不完全性脊髓损伤患者的个体化分阶段护理

发布时间：2019-03-26 10:37

【摘要】：目的 :探讨个体化分阶段护理模式对不完全性脊髓损伤(ISCI)患者的护理效果,为临床护理工作提供参考。方法:将我院2015年2月~2016年4月收治的60例ISCI患者随机分为对照组与观察组。对照组中女性10例,男性20例;年龄19~57岁,平均42.16±4.27岁;ASIA分级B级9例、C级10例、D级11例,脊髓损伤发生于颈段5例,胸段10例,腰段15例。观察组中女性8例,男性22例,年龄21~55岁,平均45.23±6.72岁;ASIA分级B级10例、C级8例、D级12例,脊髓损伤发生于颈段6例,胸段9例,腰段15例。两组在性别、年龄、脊髓损伤节段及ASIA分级等情况无统计学差异。观察组予个体化分阶段护理,包括对个性化分阶段的心理康复、功能锻炼与呼吸道、肠道、泌尿系管理,对照组住院期间给予常规护理。治疗前及治疗后(90d时)依次采用Zung氏抑郁自评量表(SDS)、康复效果评定表(ISNCSCI-2013)、改良Barthel指数量表分别对两组患者的心理健康状态(SDS评分)、运动和感觉功能及日常生活能力进行评估,并比较两组患者治疗过程中并发症的发生率。结果:观察组SDS评分治疗前61.51±2.3分,治疗后40.11±2.1分;对照组治疗前62.22±2.9分,治疗后50.50±3.1分。观察组运动功能评分治疗前47.8±10.2分,治疗后68.4±13.2分;对照组治疗前47.4±11.3分,治疗后60.1±13.5分。观察组感觉功能评分治疗前87.2±14.5分,治疗后102.5±19.3分;对照组治疗前88.3±14.7分,治疗后94.1±18.3分。观察组日常生活能力评分治疗前55.4±8.7分,治疗后78.1±9.5分;对照组治疗前55.2±9.2分,治疗后69.6±11.4分。观察组在心理健康状态、运动和感觉功能恢复情况及日常生活能力优于对照组(P0.05)。观察组的肺部感染(6.67%)、泌尿系感染(3.33%)、便秘并发症发生率(10%)低于对照组(分别为13.33%、16.67%及23.33%)(P0.05)。结论 :个体化分阶段护理模式对于不完全性脊髓损伤患者心理健康、功能康复及其减少并发症具有优势,值得应用推广。
[Abstract]:Objective: to explore the nursing effect of individualized and staged nursing model on patients with incomplete spinal cord injury (ISCI), and to provide reference for clinical nursing. Methods: from February 2015 to April 2016, 60 patients with ISCI were randomly divided into two groups: control group and observation group. In the control group, 10 cases were female (male 20), the mean age was 42.16 卤4.27 years (19 / 57), ASIA grade B (n = 9), C (n = 10), D (n = 11), spinal cord injury (n = 5), chest (n = 10) and lumbar (n = 15). In observation group, 8 cases were female, 22 cases were male, the age was 21-55 years (mean 45.23 卤6.72 years), 10 cases were ASIA grade B, 8 cases were grade C, 12 cases were grade D, spinal cord injury occurred in 6 cases of cervical segment, 9 cases of thoracic segment and 15 cases of lumbar segment. There was no significant difference in sex, age, spinal cord injury segment and ASIA grade between the two groups. The observation group was given individualized and staged nursing, including individualized and staged psychological rehabilitation, functional exercise and respiratory tract, intestinal tract, urinary management, and routine nursing during hospitalization in the control group. Before treatment and 90 days after treatment, Zung's self-rating depression scale (ISNCSCI-2013) and modified Barthel index scale were used to evaluate the mental health status (SDS score) of the two groups, in turn, the self-rating depression scale (ISNCSCI-2013) was used to evaluate the rehabilitation effect of the two groups. Motor and sensory functions and activities of daily living (ADL) were assessed and the incidence of complications during treatment was compared between the two groups. Results: the SDS scores were 61.51 卤2.3,40.11 卤2.1,62.22 卤2.9,50.50 卤3.1,62.22 卤2.9,50.50 in the observation group and control group before treatment and after treatment, respectively. The scores of motor function were 47.8 卤10.2 before treatment and 68.4 卤13.2 after treatment in observation group, 47.4 卤11.3 before treatment and 60.1 卤13.5 in control group. The scores of sensory function were 87.2 卤14.5 before treatment and 102.5 卤19.3 after treatment in the observation group, 88.3 卤14.7 before and 94.1 卤18.3 in the control group. The scores of activity of daily living before treatment and after treatment were 55.4 卤8.7,78.1 卤9.5,55.2 卤9.2,69.6 卤11.4 in the observation group and control group respectively. The observation group was better than the control group in mental health status, recovery of motor and sensory function and ability of daily living (P0.05). The incidence of pulmonary infection (6.67%), urinary tract infection (3.33%) and constipation complication (10%) in the observation group were lower than those in the control group (13.33%, 16.67% and 23.33%, respectively) (P0.05). Conclusion: the individualized and staged nursing model has advantages in mental health, functional rehabilitation and reduction of complications in patients with incomplete spinal cord injury, which is worth popularizing.
【作者单位】：佛山市中医院骨伤科门诊;
【分类号】：R473.6

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