专职化层级护理方案在重型颅脑创伤患者中的术前应用

许雪琴; 徐艳荣; 杨永杰

doi:10.16766/j.cnki.issn.1674-4152.004149

专职化层级护理方案在重型颅脑创伤患者中的术前应用

doi: 10.16766/j.cnki.issn.1674-4152.004149

山西白求恩医院(山西医学科学院)，山西医科大学第三医院; 同济山西医院急诊医学科，山西太原 030032

基金项目:

山西省基础研究计划项目 202203021221241

详细信息

通讯作者:
杨永杰，E-mail：star3266@163.com

中图分类号: R473.6
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- 文章访问数: 9
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- 被引次数: 0
出版历程
- 收稿日期: 2024-12-20
- 网络出版日期: 2025-10-31

Application of professional hierarchical nursing scheme in patients with severe craniocerebral trauma before operation

Department of Emergency Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, Shanxi 030032, China

摘要

摘要: 目的从急救效果、急救时间、护理质量、并发症发生率等方面探讨专职化层级护理方案在重型颅脑创伤(sTBI)患者术前的应用效果。方法选取2023年1月—2024年12月山西白求恩医院收治的sTBI患者82例，采用随机数字表法分为观察组(41例)和对照组(41例)。对照组实施常规护理方案，观察组实施专职化层级护理方案。比较2组急救效果、急救时间、护理质量、并发症发生率、急救前后格拉斯哥昏迷量表(GCS)、急性生理与慢性健康系统Ⅱ(APACHEⅡ)、美国国立卫生研究院卒中量表(NIHSS)评分。结果观察组急救成功率为97.56%(40/41)，高于对照组[80.49%(33/41), χ²=4.493，P=0.034]。观察组急救反应时间、抢救时间、检查时间、会诊等候时间、病房交接时间均短于对照组(P＜0.05)。观察组护理质量各维度评分高于对照组(P＜0.05)。观察组并发症发生率低于对照组(P＜0.05)。急救后2组GCS评分均高于急救前，APACHEⅡ、NIHSS评分均低于急救前，组间比较，观察组GCS评分高于对照组，APACHEⅡ、NIHSS评分低于对照组(P＜0.05)。结论专职化层级护理方案应用于sTBI患者术前，可有效提高急救效果，缩短急救时间，减少并发症，促进患者苏醒，减轻病情严重程度及神经功能缺损程度，提升护理质量。
- 重型颅脑创伤 /
- 专职化层级护理方案 /
- 急救效果 /
- 并发症
Abstract: Objective To explore the effect of a professional hierarchical nursing program in the preoperative application of severe traumatic brain injury (sTBI) patients in terms of first-aid effect, first-aid time, nursing quality, and complication rate. Methods From January 2023 to December 2024, 82 patients with severe traumatic brain injury (sTBI) were selected from Shanxi Bethune Hospital. Using a random number table method, participants were allocated to either the observation group (n=41) or the control group (n=41). The control group underwent standard nursing protocols, whereas the observation group received a professional hierarchical nursing approach. The first aid effect, first aid time, quality of care, complication rate, Glasgow coma scale (GCS), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), and National Institutes of Health stroke scale (NIHSS) scores before and after first aid were compared between the two groups. Results The observation group exhibited a significantly higher rescue success rate of 97.56% (40/41) compared to the control group' s 80.49% (33/41, χ²=4.493, P=0.034). The observation group demonstrated shorter emergency response time, rescue duration, examination time, consultation waiting time, and ward handover time than the control group (P < 0.05). Scores across all dimensions of nursing quality were higher in the observation group compared to the control group (P < 0.05). The incidence of complications was lower in the observation group than in the control group (P < 0.05). Post-rescue assessments revealed elevated GCS scores and reduced APACHE Ⅱ and NIHSS scores in both groups compared to pre-rescue baseline values. Between-group comparisons showed the observation group had significantly higher GCS scores and lower APACHE Ⅱ, NIHSS scores than the control group (P < 0.05). Conclusion The professional hierarchical nursing scheme applied to sTBI patients before surgery can effectively improve the first-aid effect, shorten the first-aid time, reduce complications, promote the recovery of patients, reduce the severity of the disease and the degree of neurological impairment, and improve the quality of nursing.
- Severe traumatic brain injury /
- Professional hierarchical nursing program /
- First aid effect /
- Complication

