降阶梯思维在老年颅脑损伤患者急救中的应用效果研究
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摘要
目的探讨降阶梯思维在老年颅脑损伤患者急救中的应用效果。方法选取2015年7月—2016年7月南通大学附属医院收治的老年颅脑损伤患者67例为常规组,行常规急救干预;选取2016年8月—2017年8月收治的老年颅脑损伤患者65例为研究组,行降阶梯思维的急救干预。比较两组急诊救治时间、急救效果、存活预后效果及满意度情况。结果研究组急诊救治时间短于常规组(t=21.843,P<0.05);研究组存活率高于常规组,总病死率低于常规组(χ~2=6.453、6.872,P<0.05);研究组存活患者的格拉斯哥昏迷量表评分高于常规组(t=7.924,P<0.001);研究组急救总满意率高于常规组(χ~2=14.678,P<0.001)。结论老年颅脑损伤患者急救中应用降阶梯思维方式可明显缩短急诊救治时间,降低病死率,改善预后效果,提高急救满意度,值得临床推广。
Objective To explore the effect of de-escalation strategies for emergency treatment of elderly patients with craniocerebral injury.Methods The participants were 132 elderly patients with craniocerebral injury,including 67 enrolled from July 2015 to July 2016 treated by the conventional emergency treatment(conventional group),and 65 enrolled from August 2016 to August 2017 treated by emergency treatment with de-escalation strategies(research group).The emergency treatment duration,outcome(survival rate,mortality,status of recovery of the survivals,prevalence of developmental disabilities) and patient satisfaction with emergency treatment were compared between the two groups.Results Compared with the conventional group,the research group had much shorter emergency treatment duration(t=21.843,P<0.05),significantly higher survival rate(χ~2=6.453,P<0.05),and notable lower case fatality rate(χ~2=6.872,P<0.05),higher score of Glasgow coma scale(t=7.924,P<0.001),but substantially lower prevalence of severe developmental disabilities(χ~2=8.786,P<0.05),and much higher level of patient satisfaction with emergency treatment(χ~2=14.678,P<0.001).Conclusion De-escalation strategies used in the emergency treatment of elderly patients with craniocerebral injury can significantly shorten the emergency treatment duration,reduce the case fatality rate,improve the prognosis as well as the patient satisfaction with emergency treatment,so it is worthy of clinical promotion.
Objective To explore the effect of de-escalation strategies for emergency treatment of elderly patients with craniocerebral injury.Methods The participants were 132 elderly patients with craniocerebral injury,including 67 enrolled from July 2015 to July 2016 treated by the conventional emergency treatment(conventional group),and 65 enrolled from August 2016 to August 2017 treated by emergency treatment with de-escalation strategies(research group).The emergency treatment duration,outcome(survival rate,mortality,status of recovery of the survivals,prevalence of developmental disabilities) and patient satisfaction with emergency treatment were compared between the two groups.Results Compared with the conventional group,the research group had much shorter emergency treatment duration(t=21.843,P<0.05),significantly higher survival rate(χ~2=6.453,P<0.05),and notable lower case fatality rate(χ~2=6.872,P<0.05),higher score of Glasgow coma scale(t=7.924,P<0.001),but substantially lower prevalence of severe developmental disabilities(χ~2=8.786,P<0.05),and much higher level of patient satisfaction with emergency treatment(χ~2=14.678,P<0.001).Conclusion De-escalation strategies used in the emergency treatment of elderly patients with craniocerebral injury can significantly shorten the emergency treatment duration,reduce the case fatality rate,improve the prognosis as well as the patient satisfaction with emergency treatment,so it is worthy of clinical promotion.
引文
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[7]石莹,雷澍,张志荣,等.穴位埋线治疗对重型颅脑损伤术后患者胃肠功能障碍的影响:一项前瞻性随机对照研究[J].中国中西医结合急救杂志,2017,24(2):155-157.DOI:10.3969/j.issn.1008-9691.2017.02.012.SHI Y,LEI S,ZHANG Z R,et al.Therapeutic effect of acupoint catgut embedding on gastrointestinal dysfunction after surgery in patients with severe traumatic brain injury:a prospective randomized controlled clinical trial[J].Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care,2017,24(2):155-157.DOI:10.3969/j.issn.1008-9691.2017.02.012.
