Wang Jingjing, Wu Zhiping, Shi Shufang, Ren Jiangyan, Ren Xiaojia
Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China.
Teaching and Clinical Skills, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, China.
Front Neurol. 2024 Jul 26;15:1382696. doi: 10.3389/fneur.2024.1382696. eCollection 2024.
After craniotomy, patients require rehabilitation efforts for the recovery process, and neurologists are mostly engaged for that (in the management of post-craniotomy complications). However, neurologists are not always available for care after neurosurgery during follow-up (situation of our institute). The objectives of the study were to compare the effects of two different types of care (nurse-led and neurologist-led) on various long-term outcomes in patients who have undergone craniotomy due to traumatic brain injuries.
Electronic medical records of patients (aged ≥18 years) who underwent craniotomy for traumatic brain injuries and their caregivers were extracted and retrospectively reviewed. Patients received nurse-led care (NL cohort, = 109) or neurologist-led care (GL cohort, = 121) for 6 months after craniotomy.
Before the nurse-or neurologist-led care (BC), all patients had activities of daily living (ADL) ≤ 11, ≤ 50 quality of life (QoL), and 69% of patients had definitive anxiety, 87% of patients had definitive depression, and all caregivers had Zarit Burden interview scores ≥50. Nurse-led post-surgical care was associated with improved ADL and QoL, relieved anxiety and depression of patients, relieved the burden on caregivers, and the higher overall satisfaction of patients and their caregivers after 6-months of care (AC) as compared to their BC condition ( < 0.05) and also compared to those of patients in the GL cohort under AC condition ( < 0.01). Patients in the GL cohort reported pressure sores ( = 0.0211) and dizziness [15 (12%) vs. 5 (5%)] after craniotomy during follow-up than those in the NL cohort.
ADL, QoL, and psychological conditions of patients who undergo craniotomy for traumatic brain injuries must be improved and the burdens of their caregivers must be relived. Not only is the care provided by nursing staff equivalent to that offered by neurologists, but in some aspects, it is superior for patients who have undergone craniotomy for traumatic brain injuries and their caregivers during follow-up.
开颅手术后，患者需要进行康复治疗以促进恢复过程，而神经科医生大多参与其中（处理开颅术后并发症）。然而，在随访期间（我院的情况），神经科医生并非总能随时提供护理。本研究的目的是比较两种不同类型的护理（护士主导和神经科医生主导）对因创伤性脑损伤接受开颅手术患者的各种长期结局的影响。
提取并回顾性分析因创伤性脑损伤接受开颅手术的患者（年龄≥18岁）及其护理人员的电子病历。患者在开颅术后接受了6个月的护士主导护理（NL队列，n = 109）或神经科医生主导护理（GL队列，n = 121）。
在护士或神经科医生主导护理之前（BC），所有患者的日常生活活动能力（ADL）≤11，生活质量（QoL）≤50，69%的患者有明确的焦虑，87%的患者有明确的抑郁，所有护理人员的扎里特负担访谈得分≥50。与BC状态相比（P < 0.05），且与AC状态下GL队列的患者相比（P < 0.01），护士主导的术后护理与ADL和QoL的改善、患者焦虑和抑郁的缓解、护理人员负担的减轻以及6个月护理后（AC）患者及其护理人员更高的总体满意度相关。在随访期间，GL队列的患者开颅术后报告的压疮发生率（P = 0.0211）和头晕发生率[15例（12%）对5例（5%）]高于NL队列。
因创伤性脑损伤接受开颅手术患者的ADL、QoL和心理状况必须得到改善，其护理人员的负担必须得到减轻。对于因创伤性脑损伤接受开颅手术的患者及其护理人员在随访期间，护理人员提供的护理不仅等同于神经科医生提供的护理，而且在某些方面更具优势。