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表 1 2组重型颅脑损伤患者一般资料比较

Table 1. Comparison of general information between two groups of patients with severe traumatic brain injury

项目	观察组(n=41)	对照组(n=41)	统计量	P值
性别[例(%)]			0.205^a	0.651
男性	24(58.54)	26(63.41)
女性	17(41.46)	15(36.59)
年龄(x±s，岁)	42.66±8.37	43.51±8.82	0.448^b	0.656
受伤至入院时间(x±s, h)	3.22±1.03	3.34±1.14	0.500^b	0.618
受伤部位[例(%)]			0.460^a	0.928
枕部	11(26.83)	13(31.71)
额部	10(24.39)	9(21.95)
颞部	8(19.51)	9(21.95)
多发挫裂伤	12(29.27)	10(24.39)
受伤原因[例(%)]			0.718^a	0.869
交通事故	16(39.02)	18(43.90)
高空坠落	10(24.39)	11(26.83)
暴力伤	10(24.39)	9(21.95)
重物砸伤	5(12.20)	3(7.32)
合并基础疾病[例(%)]
高血压	10(24.39)	12(29.27)	0.249^a	0.618
糖尿病	5(12.20)	3(7.32)	0.139^a	0.710
冠心病	4(9.76)	3(7.32)	< 0.001^a	0.999
GCS评分(x±s, 分)	5.88±0.81	6.00±0.77	0.688^b	0.494
注：^a为χ²值，^b为t值。

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表 2 2组重型颅脑损伤患者急救时间比较(x±s，min)

Table 2. Comparison of emergency treatment time between two groups of patients with severe traumatic brain Injury(x±s, min)

组别	例数	急救反应时间	抢救时间	检查时间	会诊等候时间	病房交接时间
观察组	40	10.02±1.81	23.73±3.51	10.54±2.23	7.34±1.69	3.07±0.96
对照组	33	12.03±2.12	25.51±4.06	13.65±2.58	9.05±1.86	5.10±1.01
t值		4.370	2.009	5.524	4.111	6.783
P值		＜0.001	0.048	＜0.001	＜0.001	＜0.001
注：仅统计急救成功者数据。

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表 3 2组重型颅脑损伤患者护理质量比较(x±s，分)

Table 3. Comparison of nursing quality between two groups of patients with severe traumatic brain injury(x±s, points)

组别	例数	服务态度	病区管理	急救药品器材准备	患者风险评估	急救操作	应急能力	规避纠纷	分级护理	病历书写	转运交接
观察组	40	16.35±1.76	16.93±1.23	15.68±1.42	15.10±1.38	14.95±1.52	15.68±1.38	16.10±1.42	16.38±1.50	17.10±1.29	16.58±1.42
对照组	33	15.45±1.82	16.21±1.26	14.79±1.35	14.24±1.44	14.09±1.38	15.03±1.29	15.27±1.35	15.52±1.44	16.33±1.16	15.76±1.45
t值		2.141	2.462	2.725	2.599	2.507	2.062	2.541	2.482	2.655	2.432
P值		0.036	0.016	0.008	0.011	0.015	0.043	0.013	0.015	0.010	0.018
注：仅统计急救成功者数据。

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表 4 2组sTBI患者并发症发生率比较[例(%)]

Table 4. Comparison of the incidence of complications between the two groups of sTBI patients[cases (%)]

组别	例数	伤口感染	泌尿系统感染	肺部感染	应激性消化道溃疡	压力性损伤	下肢静脉血栓形成	总发生
观察组	40	0	0	1(2.50)	0	1(2.50)	0	2(5.00)
对照组	33	1(3.03)	2(6.06)	2(6.06)	1(3.03)	1(3.03)	1(3.03)	8(24.24)
注：仅统计急救成功者数据。2组并发症总发生率比较，χ²=4.153，P=0.042。