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[9]LU H,WANG L,ZHONG W,et al.Establishment of swinepenetrating craniocerebral gunshot wound model[J].J Surg Res,2015,199(2):698-706.DOI:10.1016/j.jss.2015.01.006.
[10]沈卉,贾亚平,王云,等.降阶梯思维交班模式在急诊晨间病情交接中的应用[J].中国实用护理杂志,2016,32(35):2771-2775.DOI:10.3760/cma.j.issn.1672-7088.2016.35.015.SHEN H,JIA Y P,WANG Y,et al.The application of deescalation thinking shift mode in emergency condition of morning shift meeting[J].Chinese Journal of Practical Nursing,2016,32(35):2771-2775.DOI:10.3760/cma.j.issn.1672-7088.2016.35.015.
[11]李水莉,李颖,赵丽丽,等.降阶梯思维方式在颅脑损伤合并颈椎损伤患者急救护理中应用的效果评价[J].中国实用护理杂志,2015,31(7):498-500.DOI:10.3760/cma.j.issn.1672-7088.2015.07.009.LI S L,LI Y,ZHAO L L,et al.Application effect of deescalation thinking in craniocerebral injury complicated with cervical injury in emergency nursing[J].Chinese Journal of Practical Nursing,2015,31(7):498-500.DOI:10.3760/cma.j.issn.1672-7088.2015.07.009.
[12]周染云,范燕娜,王国权,等.系统性急救护理程序在重型颅脑损伤患者救治中的应用[J].解放军护理杂志,2015,32(3):51-54.DOI:10.14033/j.cnki.cfmr.2017.14.046.ZHOU R Y,FAN Y N,WANG G Q,et al.Application of systematic first aid nursing process in emergency medical cure of patients with severe brain injury[J].Nursing Journal of Chinese People's Liberation Army,2015,32(3):51-54.DOI:10.14033/j.cnki.cfmr.2017.14.046.
[13]WALLARD L,DIETRICH G,KERLIRZIN Y,et al.Effects of robotic gait rehabilitation on biomechanical parameters in the chronic hemiplegic patients[J].Neurophysiol Clin,2015,45(3):215-219.DOI:10.1016/j.neucli.2015.03.002.
[14]USTINOVA K I,SILKWOOD-SHERER D J.Postural perturbations induced by a moving virtual environment are reduced in persons with brain injury when gripping a mobile object[J].J Neurol Phys Ther,2014,38(2):125-133.DOI:10.1097/NPT.0000000000000035.
[15]姚世斌,何忠杰,李志辉,等.急诊绿色通道对急性颅脑损伤患者抢救时效性的效果探讨[J].中华卫生应急电子杂志,2015,1(6):35-37.DOI:10.3877/cma.j.issn.2095-9133.2015.06.009.YAO S B,HE Z J,LI Z H,et al.Effect of emergency green channel on the time-efficacy of rescue in acute craniocerebral injury patients[J].Chinese Journal of Hygiene Rescue(Electronic Edition),2015,1(6):35-37.DOI:10.3877/cma.j.issn.2095-9133.2015.06.009.
[16]姚远,方政晗,于长久.急重症颅脑损伤患者抢救时紧急人工气道的建立及其管理[J].创伤外科杂志,2017,19(8):570-573.DOI:10.3969/j.issn.1009-4237.2017.08.003.YAO Y,FANG Z H,YU C J.Establishment and management of emergency artificial airway in patients with severe craniocerebral injury[J].Journal of Traumatic Surgery,2017,19(8):570-573.DOI:10.3969/j.issn.1009-4237.2017.08.003.
[17]刘富强,师聪红,张桂琴,等.急诊昏迷患者的迅速分诊与急救方法研究[J].中国全科医学,2012,15(11):1281-1282.DOI:10.3969/j.issn.1007-9572.2012.11.032.LIU F Q,SHI C H,ZHANG G Q,et al.Research of rapid triage and first aid for emergency patients under coma[J].Chinese General Practice,2012,15(11):1281-1282.DOI:10.3969/j.issn.1007-9572.2012.11.032.
