循证护理在重型脑外伤后盐耗综合征患者应用研究.docVIP

循证护理在重型脑外伤后盐耗综合征患者应用研究 　　【摘要】 目的 将循证护理方法应用于重型颅脑外伤后盐耗综合征患者的观察和护理。方法 将46例重型脑外伤后盐耗综合征的患者随机分为循证组和常规组,成立由护士长、监护护士、护士组成的循证小组,应用计算机网络检索相关文献,对证据的真实性、可靠性和实用性作出评价后,对循证组患者实行循证护理,两组基础治疗和护理措施相同。观察两组患者的致残率和死亡率,所得结果用χ?2检验。结果 循证组通过循证护理的实践,循证组致残率、死亡率明显低于常规组(P 　　【关键词】 循证护理;重型脑外伤;盐耗综合征;护理 　　Evidence-based care after traumatic brain injury in severe salt wasting syndrome application 　　JIN Yao-hua,XING Hai-yun.Liaocheng City,Shandong Taishan Medical College,Second Hospital of Neurosurgery 252601,China 　　【Abstract】 Objective To used the ethods in evidence-based care after severe brain injury observed in patients with salt wasting syndrome and care.Methods 46 patients with severe salt wasting syndrome after traumatic brain injury were randomly divided into evidence-based group and the conventional group,set up by the matron,care nurses,nurses evidence-based group,application of computer network retrieval literature,the real evidence,reliability and usefulness of evaluation,the patients on the evidence-based practice evidence-based care,treatment and care measures for the two groups the same basis.Were observed in patients with disability and mortality,the results with the χ?2 test.Results Evidence-based group practice through evidence-based care,evidence-based group of disability,mortality was significantly lower than the conventional group(P[1]。脑性盐耗综合征(CSWS)是指颅内疾病过程中出现的钠自尿中大量流失,并带走过多水分,从而导致低钠血症和细胞外液容量下降,以低钠血症、尿钠增高和低血容量为主要临床表现的综合征[2]。是重型颅脑外伤后常见的并发症,其临床表现不典型,难与颅脑损伤后的其他症状相鉴别,进一步发展有脑疝发生的可能。为提高该类患者的治愈率,降低其死亡率,对2005年1月至2008年12月本科收治的46例急性重型颅脑损伤后并发盐耗综合征的患者,采用不同护理方法进行护理和治疗,结果报告如下。 　　1 资料 　　1.1 一般资料 本组46例,其中??31例,女15例,年龄16~68岁,平均38.6岁,入院时GCS评分5~8分。35例行开颅血肿清除术,11例保守治疗。发病时间为术后或伤后5~10 d(平均7.8 d)。主要损伤病理类型为广泛脑挫裂伤、弥漫性脑损伤、外伤性颅内血肿。血钠120~130 mmol/L 24例,110~119 mmol/L 15例,7例低于110 mmol/L。尿钠测定80 mmol/d28例,200 mmol/d 18例。尿密度1.012~1.020 8例,1.020 5例。两组患者主要临床资料差异无统计学意义,具可比性。 　　2 实施步骤 　　2.1 提出问题 颅脑损伤是常见的损伤,其发生率仅次于四肢。约占全身各部位外伤的15%~20%,但死亡率(30%~40%)和致残率(10%左右),占各部位之首[3]。首先,需找出影响抢救成功的各种因素,然后逐一进行“教育与培训”,经循证小组