目的 对特殊部位脑膜瘤显微手术患者临床护理路径(Clinical nursing pathway,CNP)构建实践进行效果评价.方法 选择2013年1月—2016年3月行显微手术治疗的422例患者,分为实施CNP的路径组211例和对照组211例,对两组患者的住院满意度、焦虑情况、住院时间、并发症、护理不良事件进行比较,评价CNP在特殊部位脑膜瘤显微手术患者中的应用效果.结果 各特殊部位脑膜瘤路径组患者住院满意度均高于对照组(P<0.05),其中桥小脑角、矢状窦旁、岩斜区脑膜瘤路径组患者住院时间短于对照组(P<0.05),前颅底、枕骨大孔区、岩斜区脑膜瘤路径组患者焦虑程度低于对照组(P<0.05),住院期间路径组并发症、护理不良事件发生率低于对照组(P<0.05).结论 临床护理路径的构建实践能够提高特殊部位脑膜瘤显微手术患者住院满意度,缩短住院时间,缓解患者焦虑程度,降低患者术后并发症,促进患者机体康复.

目的 分析高分级颅内动脉瘤继发急性呼吸窘迫综合症(acute respiratory distress syndrome,ARDS)的高危因素,根据高危因素采取综合护理措施.方法 对我科近5年来19例高分级颅内动脉瘤合并ARDS的病人资料进行回顾性分析,对患者发病的高危因素及治疗方法进行讨论.结果 19例患者均诊断明确,10例抢救成功,9例死亡.对各种危险因素进行统计学分析,差异均有统计学意义(P<0.05).结论 高分级颅内动脉瘤并发ARDS病死率较高.预防高危因素的发生,早期诊断、早期治疗,早期精心护理以及正确使用呼吸机是其抢救成功的关键.

[Objective]To investigate the clinical value of noninvasive intracranial pressure monitoring in the treatment of posttraumatic acute diffuse brain swelling (PADBS) and to evaluate its significance to the prognosis.[Methods]A retrospective analysis of the clinical data of 69 patients with PADBS treated by neurosurgery from January 2009 to December 2014 in the 163 Hospital of People's Liberation Army was performed.All patients were in ICU ward within 2~24 hours after injury and were monitored by noninvasive intracranial pressure monitor (MICP-1A, flash visual evoked potential noninvasive intracranial pressure detection analyzer).Patients were divided into mild, moderate, and severe intracranial hypertension according to the value of noninvasive intracranial pressure monitoring and were treated accordingly based on their symptoms and brain CT examination.The Glasgow prognosis scores were evaluated for patients' prognosis among different types of PADBS.[Results]The overall accurate prognosis rate was 43.5% (30/69) and poor prognosis rate was 56.5% (39/69).The mortality rate was 31.8% (22/69).The accurate prognosis rates of mild, moderate, and severe intracranial hypertension patients were 90.1% (10 / 11), 65.22% (15/23), and 14.29% (5/35), respectively.The accurate prognosis of patients with mild intracranial hypertension was significantly higher than that of moderate and severe intracranial hypertension.The difference was statistically significant (P<0.05).The proportion of death in patients with severe intracranial hypertension was significantly higher than that in patients with mild to moderate intracranial hypertension;the difference was statistically significant (P<0.05).[Conclusion]The value of noninvasive intracranial pressure monitor was closely related to the prognosis of PADBS patients.Continuous monitoring can provide an important indicator for the treatment of posttraumatic acute diffuse brain swelling.

Objective To investigate the effect of flash visual evoked potential(FVEP)noninvasive in-tracranial pressure (ICP)monitoring combined with simple invasive ICP monitoring in the treatment of acute traumatic brain swelling. Methods A lot of 39 cases suffered acute traumatic brain swelling carried out non-invasive and simple invasive ICP monitoring admitted from January 2010 to December 2014 were analyzed retro-spectively. The GCS scored 3 to 5 in 8 cases,6 to 8 in 17 cases and 9 to 12 in 14 cases. CT scanning showed midline shift <5 mm in 11,5 to 10 mm in 10,>10 mm in 6 and bilateral diffuse cerebral swelling in 12 ca-ses. According to initial ICP,all cases were divided into three types:11 of mild intracranial hypertension type (ICP l5~25 mmHg),13 of mid intracranial hypertension type (ICP 25~35 mmHg)and 15 of severe intracra-nial hypertension type (ICP>35 mmHg). Results The eusemia rate of mild,mid and severe intracranial hypertension patients was 90. 1%(10/11),61. 5%(8/13)and 20%(3/15),the unfavourable prognosis rate was 9. 1%(1/11),38. 5%(5/13)and 80%(12/15);there was statistic differences between two groups (P<0. 05). Conclusions The initial ICP is correlated to prognosis in the acute traumatic brain swelling pa-tients. The technique of FVEP noninvasive combined with simple invasive ICP monitoring is manipulative and practical,and can be popularized in basic hospital. The ICP monitoring combined with external ventricular drainage can play an important role in the treatment of acute traumatic brain swelling.

