循证护理对高分级动脉瘤性蛛网膜下腔出血行早期手术的预后及并发症影响

循证护理对高分级动脉瘤性蛛网膜下腔出血行早期手术的预后及并发症影响

唐婷,谢飞,张碧先△

四川大学华西医院.资阳市第一人民医院,四川大学华西医院.资阳市第一人民医院,四川大学华西医院.资阳市第一人民医院

收稿日期:2017-08-01 修回日期:2017-09-07 出版日期:2017-09-25
基金资助:
四川省卫生厅科研课题支持（项目编号：130505；项目名称：Hunt-Hess分级Ⅲ-Ⅳ级动脉瘤性蛛网膜下腔出血的早期手术的临床研究）

Effect of Evidence-based Nursing on Prognosis and Complications of Early Stage Operation for High Grade Aneurysmal Subarachnoid Hemorrhage

TANG Ting,XIE Fei and ZHANG Bixian

West China Hospital of Sichuan University.The first people's Hospital of Ziyang,West China Hospital of Sichuan University.The first people's Hospital of Ziyang,West China Hospital of Sichuan University.The first people's Hospital of Ziyang

Received:2017-08-01 Revised:2017-09-07 Online:2017-09-25

摘要/Abstract

摘要： 目的：探讨循证护理干预对Hunt-Hess高分级动脉瘤性蛛网膜下腔出血（aSAH）早期手术的预后及并发症影响。方法：选择我院2012年1月至2016年12月收治的高分级动脉瘤性蛛网膜下腔出血患者70例为研究对象，随机分为对照组35例、观察组35例，均在早期行手术治疗，对照组行常规护理，观察组行循证护理干预，比较两组患者预后及并发症发生情况，并进行统计学分析。结果：观察组患者治疗效果显著好于对照组，P＜0.05；观察组患者GOS评分、VAS评分、大脑中动脉流速（Vm）显著低于对照组，颅内压恢复正常时间、头痛缓解时间也短于对照组，P＜0.05；观察组患者脑血管痉挛、脑积水发病率明显低于对照组，P＜0.05。结论：Hunt-Hess高分级动脉瘤性蛛网膜下腔出血患者早期手术后，采用循证护理模式可以提高患者治疗效果，预防并发症发生。

Abstract: Objective：To investigate the effects of evidence-based nursing on prognosis and complications of early stage operation for high grade aneurysmal subarachnoid hemorrhage（aSAH）.Methods：We selected patients with high grade aneurysmal subarachnoid hemorrhage treated in our hospital as subject investigated，all patients were treated at an early stage. The patients were divided into control group and observation group，the control group received routine nursing care，and the observation group received evidence-based nursing intervention.We compared the prognosis and complications in the two groups.Results：The curative effect of the observation group was better than that of the control group(P＜0.05).The GOS score， VAS score and middle cerebral artery flow velocity (Vm) of the observation group were significantly lower than those of the control group，the normal time of intracranial pressure recovery and the time of headache relief were shorter than those of the control group(P＜0.05).The incidence of cerebral vasospasm and hydrocephalus in the observation group was significantly lower than that in the control group(P＜0.05).Conclusion：After the early operation of the patients with high grade aneurysmal subarachnoid hemorrhage，the evidence-based nursing mode can improve the curative effect and prevent the complications.

唐婷,谢飞,张碧先△. 循证护理对高分级动脉瘤性蛛网膜下腔出血行早期手术的预后及并发症影响[J]. .

TANG Ting,XIE Fei and ZHANG Bixian. Effect of Evidence-based Nursing on Prognosis and Complications of Early Stage Operation for High Grade Aneurysmal Subarachnoid Hemorrhage[J]. .

