Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Int J Nurs Stud. 2017 Sep;74:44-52. doi: 10.1016/j.ijnurstu.2017.05.014. Epub 2017 Jun 4.
Despite the well-defined effects of sensory stimulation, the knowledge of the pure effects of affective stimulation is scarce.
To evaluate the effects of family-centered affective stimulation on the level of consciousness among comatose patients with brain injuries.
This study was designed as a three-group double-blinded Randomized Controlled Trial.
Ninety consecutive patients with traumatic brain injuries and a Glasgow Coma Scale score of 5-8 were selected. Patients were randomly allocated to an experimental, a placebo, and a control group using permuted block randomization. Affective stimulation intervention was provided to patients in the experimental group by their family members twice a day during the first seven days of their hospitalization. In the placebo group, a sensory stimulation program was implemented by a fixed trained person who was not familiar with the patients. Patients in the control group solely received sensory stimulation which was routinely provided to all patients. The level of consciousness among the patients using the Glasgow Coma Scale and Coma Recovery Scale-Revised were measured both before and after a family visit. The SPSS software (version 17.0) was used to analyze the data through running the one-way and the repeated measure analyses of variance.
Despite an insignificant difference among the groups regarding baseline level of consciousness, the results of the one-way analysis of variance revealed at the seventh day of this study, however, the level of consciousness in the experimental group was significantly higher (9.1±2.1) than the placebo (7.2±1.1), the control groups (6.6±1.7) (P<0.001), subsequently. Moreover, at the seventh day of the study, the Coma Recovery Scale score in the experimental group (11.9±3.7) was significantly greater than the placebo (9.0±2.0) and the control (6.6±1.6) groups (P<0.001). Recovery rate and effect size values also confirmed the greater effectiveness of affective stimulation compared with pure sensory stimulation.
Our findings in this study indicate that early family-centered affective stimulation is more effective than sensory stimulation in improving the level of consciousness among comatose patients with brain injuries. Family-centered affective stimulation is recommended to be integrated into the nursing curricula and routine care plans for comatose trauma patients in intensive care units.
尽管感官刺激的效果已经得到明确界定，但情感刺激的纯粹效果却知之甚少。
评估以家庭为中心的情感刺激对脑损伤昏迷患者意识水平的影响。
这是一项三组分双盲随机对照试验。
连续纳入 90 例创伤性脑损伤且格拉斯哥昏迷量表评分为 5-8 分的患者。采用区组随机化方法将患者随机分为实验组、安慰剂组和对照组。在患者住院的头 7 天，实验组患者的家属每天进行两次情感刺激干预。在安慰剂组，由一位不熟悉患者的固定训练人员实施感觉刺激方案。对照组患者仅接受常规提供给所有患者的感觉刺激。使用格拉斯哥昏迷量表和昏迷恢复量表修订版评估患者在家庭探视前后的意识水平。采用 SPSS 软件（版本 17.0）进行数据分析，采用单向和重复测量方差分析。
尽管各组患者在基线意识水平方面无显著差异，但在本研究的第 7 天，单向方差分析结果显示，实验组患者的意识水平（9.1±2.1）显著高于安慰剂组（7.2±1.1）和对照组（6.6±1.7）（P<0.001）。此外，在研究的第 7 天，实验组患者的昏迷恢复量表评分（11.9±3.7）显著高于安慰剂组（9.0±2.0）和对照组（6.6±1.6）（P<0.001）。恢复率和效应量值也证实了情感刺激比单纯感觉刺激更有效。
本研究结果表明，早期以家庭为中心的情感刺激比感觉刺激更能有效改善脑损伤昏迷患者的意识水平。建议将以家庭为中心的情感刺激纳入重症监护病房昏迷创伤患者的护理课程和常规护理计划中。
