limbs paralysis after hypertensive intracerebral hemorrhage:A protocol for a systematic review[J].Medicine (Baltimore),2019,98(10):e14750.DOI:10.1097/MD.0000000000014750.
• [34]HALLER J T,WISS A L,MAY C C,et al.Acute Management of Hypertension Following Intracerebral Hemorrhage[J].Crit Care Nurs Q,2019,42(2):129-147.DOI:10.1097/CNQ.0000000000000247.
• [35]ROEDERER A,HOLMES J H,SMITH M J,et al.Prediction of significant vasospasm in aneurysmal subarachnoid hemorrhage using automated data[J].Neurocrit Care,2014,21(3):444-450.DOI:10.1007/s12028-014-9976-9.
• [36]BLISSITT P A.Hemodynamic monitoring in the care of the critically ill neuroscience patient[J].AACN Adv Crit Care,2006,17(3):327-340.DOI:10.4037/15597768-2006-3010.