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表 5 2组sTBI患者急救前后GCS、APACHEⅡ、NIHSS评分比较(x±s，分)

Table 5. Comparison of GCS, APACHEⅡ, and NIHSS scores before and after emergency treatment in the two groups of sTBI patients(x±s, points)

组别	例数	GCS		APACHEⅡ		NIHSS
组别	例数	急救前	急救后	急救前	急救后	急救前	急救后
观察组	40	5.90±0.80	8.50±1.05^b	20.65±2.54	17.73±2.18^b	25.65±3.26	21.63±3.05^b
对照组	33	6.03±0.78	7.67±1.12^b	21.09±2.29	19.15±2.31^b	26.39±2.13	23.24±2.94^b
统计量		0.699^a	10.233^c	0.770^a	9.861^c	1.121^a	9.725^c
P值		0.487	＜0.001	0.444	＜0.001	0.266	＜0.001
注：仅统计急救成功者数据。^a为t值，^c为F值；与同组急救前比较，^bP＜0.05。

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参考文献(20)

[1]	PUSTILNIK H N, MEDRADO-NUNES G S, CERQUEIRA G A, et al. Brain tissue oxygen plus intracranial pressure monitoring versus isolated intracranial pressure monitoring in patients with traumatic brain injury: an updated meta-analysis of randomized controlled trials[J]. Acta Neurochir (Wien), 2024, 166(1): 240-251. doi: 10.1007/s00701-024-06125-8
[2]	祁彬, 姜宇辉, 张贺, 等. 气道阻力和静态肺顺应性测定在重型颅脑损伤患者脱机筛查中的应用研究[J]. 中华全科医学, 2024, 22(8): 1344-1346. QI B, JIANG Y H, ZHANG H, et al. Application of airway resistance and static lung compliance measurement in weaning screening for patients with severe traumatic brain injury[J]. Chinese Journal of General Practice, 2024, 22(8): 1344-1346.
[3]	ZHANG C, ZHOU L, ZHANG K, et al. Brain tissue oxygen pressure combined with intracranial pressure monitoring may improve clinical outcomes for patients with severe traumatic brain injury: a systemic review and meta-analysis[J]. Peer J, 2024, 12(1): e18086-e18098.
[4]	HOFFMAN H, ABI-AAD K, BUNCH K M, et al. Outcomes associated with brain tissue oxygen monitoring in patients with severe traumatic brain injury undergoing intracranial pressure monitoring[J]. J Neurosurg, 2021, 135(6): 1799-1806. doi: 10.3171/2020.11.JNS203739
[5]	EL-SWAIFY S T, KAMEL M, ALI S H, et al. Initial neurocritical care of severe traumatic brain injury: new paradigms and old challenges[J]. Surg Neurol Int, 2022, 13(1): 431-443.
[6]	王宁, 万烨东, 杜国森, 等. 互联网+智慧急救在重型颅脑创伤患者开颅术前应用效果的研究[J]. 中华急诊医学杂志, 2020, 29(12): 1554-1558. WANG N, WAN Y D, DU G S, et al. Application of Internet Plus smart emergency care in pre-craniotomy management of patients with severe traumatic brain injury: A study on its effectiveness[J]. Chinese Journal of Emergency Medicine, 2020, 29(12): 1554-1558.
[7]	孙莉莉, 刘延锦, 张文静, 等. 护理人员分层级管理评价标准体系的构建[J]. 护士进修杂志, 2020, 35(20): 1886-1890. SUN L L, LIU Y J, ZHANG W J, et al. Construction of an evaluation criteria system for hierarchical management of nursing staff[J]. J Nurs Train, 2020, 35(20): 1886-1890.
[8]	张利. 层级护理干预在重症中心静脉置管患者导管相关性感染及上肢静脉血栓控制中的应用[J]. 血栓与止血学, 2021, 27(2): 351-352, 355. ZHANG L. The application of hierarchical nursing intervention in catheter-related infections and upper extremity venous thrombosis control in patients with severe illness undergoing central venous catheterization[J]. Chinese Journal of Thrombosis and Hemostasis, 2021, 27(2): 351-352, 355.
[9]	BODIEN Y G, BARRA A, TEMKIN N R, et al. Diagnosing level of consciousness: the limits of the Glasgow coma scale total score[J]. J Neurotrauma, 2021, 38(23): 3295-3305. doi: 10.1089/neu.2021.0199