失禁性皮炎(IAD)是潮湿相关性皮肤损伤(MASD)中的一种,是由于皮肤暴露于大小便中而引起的一种刺激性皮炎,主要由大小便失禁,会阴及外生殖器周围的皮肤接触尿或粪便而引起,其主要表现为肛周皮肤发红、产生水泡、水肿及含澄清渗出物的大小疱[1].重症监护室(ICU)患者由于机械通气、肠道感染、广谱抗生素及肠内营养液的使用等多种原因导致腹泻发生率较高.有研究显示,危重患者腹泻致IAD发生率可高达11.26%[2].IAD不仅仅会给患者带来痛苦,还会延长住院时间,增加经济负担,给护理工作带来极大的不便[3].如何缩短IAD的治愈时间、提高治愈率,是目前护理的重点及难点.本院应用磺胺嘧啶银粉治疗IAD,效果显著,现将结果报告如下.

Objective To analyze the risk factors of multi-drug resistant bacteria infection in patients with tracheotomy at department of neurosurgery in order to provide reference for clinical prevention and treatment of hospital infection.Methods Two hundred and sixteen patients with tracheotomy between September 2014 and September 2016 at our department were divided into MDRB group (multi-drug resistant bacteria infection) and NMDRB group (non multi-drug resistant bacteria infection).Sputum samples were collected for culture,isolation and identification of bacteria strains.Drug sensitivity tests were carried out.Hospital infectio(n) related factors were collected,and the risk factors were analyzed.Results There were 43 patients with multiple drug resistant bacteria infection (19.9％).From the 43 patients,68 strains of pathogenic bacteria were identified in which the main pathogens were gram-negative bacilli.Univariate analysis showed that there were significant differences in age,smoking history,diabetes,disturbance of consciousness,tracheotomy time,bedtime,hypoalbuminemia,combined use of broad-spectrum antibiotics and mechanical ventilation time between the two groups (P ＜ 0.05).Multivariate logistic regression analysis showed that age,diabetes,disturbance of consciousness,time of tracheotomy,hypoalbuminemia,combined use of broad-spectrum antibiotics and duration of mechanical ventilation were independent risk factors of multi-drug resistant bacteria infection in these patients.Conclusion The patients with tracheotomy at department of neurosurgery prone to multi-drug resistant bacteria infection,especially gram negative bacilli.Age,diabetes,disturbance of consciousness,time of tracheotomy,hypoalbuminemia,combined use of broad-spectrum antibiotics and duration of mechanical ventilation are independent risk factors of multi-drug resistant bacteria infection in these patients.Cluster nursing should be taken to prevent and control the hospital infection.

目的：探讨中医针灸疗法配合高压氧治疗脑干梗死患者的疗效。方法将2012年1月至2014年9月共收治脑干梗死患者27例随机分为观察组（15例）与对照组（12例），分别采用药物、高压氧配合中医针灸法相结合的方式以及药物与高压氧治疗相结合的方式进行治疗，比较治疗后患者日常生活活动情况（ADL）评分。结果系统治疗2个疗程后，参照 Barthel 指数对治疗前后的 ADL 进行评分，观察组 ADL 评分值明显升高，对照组 ADL评分值上虽然也有升高，但变化幅度相对较小，2组比较差异有统计学意义（P ＜0．05）。结论应用针灸配合高压氧治疗脑干梗死，治疗效果显著，患者生活质量得到最大程度的改善。

Objective]To observe the effect of using modified early warning score (MEWS) on the screen‐ing of potential critical illnesses in the Department of Neurosurgery .[Methods]Two hundred and four cases in the Department of Neurosurgery from July to December 2014 were selected as the control group .These cases experienced the routine nursing scheme .Two hundred and eighty‐four cases in the Department of Neurosurger‐y from January to June 2015 were selected as the observation group .MEWS scores were observed for these ca‐ses .Procedural nursing varied according to the MEWS scores .The nursing effect in two groups was compared .[Results]The incidence of accidents was lower(5 .63% vs 16 .17% ,χ2 = 4 .44 ,P < 0 .05) ,the preparation time of rescue was shortened[(2 .54 ± 1 .80)min vs (7 .06 ± 2 .65)min ,t = 6 .85 ,P < 0 .01] ,the rate of successful rescue was higher(87 .5% vs 39 .4% ,χ2 = 8 .64 ,P < 0 .01) ,and the GOS Scores when discharged was higher [(4 .41 ± 0 .85)vs (3 .40 ± 2 .07) ,t = 7 .62 ,P < 0 .01] in the observation group than that of the control group . And MEWS was negatively correlated with GOS ( r = - 0 .659) .[Conclusion]MEWS scores can effectively fil‐ter potential critical illness in neurosurgery ;it can help detect and handle condition changes in time so as to im‐prove the quality of care and harmony between nurse and patient .

