护理专题论文-(30).docVIP

原发性脑干出血30例观察和护理效果分析 作者：陶芳,张群花,程 远 作者单位：400010 重庆，重庆医科大学附属第二医院神经外科 【摘要】 目的 探讨原发性脑干出血急性期病情观察、护理效果与预后的相关性，提高和加强急性期相关护理的必要性。方法 回归性分析30例原发性脑干出血患者急性期的临床观察指标、脑干功能评分、亚低温治疗及相关护理干预与预后的相关性。结果 30例高血压脑干出血患者6个月后按格拉斯哥预后分级(GOS)评分，良好2例，中度残疾5例，重度残疾7例，植物生存4例，死亡12例。结论 早期和动态的病情观察、评分，有效控制血压，亚低温和呼吸机辅助呼吸，预防并发症等，有助于改善原发性脑干出血患者的预后，降低死亡率和残疾率。 【关键词】 脑干出血;预后;护理 Analysis of nursing care and prognosis of 30 cases with primary brainstem hemorrhage 　　TAO Fang, ZHANG Qun-hua, CHENG Yuan.Department of Neurosurgery, The Second Hospital Affiliated of Chongqing Medical University, Chongqing 400010,China 　　[Abstract] Objective To explore the correlations between observation, nursing care and prognosis of primary brainstem hemorrhage to strengthen the essentiality to nursing care in the acute stage.Methods Data extracted from 30 cases included clinical manifestation, score of brain stem function, vital sign, mild hypothermia treatment and nursing care that might affect the prognosis, further were analyzed by regression analysis.Results All the 30 patients after 3 months were included in our study. Two patients with good GCS, 5 cases with middle disability, 7 cases with severe disability, 4 cases with vegetative state and 12 patients with death.Conclusion Intervention measures that dynamic and rigorous observation, valid blood pressure control, early mild hypothermia treatment, assisted respiration with ventilator and prevention complications, contribute to improve the prognosis, reduce mortality and disability rate of primary brainstem hemorrhage. 　　[Key words] brainstem hemorrhage; prognosis; nursing care 　　原发性脑干出血是一种特殊类型的脑出血，多数与高血压病有关，约占脑出血的10%，其发病急剧，危害极大，尤其是发病后昏迷发生早、程度深，持续时间长，并发症多，其死亡率高达80%以上，重残和植物生存占相当比例[1]。保持呼吸道通畅，维持内环境的平衡、积极防治并发症的发生以及重点、精心、全面的护理是提高原发性脑干出血生存率的关键。本文通过回顾性分析，总结了我科2005年3月—2008年3月收治并经CT、临床确诊的原发性脑干出血30例医疗和护理体会，现报告如下。 　　1 资料与方法 　　1.1 一般资料 本组入选原发性脑干出血30例，男19例，女11例;年龄38～72岁，平均55岁。既往有高血压病史24例，无高血压病史6例。入院时检查，所有患者均立即出现不同程度的意识障碍，去大脑强直状态者11例;瞳孔大小多变，正常大小6例，形态不规则7例，双侧瞳孔大小不等6例，双侧瞳孔缩小6例，双