[2]刘慧权,张建宁,尹悦,等.抗血小板治疗对中老年轻型颅脑损伤患者预后的影响[J].中华创伤杂志,2017,33(1):47-50.DOI:10.3760/cma.j.issn.1001-8050.2017.01.011.LIU H Q,ZHANG J N,YIN Y,et al.The effect of antiplatelet therapy on the prognosis of light brain injury patients in middle and old age[J].Chinese Journal of Trauma,2017,33(1):47-50.DOI:10.3760/cma.j.issn.1001-8050.2017.01.011.
[3]朱辉,周树生.急性重症颅脑损伤患者血清NSE、MMP-9水平及与脑部神经功能恢复的关系[J].中国老年学杂志,2017,37(13):3226-3227.DOI:10.3969/j.issn.1005-9202.2017.13.047.ZHU H,ZHOU S S.The relationship between the level of serum NSE,MMP-9 and the recovery of brain nerve function in patients with acute severe craniocerebral injury[J].Chinese Journal of Gerontology,2017,37(13):3226-3227.DOI:10.3969/j.issn.1005-9202.2017.13.047.
[4]冯程.两种急救护理模式在多发伤并重型颅脑损伤患者中的急救效果[J].职业卫生与应急救援,2017,35(2):128-130.DOI:10.16369/j.oher.issn.1007-1326.2017.02.010.FENG C.Clinical effect of two kinds of emergency nursing programs in patients with multiple trauma complicated with severe craniocerebral injury[J].Occupational Health and Emergency Rescue,2017,35(2):128-130.DOI:10.16369/j.oher.issn.1007-1326.2017.02.010.
[5]潘小燕,方雅,俞夏娣,等.急救护理路径对严重创伤患者绿色通道停留时间的影响[J].中华现代护理杂志,2017,23(16):2145-2148.DOI:10.3760/cma.j.issn.1674-2907.2017.16.016.PAN X Y,FANG Y,YU X D,et al.Effects of emergency treatment nursing pathway on residence time of the green channel in patients with severe trauma[J].Chinese Journal of Modern Nursing,2017,23(16):2145-2148.DOI:10.3760/cma.j.issn.1674-2907.2017.16.016.
[6]周慧飞,邹静.系统性急救护理程序对重型颅脑损伤患者急救效率及并发症的影响分析[J].浙江创伤外科,2017,22(1):200-201.DOI:10.3969/j.issn.1009-7147.2017.01.092.ZHOU H F,ZOU J.Analysis of the effect of systematic first aid nursing procedure on first aid efficiency and complications of patients with severe craniocerebral injury[J].Zhejiang Journal of Traumatic Surgery,2017,22(1):200-201.DOI:10.3969/j.issn.1009-7147.2017.01.092.
[7]石莹,雷澍,张志荣,等.穴位埋线治疗对重型颅脑损伤术后患者胃肠功能障碍的影响:一项前瞻性随机对照研究[J].中国中西医结合急救杂志,2017,24(2):155-157.DOI:10.3969/j.issn.1008-9691.2017.02.012.SHI Y,LEI S,ZHANG Z R,et al.Therapeutic effect of acupoint catgut embedding on gastrointestinal dysfunction after surgery in patients with severe traumatic brain injury:a prospective randomized controlled clinical trial[J].Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care,2017,24(2):155-157.DOI:10.3969/j.issn.1008-9691.2017.02.012.
[8]原宇宙,郝永莲,王旭升.喉罩和气管插管在重度颅脑损伤昏迷患者院前急救中的应用对比研究[J].中国药物与临床,2017,17(2):261-263.DOI:10.11655/zgywylc2017.02.045.YUAN Y Z,HAO Y L,WANG X S.Comparative study on the application of laryngeal mask and tracheal intubation in pre hospital first aid for severe craniocerebral injury patients with coma[J].Chinese Remedies&Clinics,2017,17(2):261-263.DOI:10.11655/zgywylc2017.02.045.