Objective To investigate the nursing countermeasures to posterior fossa tumors complicated by subcutaneous effusion after microsurgery.Methods Clinical data and nursing countermeasures of 31 patients with subcutaneous effusion after surgery for posterior fossa tumors were analyzed retrospectively.Results After intensive care and positive symptomatic treatment,29 patients received follow-up,1 patient underwent bypass surgery due to hydroceph-alus,and 1 patient underwent craniotomy again due to recurrence after continuous lumbar punc-ture drainage.The remaining cases had good prognosis.Conclusion Subcutaneous effusion is a common complication after surgery for posterior fossa tumors,and early detection and proper treatment can prevent infection and lead to good prognosis.

目的 探讨桥小脑角脑膜瘤显微手术应用临床护理路径的护理效果.方法 将102例住院治疗的桥小脑角脑膜瘤显微手术患者随机分为对照组和路径组各51例,对照组采用常规护理方法,路径组在常规护理的方法上严格执行临床护理路径予以护理,比较两组患者的住院天数、术后并发症发生率、不良事件发生率及满意度.结果 路径组的住院天数、术后并发症发生率及护理不良事件发生率低于对照组,差异有统计学意义(均P ＜0.05);路径组的满意度高于对照组,差异有统计学意义(P＜0.05).结论 在桥小脑角脑膜瘤显微手术患者中实施临床护理路径,可以有效提高护理质量,明显缩短患者住院时间,减少术后并发症发生率,提高护理满意度.

目的:通过实施心理护理来完善神经外科脑肿瘤患者护理工作,从而提高神经外科肿瘤护理工作的质量.方法:针对神经外科脑肿瘤患者特点,有效改进并实施心理护理措施.结果:采用zung评定抑郁量表(SDS)和评定焦虑量表(SAS)进行评定,在实施心理护理措施后,患者在心理状态上有显著好转,同时对护理工作满意度也有明显提高.结论:心理护理在神经外科脑肿瘤患者护理工作中具有举足轻重的地位,其在有效调整患者机体及心理状态的同时,增加了患者对医院护理工作的认同,有利于构建和谐的医患关系.

目的探讨全方位护理在行脐血源间充质干细胞移植患者中的有效性。方法对81例患者在经蛛网膜下腔注入脐血源间充质干细胞后,根据手术要求制定了一系列的护理计划,包括术前宣教及常规术前准备,术后体位、术后知识宣教、术后密切观察和预防并发症及康复指导等,确保了脐血源间充质干细胞移植的治疗效果。结果对脐血源间充质干细胞移植患者行全方位护理后,干预前后结果有统计学意义(P<0.05)。结论全方位护理可有效提高行脐血源间充质干细胞移植患者的治愈率。

[目的]总结对外伤性脑脊漏患者的临床观察与护理经验.[方法]305例颅脑外伤合并外伤性脑脊液漏患者密切配合治疗,严密观察患者的意识、瞳孔、生命体征的变化及脑脊液漏的情况,预防逆行感染并加强心理护理.[结果]305患者中279例经保守治疗痊愈,26例因脑脊液漏口超过4周不愈,行脑脊液漏口修补手术治疗,其中仅1例感染经二次手术治愈.[结论]密切的护理配合能有效降低外伤性脑脊液漏患者颅内感染的发生率,促进漏口愈合.

Objective Analysis of risk factors of ARDS caused by severe traumatic brain injury,adopt effective precautions and nursing interventions according to risk factors.Methods The datas of 28 patients with severe traumatic brain injury caused ARDS during last five years were retrospectively analyzed and the incidence of patient risk factors and treatment methods were discussed.Resul 28 patients were diagnosed clearly,16 patients were successfully rescued and 12 patients died.The achievement ratio of rescue is up to 57.1%.Conclusion Severe craniocerebral injury complicated by ARDS caused a high mortality.To prevent the occurrence of risk factors,early diagnosis,early tracheotomy and the correct use of breathing machine as well as high qualified basic nursing are the key to the success of their rescue.

Objective To investigate the application of procedural management in nursing work of Neurosurgical ICU.Methods Instruments and equipment,drugs,nursing staff,procedures of nursing and nursing regulaitons were procedurally managed with perfected rules and regulations,standarized nursing procedure and established emergency preplans.Results Since the practice of procedural management for half a year,nurses' preparation time before emergency surgery was significantly shortened and patients and families' satisfaction about each index of nursing quality was greatly improved(P0.001,P0.05).The degree of recognitiun for procedural management by nurses was above 91%.Conclusion Application of procedural management in neurogical ICU can enhance the work efficiency,degree of patients' satisfaction and nursing qualities.

【目的】探讨颅内巨大脑膜瘤显微手术的护理经验。【方法】回顾性分析本院开展颅内巨大脑膜瘤显微手术病人术前准备、心理护理、术后的病情观察及并发症防治等围手术的护理方案。【结果】临床痊愈80例,好转18例,死亡4例,颅内继发血肿再手术3例,气管切开5例。【结论】术前有效心理护理,术后加强病情观察,积极防治并发症是脑膜瘤术后病人顺利康复的重要条件。