[10]	中国医师协会神经外科医师分会, 中国神经创伤专家委员会. 中国颅脑创伤外科手术指南[J]. 中华神经创伤外科电子杂志, 2015, 1(1): 59-60. NeurosurgicaL Branch of Chinese Medical Doctor Association; Chinese Neurotrauma Expert Committee. Chinese Guidelines for Surgical Management of Craniocerebral Trauma[J]. Chinese Journal of Neurotrauma Surgery (Electronic Edition), 2015, 1(1): 59-60.
[11]	曾琳, 陶立元, 赵英帅. 健康管理学研究中的样本量估计[J]. 中华健康管理学杂志, 2021, 15(2): 205-208. ZENG L, TAO L Y, ZHAO Y S. Sample Size Estimation in Health Management Research[J]. Chinese Journal of Health Management, 2021, 15(2): 205-208.
[12]	BAHTOUEE M, EGHBALI S S, MALEKI N, et al. Acute physiology and chronic health evaluation Ⅱ score for the assessment of mortality prediction in the intensive care unit: a single-centre study from iran[J]. Nurs Crit Care, 2019, 24(6): 375-380. doi: 10.1111/nicc.12401
[13]	BABY P, SRIJITHESH P R, REDDY A V, et al. Transcultural adaptation and validation of Kannada version of the national institute of health stroke scale (NIHSS)[J]. Ann Indian Acad Neurol, 2022, 25(2): 224-228. doi: 10.4103/aian.aian_707_21
[14]	HOSSAIN I, ROSTAMI E, MARKLUND N. The management of severe traumatic brain injury in the initial postinjury hours-current evidence and controversies[J]. Curr Opin Crit Care, 2023, 29(6): 650-658.
[15]	ROBERTS C J, BARBER J, TEMKIN N R, et al. Clinical outcomes after traumatic brain injury and exposure to extracranial surgery: a track-tbi study[J]. JAMA Surg, 2024, 159(3): 248-259. doi: 10.1001/jamasurg.2023.6374
[16]	MAAS A I R, MENON D K, MANLEY G T, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research[J]. Lancet Neurol, 2022, 21(11): 1004-1060. doi: 10.1016/S1474-4422(22)00309-X
[17]	GANTNER D, WIEGERS E, BRAGGE P, et al. Decompressive craniectomy practice following traumatic brain injury in comparison with randomized trials: harmonized, multi-center cohort studies in Europe, the United Kingdom, and Australia[J]. J Neurotrauma, 2022, 39(11-12): 860-869. doi: 10.1089/neu.2021.0312
[18]	IACCARINO C, LIPPA L, MUNARI M, et al. Management of intracranial hypertension following traumatic brain injury: a best clinical practice adoption proposal for intracranial pressure monitoring and decompressive craniectomy. Joint statements by the traumatic brain injury section of the italian society of neurosurgery (SINch) and the neuroanesthesia and neurocritical care study group of the italian society of anesthesia, analgesia, resuscitation and intensive care (SIAARTI)[J]. J Neurosurg Sci, 2021, 65(3): 219-238.
[19]	武艳华. 层级护理干预应用在ICU护理及对患者感染控制效果的影响分析[J]. 河北医学, 2016, 22(4): 675-677. ZHANG J Y, WANG Y C. Application of hierarchical nursing management model in hospitalized patients of respiratory medicine[J]. Hebei Medicine, 2016, 22(4): 675-677.
[20]	刘艺红, 邱晓燕, 庄丽丽. 专职化层级护理模式干预对急性脑梗死患者抢救效果与日常生活能力的影响[J]. 山西医药杂志, 2022, 51(3): 325-328. LIU Y H, QIU X Y, ZHUANG L L. Impact of specialized hierarchical nursing model intervention on rescue outcomes and activities of daily living in patients with acute cerebral infarction[J]. Shanxi Medical Journal, 2022, 51(3): 325-328.