Department of Neurosurgery Ward 3, Xingtai Third Hospital, Xingtai Cardiovascular Disease Hospital, Xingtai City, Hebei Province, China.
Medicine (Baltimore). 2024 Mar 22;103(12):e37644. doi: 10.1097/MD.0000000000037644.
To explore the effectiveness of multidisciplinary management based on a clinical nursing pathway model for the treatment of hypertensive intracerebral hemorrhage (HICH).
A total of 124 patients with HICH admitted to our hospital between February 2021 and June 2023 were selected as research subjects in this randomized, controlled, unblinded study. They were divided into Control-group and Study-group using a random number table method, with 62 cases in each group. The Control-group received routine care and the Study-group adopted a multidisciplinary management approach based on the clinical nursing pathway model. A multidisciplinary intervention group including 1 attending physician, 1 psychotherapist, 1 nutritionist, 1 rehabilitation specialist, and 4 responsible nurses was constructed. From preoperative to postoperative day, patients were provided with psychological intervention, health education, respiratory tract management, and specific care for patients who were restless. One to 3 days after operation, the patients and their family members were guided in basic postoperative care and nutrition care. From the 4th day after surgery to the 1st day before discharge, patients were guided for rehabilitation exercises. Patients also received discharge advices upon discharge. Activities of daily living, neurological function, stress response indicators, incidence of complications, and nursing satisfaction before and after the intervention were compared between the 2 groups.
After the intervention, the activities of daily living and neurological function of the 2 groups were significantly improved compared to before the intervention, and the Study-group was significantly higher than the Control-group (P < .05). After intervention, the levels of stress response indicators in both groups significantly decreased compared to before the intervention, and the Study-group was significantly lower than the Control-group (P < .05). The incidence of complications in the Study-group (3.23%) was lower than that in the Control-group (15.00%) (P < .05). Nursing satisfaction in the Study-group (95.16%) was higher than that in the Control-group (83.33%) (P < .05).
Our findings indicate that adopting a multidisciplinary management approach based on clinical nursing pathways to intervene in patients with HICH can reduce stress response levels, reduce the risk of complications, and facilitate the recovery of neurological function and activities of daily living with high patient satisfaction.
探讨基于临床护理路径模型的多学科管理治疗高血压性脑出血（HICH）的效果。
采用随机、对照、非盲法，选取 2021 年 2 月至 2023 年 6 月我院收治的 124 例 HICH 患者为研究对象，采用随机数字表法分为对照组和观察组，每组 62 例。对照组给予常规护理，观察组采用基于临床护理路径模型的多学科管理方法。构建包括 1 名主治医生、1 名心理治疗师、1 名营养师、1 名康复专家和 4 名责任护士的多学科干预小组。从术前到术后第 1 天，为患者提供心理干预、健康教育、呼吸道管理以及躁动患者的特殊护理。术后第 1-3 天，指导患者及其家属进行术后基本护理和营养护理。术后第 4 天至出院前 1 天，指导患者进行康复锻炼。患者出院时给予出院建议。比较两组患者干预前后日常生活活动能力、神经功能、应激反应指标、并发症发生率和护理满意度。
干预后，两组患者日常生活活动能力和神经功能均明显优于干预前，观察组明显优于对照组（P ＜ 0.05）。干预后，两组患者应激反应指标水平均明显低于干预前，观察组明显低于对照组（P ＜ 0.05）。观察组并发症发生率（3.23%）低于对照组（15.00%）（P ＜ 0.05）。观察组护理满意度（95.16%）高于对照组（83.33%）（P ＜ 0.05）。
采用基于临床护理路径的多学科管理方法对 HICH 患者进行干预，可以降低应激反应水平，降低并发症风险，促进神经功能和日常生活活动能力的恢复，患者满意度高。
