[1]郝庆英,付婵娟,张晓华,等.颈椎前路术后硬膜外血肿的临床护理[J].中国中医骨伤科杂志,2015,23(03):32-35.
　HAO Qingying,FU Chanjuan,ZHANG Xiaohua,et al.Clinical Observation and Nursing Care on Post-operative Epidural Hematoma with Anterior Cervical Approaches[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2015,23(03):32-35.
点击复制

颈椎前路术后硬膜外血肿的临床护理
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第23卷
期数:
2015年03期
页码:
32-35
栏目:
临床研究
出版日期:
2015-03-15

文章信息/Info

Title:
Clinical Observation and Nursing Care on Post-operative Epidural Hematoma with Anterior Cervical Approaches
文章编号:
1005-0205(2015)03-0032-04
作者:
郝庆英1; 付婵娟1; 张晓华1; 谭明生1△;
1中日友好医院(北京,100029)
Author(s):
HAO Qingying1; FU Chanjuan1; ZHANG Xiaohua1; TAN Mingsheng1;
1China-Japan Friendship Hospital, Beijing 100029, China.
关键词:
颈椎;  手术后医护;  神经功能恶化
Keywords:
cervical vertebrae;  postoperative care;  neurological deterioration
分类号:
R473.6
文献标志码:
A
摘要:
目的:探讨颈椎前路术后硬膜外血肿患者的临床护理要点。方法:回顾分析我院2001年1月-2013年6月1682例行颈椎前路手术病例,共12例(0.71%)发生术后血肿并行急诊手术。其中男8例,女4例; 年龄38～69岁,平均52.5岁。护理措施包括:1)术前按规范行评估、宣教及训练; 2)术后严密观察生命体征和神经功能,强调及时医护、医患沟通; 3)术后正确给药、重视心理护理并给予康复训练指导。结果:12例患者急诊行原入路探查、血肿清除术后症状即刻或逐渐改善。随访6～24个月(平均12个月),脊髓神经功能评价采用ASIA分级,其中手术前B级1例、C级5例、D级6例,末次随访时C级2例、D级5例、E级5例。结论:对于颈椎前路患者,严密观察生命体征和神经功能、及时医护沟通、早期发现术后硬膜外血肿并尽快再次手术清除血肿,是及时抢救患者生命、恢复神经功能的关键。另外,采取积极有效的护理措施和康复训练可有效地降低致残率,提高神经功能的恢复。
Abstract:
To investigate the nursing care for patients suffering post-operative epidural hematoma with anterior cervical approaches. Methods: All 1682 patients received surgeries with anterior cervical approaches from January 2001 to June 2013. Twelve cases(0.71%, male 9 cases, female 6 cases, mean age 52.5 years)suffered from post-operative epidural hematoma and treated with emergency surgeries. The nursing interventions included: 1)Evaluate the condition of patients, and give propaganda, education and training to the patients before the surgery; 2)Observe the vital signs and nerve function intensively after the surgery, and pay attention to the communication between doctors, nurses and patients; 3)Use medicine correctly, give mental nursing and rehabilitation training. Results: All the cases were given surgeries with the same approach to remove the hematoma. Symptoms had alleviated right after the surgery or gradually. All patients were followed up for 6～24 months(mean time 12 months). ASIA classification was used to evaluate the nerve function of the patients. There were 6 cases in D, 5 cases in C and 1 case in B before the surgery. At the last follow-up there were 2 cases in C, 5 cases in D and 5 cases in E after the surgery. Conclusion: It is very important to observe the vital signs and nerve function of patients with post-operative epidural hematoma. It is crucial to discover the symptoms and inform the doctors in time. Besides, effective nursing interventions and rehabilitation training can decrease disability rate and enhance the recovery of nerve function.

参考文献/References:

[1] 张宏其,陈凌强,刘少华,等.颈椎前路术后硬膜外血肿的相关因素分析及防治[J].中国脊柱脊髓杂志,2009,19(7):506-509.
[2] ALAWNEH J A,MOUSTAFA R R,BARON J C.Hemodynamic factors and perfusion abnormalities in early neurological deterioration[J]. Stroke,2009,40(6):e443-450.
[3] DOKAI T,NAGASHIMA H,NANJO Y,et al.Surgical outcomes and prognostic factors of cervical spondylotic myelopathy in diabetic patients[J]. Arch Orthop Trauma Surg,2012,132(5):577-582.
[4] 王新伟,袁文,陈德玉,等.颈椎病术后早期神经功能严重恶化原因分析[J].中华骨科杂志,2009,29(12):6.
[5] NEW P W.Functional outcomes and disability after nontraumatic spinal cord injury rehabilitation:Results from a retrospective study[J].Arch Phys Med Rehabil,2005,86(2):250-261.
[6] AONO H,OHWADA T,HOSONO N,et al.Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery[J]. J Neurosurg Spine,2011,15(2):202-205.
[7] 王少波,蔡钦林,党耕町,等.颈椎椎管扩大术后硬膜外血肿[J].中华骨科杂志,1999,19(2):86-88.
[8] OMORI N,TAKADA E,NARAI H,et al.Spontaneous cervical epidural hematoma treated by the combination of surgical evacuation and steroid pulse therapy[J]. Intern Med,2008,47(5):437-440.
[9] 邓益帼,魏明霞,麦春蕾. 外科患者围手术期的心理护理[J]. 中国医疗前沿,2008,3(16):116-117.
[10] KUNIHIRO M,SOMURA H,MATSUMOTO M,et al.Changes in psychological features in patients for anesthesia and operation during perioperative period[J].Masui,1998,47(9):1085-1089.
[11] 张飞兰. 颈椎手术围手术期康复护理[J]. 现代中西医结合杂志,2007,16(23):3429-3430.

备注/Memo

备注/Memo:
收稿日期:2014-08-12
基金项目:国家自然科学基金(项目批准号:81173423)
△通讯作者 E-mail:zrtanms@sina.com
更新日期/Last Update: 2015-03-01