参考文献

[1] Choi W, Kwon SC, Lee WJ, et al. Feasibility and Safety of Mild Therapeutic Hypothermia in Poor-Grade Subarachnoid Hemorrhage: Prospective Pilot Study[J]. J Korean Med Sci, 2017, 32(8):1337-1344.
[2] Tanaka K, Kanamaru H, Morikawa A, et al. Central Hypoventilation Syndrome Complicated with Lateral Medullary Infarction after Endovascular Treatment of the Vertebral Artery Dissecting Aneurysm: A Case Report[J]. NMC Case Rep J, 2016, 3(4):133-136.
[3] 宋炳伟,甄勇,何亮,等.显微夹闭手术时机对高分级动脉瘤性蛛网膜下腔出血患者预后的影响[J].中国脑血管病杂志,2015,12(7)：352-359.
[4] 陈璐,王芳.疼痛管理流程在蛛网膜下腔出血重症患者护理中的应用效果[J].中华现代护理杂志,2016,22(16)：2287-2290.
[5] 谷春平,童岚,周晶,等.两种不同的肠内营养途径在高分级动脉瘤性蛛网膜下腔出血患者中的临床价值探讨[J].中国实验诊断学,2016,20(5)：832-833.
[6] 马吉芬.护理干预对动脉瘤性蛛网膜下腔出血患者预后及并发症的影响[J].现代中西医结合杂志,2016,25(13)：1471-1473.
[7] 邱吕琴.“医护合作”式疼痛管理在外伤性蛛网膜下腔出血患者头痛控制中的应用[J].齐鲁护理杂志,2015,21(24)：32-34.
[8] Mijiti M, Mijiti P, Axier A, et al. Incidence and Predictors of Angiographic Vasospasm, Symptomatic Vasospasm and Cerebral Infarction in Chinese Patients with Aneurysmal Subarachnoid Hemorrhage[J]. PLoS One, 2016, 11(12):e0168657.
[9] 刘炎,杭春华,茅磊,等.高分级动脉瘤性蛛网膜下腔出血颅内动脉瘤夹闭术后不同引流方式的疗效及对预后的影响[J].疑难病杂志2017,16(6)：623-625.
[10] Kilic M, Yilmaz I, Tanriverdi O, et al. Factors that Affect Postoperative Hydrocephalus Development in Aneurysmal Subarachnoid Hemorrhage: A Clinical Study[J]. Turk Neurosurg, 2017, 27(3):353-361.
[11] Kozak N, Bereczki D, Szabo S. Predictors of Symptomatic Vasospasm After Subarachnoid Hemorrhage: A Single Center Study of 457 Consecutive Cases[J]. Turk Neurosurg, 2016, 26(4):545-549.
[12] 郑匡,田作富,谭显西,等.早期治疗高分级动脉瘤性蛛网膜下腔出血的一年预后因素多中心研究[J].中华外科杂志,2017,54(7)：534-539.
[13] 杜世正.循证护理实践模式及应用启示.护理学杂志,2016,31(2)：87-91.
[14] 李帮兰,高阳.循证护理在动脉瘤性蛛网膜下腔出血患者中的应用[J].中国基层医药,2013,20(22)：3499-3501.
[15] Duan G, Yang P, Li Q, et al. Prognosis Predicting Score for Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage: A Risk Modeling Study for Individual Elderly Patients[J]. Medicine (Baltimore), 2016, 95(7):e2686.
[16] Kumar M, Cao W, McDaniel JK, et al. Plasma ADAMTS13 activity and von Willebrand factor antigen and activity in patients with subarachnoid haemorrhage[J]. Thromb Haemost, 2017, 117(4):691-699.
[17] Hamasaki T, Yamada K, Kuratsu J. Seizures as a presenting symptom in neurosurgical patients: a retrospective single-institution analysis[J]. Clin Neurol Neurosurg, 2013, 115(11):2336-2340
[18] Zhang Q, Ma L, Liu Y, et al. Timing of operation for poor-grade aneurysmal subarachnoid hemorrhage: study protocol for a randomized controlled trial[J]. BMC Neurol, 2013, 13(1):108
[19] Park S, Kaffashi F, Loparo KA, et al. The use of heart rate variability for the early detection of treatable complications after aneurysmal subarachnoid hemorrhage[J]. J Clin Monit Comput, 2013, 27(4):385-393.
[20] Yang TC, Chang CH, Liu YT, et al. Predictors of shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid haemorrhage[J]. Eur Neurol. 2013, 69(5):296-303.

快速检索引用检索图表检索高级检索