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目的探讨音乐联合抚触的唤醒对动脉瘤性蛛网膜下腔出血后脑性昏迷的意识状态及神经功能的影响。方法选取2013年1月至12月在哈尔滨医科大学附属第四医院微创神经外科进行治疗的动脉瘤性蛛网膜下腔出血后脑性昏迷患者38例为对照组,给予脑性昏迷常规护理。选取2014年5月至2015年4月在同院微创神经外科进行治疗的动脉瘤性蛛网膜下腔出血后脑性昏迷患者41例为干预组,在对照组的基础上增加音乐联合抚触刺激法进行护理。分别评价患者护理前及护理1、2、3个月时患者的格拉斯哥昏迷评分(GCS)、脑功能障碍评分(DRS)、脑电监测(EEG)、听觉脑干诱发电位监测(ABEP)和苏醒情况。结果护理干预前,两组患者的GCS、DRS和EEG评分差异均无统计学意义(P均>0.05)。护理干预1、2、3个月时,干预组患者的GCS、EEG评分均高于对照组,差异有统计学意义(P均<0.05);而DRS评分明显低于对照组,差异有统计学意义(P<0.05)。两组患者ABEP各个潜伏期评分差异均无统计学意义(P均>0.05);干预后干预组患者的各个潜伏期评分均明显低于对照组,差异有统计学意义(P均<0.05)。干预组患者共苏醒36例,占87.80%,对照组苏醒17例,占44.74%,干预组总苏醒率与对照组比较,差异有统计学意义(P<0.05)。干预组在各时间段的苏醒率均高于对照组,差异有统计学意义(P<0.05);干预组患者苏醒时间为(54.3±6.7)d,明显短于对照组[(72.5±8.5)d,P<0.05]。结论音乐联合抚触唤醒法应用于动脉瘤性蛛网膜下腔出血后脑性昏迷患者,能明显改善患者的意识状况,缩短脑功能恢复时间及苏醒时间。
Objective To explore the effect of music combined with touch on awakening consciousness and neurological function of cerebral coma after aneurysmal subarachnoid hemorrhage. Methods Thirty-eight patients with cerebral coma after aneurysm subarachnoid hemorrhage treated with minimally invasive neurosurgery at the Fourth Affiliated Hospital of Harbin Medical University from January to December 2013 were selected as the control group and received routine nursing care of cerebral coma. Forty-one patients with cerebral coma after atrial aneurysm subarachnoid hemorrhage treated in Department of Minimally Invasive Neurosurgery from May 2014 to April 2015 were selected as the intervention group. Based on the control group, the music combined with touch stimulation Nursing. Patients were assessed for Glasgow Coma Scale (GCS), Brain Dysfunction Score (DRS), EEG, ABEP, and Recurrence before care and at Nursing 1, 2, Happening. Results Before nursing intervention, there was no significant difference in GCS, DRS and EEG scores between the two groups (all P> 0.05). The scores of GCS and EEG in intervention group were higher than those in control group (P <0.05), while the scores of DRS in intervention group were significantly lower than those in control group Significance (P <0.05). There was no significant difference in the latency score of ABEP between the two groups (P> 0.05). The score of each latency in the intervention group was significantly lower than that of the control group after intervention (P <0.05). There were 36 cases (87.80%) in the intervention group and 17 cases in the control group (44.74%). The total recovery rate in the intervention group was significantly higher than that in the control group (P <0.05). The recovery rate in intervention group was higher than that in control group (P <0.05). The recovery time in intervention group was (54.3 ± 6.7) d, which was significantly shorter than that in control group [(72.5 ± 8.5) d, P <0.05]. Conclusions The music combined with arousal awake method applied to patients with cerebral coma after aneurysmal subarachnoid hemorrhage can significantly improve the patients’ consciousness and shorten the recovery time and recovery time of brain function.