[9]LU H,WANG L,ZHONG W,et al.Establishment of swinepenetrating craniocerebral gunshot wound model[J].J Surg Res,2015,199(2):698-706.DOI:10.1016/j.jss.2015.01.006.
[10]沈卉,贾亚平,王云,等.降阶梯思维交班模式在急诊晨间病情交接中的应用[J].中国实用护理杂志,2016,32(35):2771-2775.DOI:10.3760/cma.j.issn.1672-7088.2016.35.015.SHEN H,JIA Y P,WANG Y,et al.The application of deescalation thinking shift mode in emergency condition of morning shift meeting[J].Chinese Journal of Practical Nursing,2016,32(35):2771-2775.DOI:10.3760/cma.j.issn.1672-7088.2016.35.015.
[11]李水莉,李颖,赵丽丽,等.降阶梯思维方式在颅脑损伤合并颈椎损伤患者急救护理中应用的效果评价[J].中国实用护理杂志,2015,31(7):498-500.DOI:10.3760/cma.j.issn.1672-7088.2015.07.009.LI S L,LI Y,ZHAO L L,et al.Application effect of deescalation thinking in craniocerebral injury complicated with cervical injury in emergency nursing[J].Chinese Journal of Practical Nursing,2015,31(7):498-500.DOI:10.3760/cma.j.issn.1672-7088.2015.07.009.
[12]周染云,范燕娜,王国权,等.系统性急救护理程序在重型颅脑损伤患者救治中的应用[J].解放军护理杂志,2015,32(3):51-54.DOI:10.14033/j.cnki.cfmr.2017.14.046.ZHOU R Y,FAN Y N,WANG G Q,et al.Application of systematic first aid nursing process in emergency medical cure of patients with severe brain injury[J].Nursing Journal of Chinese People's Liberation Army,2015,32(3):51-54.DOI:10.14033/j.cnki.cfmr.2017.14.046.
[13]WALLARD L,DIETRICH G,KERLIRZIN Y,et al.Effects of robotic gait rehabilitation on biomechanical parameters in the chronic hemiplegic patients[J].Neurophysiol Clin,2015,45(3):215-219.DOI:10.1016/j.neucli.2015.03.002.
[14]USTINOVA K I,SILKWOOD-SHERER D J.Postural perturbations induced by a moving virtual environment are reduced in persons with brain injury when gripping a mobile object[J].J Neurol Phys Ther,2014,38(2):125-133.DOI:10.1097/NPT.0000000000000035.
[15]姚世斌,何忠杰,李志辉,等.急诊绿色通道对急性颅脑损伤患者抢救时效性的效果探讨[J].中华卫生应急电子杂志,2015,1(6):35-37.DOI:10.3877/cma.j.issn.2095-9133.2015.06.009.YAO S B,HE Z J,LI Z H,et al.Effect of emergency green channel on the time-efficacy of rescue in acute craniocerebral injury patients[J].Chinese Journal of Hygiene Rescue(Electronic Edition),2015,1(6):35-37.DOI:10.3877/cma.j.issn.2095-9133.2015.06.009.
[16]姚远,方政晗,于长久.急重症颅脑损伤患者抢救时紧急人工气道的建立及其管理[J].创伤外科杂志,2017,19(8):570-573.DOI:10.3969/j.issn.1009-4237.2017.08.003.YAO Y,FANG Z H,YU C J.Establishment and management of emergency artificial airway in patients with severe craniocerebral injury[J].Journal of Traumatic Surgery,2017,19(8):570-573.DOI:10.3969/j.issn.1009-4237.2017.08.003.
[17]刘富强,师聪红,张桂琴,等.急诊昏迷患者的迅速分诊与急救方法研究[J].中国全科医学,2012,15(11):1281-1282.DOI:10.3969/j.issn.1007-9572.2012.11.032.LIU F Q,SHI C H,ZHANG G Q,et al.Research of rapid triage and first aid for emergency patients under coma[J].Chinese General Practice,2012,15(11):1281-1282.DOI:10.3969/j.issn.1007-9572.2012.11.032.