中西医结合护理促进脑出血显微术后患者康复的临床效果
[摘要] 目的 探讨中西医结合护理干预对脑出血显微术后患者康复的临床效果。 方法 将2010年1月～2013年1月浙江医院收治的基底节区脑出血经侧裂-岛叶入路显微手术治疗患者60例，按照随机分组原则分为观察组与对照组，每组各30例。对照组术后给予常规脑出血显微术后神经外科护理方案进行干预；观察组术后在常规护理方案的基础上，结合中医护理理论，进行中西医结合护理干预。护理干预10周后，对两组患者的临床神经功能缺损评分、Fugl-Meyer评分及Batbel指数评分进行比较。护理干预1年后，对两组患者的临床护理效果进行评价。 结果 观察组经过10周护理干预后，临床神经功能缺损评分、改良Fugl-Meyer评分、Batbel指数评分指标均较对照组有所改善，且差异均有统计学意义（t = 4.782、7.908和8.117，P < 0.05或P < 0.01）。护理介入治疗1年后，观察组患者的总有效率为93.3%，优于对照组（73.3%），且差异有统计学意义（χ2=4.32，P < 0.05）。 结论 基底节区出血的患者采用经侧裂-岛叶入路显微手术结合术后中西医结合护理干预治疗能提高手术成功率，降低患者病死率，并能加速术后神经功能康复，较传统护理模式有一定的优势，是一种安全、有效的治疗方法。
[中图分类号] R473.5[文献标识码] B[文章编号] 1673-7210（2014）06（b）-0106-04
Clinical effect of integrative care for promotion of cerebral hemorrhage patients rehabilitation after microsurgery
JIN Hongyan ZHOU Jianmin ZHENG Qun ZHENG Shengming
Zhejiang Hospital, Zhejiang Province, Hangzhou 310013, China
[Abstract] Objective To investigate clinical effect of integrative care for promotion of cerebral hemorrhage patients rehabilitation after microsurgery. Methods 60 patients from January 2010 to January 2013 in Zhejiang Hospital between basal ganglia hemorrhage through lateral fissure - insular approach for microsurgical treatment of after surgery, in accordance with the principle of randomization were divided into observation group and control group with 30 cases in each group. The control group were treated with routine postoperative cerebral hemorrhage microsurgery neurosurgery care program intervention; observation group were given the conventional care regimens combined with traditional Chinese medicine nursing theory, for integrative nursing intervention. Nursing intervention after 10 weeks, two groups of patients in clinical neurological deficit score, Fugl-Meyer score and Batbel index scores were compared. Nursing intervention after 1 year, the effect of clinical care in two groups of patients were evaluated. Results Compared with the control group, observation group improved after 10 weeks of nursing intervention with clinical neurological deficit score, Fugl-Meyer score and Batbel index scores, and the differences were statistically significant (t = 4.782, 7.908, 8.117, P < 0.05 or P < 0.01). Nursing interventions after 1 year of treatment, the total effective rate of patients in observation group was 93.3%, which was better than 73.3% of the control group, and the difference was statistically significant (χ2=4.32, P < 0.05). Conclusion Basal ganglia hemorrhage treated by lateral fissure - insular approach combining surgery microsurgery integrative care intervention can improve the success rate and reduce the mortality, and can accelerate postoperative neurological rehabilitation, the more traditional care model has certain advantages too, and it is a safe and effective method of treatment.
[Key words] Cerebral hemorrhage; Microsurgical operation; Integrated traditional Chinese and Western medicine; Nursing intervention
基底节是埋藏在两侧大脑半球深部的一些灰质团块，是组成锥体外系的主要结构。基底节区的范围主要包括尾状核、豆状核以及屏状核。这一区域是脑出血（尤其是高血压性脑出血）的好发部位，一旦发病会严重危害患者的生命健康及生存质量[1-2]。浙江医院3年来通过显微手术联合中西医结合护理干预治疗基底节区脑出血患者，现将护理体会报道如下：
近年来国家卫生和计划生育委员会为了加强医院临床护理工作，专门下发了《优质护理服务示范工程”活动方案》，该文件明确要求临床护理工作中要将传统简单式、片段式的护理模式，转变成全面、全程、无缝隙的整体护理模式[9]。本研究根据这一精神，认真分析了传统脑出血术后护理模式的不足，传统护理中护士按照打针、输液、发药等具体护理工作进行分工，这种模式使每名护士对患者的照顾是片段式的，并且偏重治疗，忽视了对患者的整体照顾，不利于患者的康复[10]。笔者进一步分析认为，中医护理理论中的整体观念和辨证施护正好符合优质护理的要求。中医护理的优点在于强调整体观念，运用辨证施护的思想和方法，根据临床所见病症，针对不同病情，应用扶正祛邪，标本缓急，同病异护，异病同护，正护反护，以及因人、因时、因地制宜和预防为主等护理原则来制订相应的护理措施[11]。中医将脑出血归为于中风的“闭证”、“脱证”，同时认为血瘀是致病的主要病机，通过中医的整体护理及辨证施护可以加强活血化瘀的疗效，同时还能给予患者具有中医特色的康复指导、健康宣教、情志护理等，与常规护理优势互补，进一步促进了患者的康复，提升护理服务质量[12]。
本文结果显示，在行中西医结合护理干预治疗10周后患者的临床神经功能缺损程度评分、Fugl-Meyer评分法评定及Bathel指数评分均优于传统护理方案。同时，本研究在对观察组30例患者随访1年后发现，除1例患者病情恶化，1例疗效无变化外，其余28例患者各项症状均得到明显缓解，且在治疗过程中未出现其他严重并发症，总有效率达到93.3%，优于对照组（73.3%）。据此笔者认为基底节区出血的患者采用经侧裂-岛叶入路显微手术结合术后采用中西医结合护理干预治疗能提高手术成功率、降低患者病死率，并能加速术后神经功能康复，极大地提高了脑出血术后患者的的生存率和生活质量，较传统护理模式有明显优势，是一种安全、有效的术后辅助治疗方法。
