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中国临床研究英文版:2024,37(10):1640-1645
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舒适化浅镇静护理模式在多发伤患者中的应用效果
(南京医科大学第一附属医院 江苏省人民医院急诊科,江苏 南京 210029)
Application effect of the early comfort using analgesia, minimal sedatives and maximal humane care model in patients with multiple injuries
(Department of Emergency Medicine, The First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China)
摘要
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Received:March 07, 2024   Published Online:October 20, 2024
中文摘要: 目的 探讨护士主导下舒适化浅镇静(eCASH)护理模式在多发伤患者中的应用效果,为临床针对多发伤的护理提供新的参考。 方法 分别选取江苏省人民医院2023年2月至12月、2022年2月至12日接受治疗的多发伤患者作为试验组和对照组,各102例。试验组采用护士主导下eCASH护理模式,对照组采用常规护理方法干预。记录两组的临床指标及预后指标。干预两周后,比较两组的昏迷状态、生理健康状态、疼痛程度、疼痛因子[5羟色胺(5-HT)、神经肽Y(NPY)]、负面情绪及护理满意度。 结果 试验组患者的机械通气时间[(8.03±1.67)d vs (10.45±2.01)d]、住院时间[(26.91±4.03)d vs (30.58±4.81)d]、酒石酸布托啡诺用量[(107.25±30.51)mg/(kg·h) vs (172.69±35.08)mg/(kg·h)]、右美托咪定用量[(271.83±60.29)mg/(kg·h) vs (502.73±72.15)mg/(kg·h)]均低于对照组(P<0.05)。试验组患者创伤后应激综合征和谵妄的发生率(14.71% vs 26.47%,1.96% vs 8.82%)低于对照组(P<0.05)。干预后,两组患者的格拉斯哥昏迷指数(GCS)评分较干预前升高,试验组高于对照组(P<0.05);两组患者的急性生理与慢性健康Ⅱ(APACHE Ⅱ)评分、Richmond躁动—镇静(RASS)评分、疼痛数字评价量表(NRS)评分、汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分、NPY水平均较干预前降低,试验组低于对照组(P<0.05)。两组患者的护理满意度均为100.00%。 结论 护士主导下eCASH护理模式应用于多发伤患者的临床实践中,有利于减少患者的麻醉药物使用量,缩短机械通气时间,减轻患者疼痛反应,缓解不良情绪,安全性良好,且护理满意度高。
Abstract:ObjectiveTo explore the application effect of nurse-led early comfort using analgesia, minimal sedatives and maximal humane care (eCASH) model in patients with multiple injuries, so as to provide a new reference for nursing of multiple injuries. Methods Multiple injury patients who received treatment at Jiangsu Province Hospital from February to December 2023, February to December 2022 were selected as the experimental group and the control group, respectively, with 102 cases in each group. The experimental group was subjected to the nurse-led eCASH model, while the control group received conventional nursing interventions. The clinical indexes and prognosis iudexes of the two groups were recorded. After two weeks of intervention, the levels of consciousness, physiological health status, pain intensity, pain factors [serotonin (5-HT), neuropeptide Y (NPY)], negative emotions, and nursing satisfaction were compared between the two groups. Results The duration of mechanical ventilation [(8.03 ± 1.67) d vs (10.45 ± 2.01) d], hospital stays [(26.91 ± 4.03) d vs (30.58 ± 4.81) d], dosage of butorphanol tartrate [(107.25 ± 30.51) mg /(kg·h) vs (172.69 ± 35.08) mg/ (kg·h)], and dosage of dexmedetomidine [(271.83 ± 60.29) mg /(kg·h) vs (502.73 ± 72.15) mg /(kg·h)] in the experimental group were lower than those in the control group (P<0.05). The incidence of post-traumatic stress syndrome and delirium of patients in the experimental group (14.71% vs 26.47%, 1.96% vs 8.82%) were lower than those in the control group (P<0.05). After intervention, the Glasgow Coma Scale (GCS) scores of both groups increased compared to before intervention, and the experimental group was higher than the control group (P<0.05). Acute Physiological and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores, Richmond Agitation-Sedation Scale (RASS) scores, and pain Numeric Rating Scale (NRS) scores, Hamilton Anxiety Scale (HAMA) scores, Hamilton Depression Scale (HAMD) scores, 5-HT and NPY levels all decreased compared to before intervention, and the experimental group were lower than the control group (P<0.05). The nursing satisfaction of both groups of patients was 100.00%. Conclusion The application of nurse-led eCASH model in the clinical practice of multiple injuries patients is beneficial in reducing the use of anesthesia drugs, shortening mechanical ventilation time, alleviating patient pain responses, relieving negative emotions, and ensuring good safety and high nursing satisfaction.
文章编号:     中图分类号:R473.6    文献标志码:B
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