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统计我院33例重型颅脑损伤患者的临床监护及护理,其主要临床表现:意识障碍,呼吸异常,颅内压升高,动脉血气分析异常,体温升高,肺部感染及肌肉萎缩。通过监护与护理,成活患者大部分肢体活动障碍及失语得到恢复,治愈率75.8%,死亡率18.2%。体会:重型颅脑损伤后,因氧不足加重脑细胞损害,呼吸功能障碍是颅脑外伤最常见的死因,加强呼吸管理对脑保护非常重要,包括呼吸道插管及拔管后的监护与护理,观察肺部体征、吸痰、生理盐水+庆大霉素气道冲洗,雾化吸入、翻身、保证呼吸道通畅。重型颅脑损伤患者颅压升高明显,随时可危及生命,应密切观察病人意识、瞳孔、呼吸,护理中避免影响颅内压。因重型颅脑损伤患者皮肤失去神经支配,而有运动调节障碍,肢体受压,褥疮是这类病人常见的并发症,治疗困难,难以愈合。在我们工作中应加强气垫护理,定时受压部位按摩、理疗,尽早开始肢体活动。通过对病人在呼吸、意识、皮肤及肢体方面的监护护理,患者病情得到满意恢复,大大减少了病死率及致残率。
Statistics of 33 cases of severe head injury in our hospital clinical care and nursing, its main clinical manifestations: disturbance of consciousness, respiratory abnormalities, increased intracranial pressure, arterial blood gas analysis abnormalities, increased body temperature, lung infection and muscle atrophy. Through guardianship and care, most of limb survivors and aphasia survived were recovered, with a cure rate of 75.8% and a mortality rate of 18.2%. Experience: After severe craniocerebral injury, due to lack of oxygen to aggravate brain cell damage, respiratory dysfunction is the most common cause of traumatic brain injury, strengthening respiratory management is very important for brain protection, including respiratory intubation and extubation care and care, Observe the signs of the lungs, suction, saline + gentamicin airway flushing, inhalation, stand up, to ensure airway patency. Patients with severe head injury increased intracranial pressure significantly, at any time can be life-threatening, should closely observe the patient awareness, pupil, breathing, nursing to avoid affecting intracranial pressure. Because of severe craniocerebral injury in patients with loss of innervation of the skin, and motor regulation disorders, limb compression, bedsore is a common complication of such patients, treatment difficulties, it is difficult to heal. In our work should strengthen the air cushion care, regular pressure massage, physical therapy, physical activity as soon as possible. Through patient care, respiration, awareness, skin and limb care, the patient’s condition was satisfactorily restored, greatly reducing mortality and morbidity.