CAJ | 학술논문

总结42例动脉瘤性蛛网膜下腔出血后迟发性缺血性神经功能障碍（DIND）的临床特点及护理对策。认为动脉瘤性蛛网膜下腔出血患者延迟性缺血性神经功能障碍的主要临床特点为紧张焦虑等心理障碍、颅内压增高、血液黏稠度增高、脑血管痉挛、动脉瘤再破裂，以及中枢性高热、水电解质平衡失调、肺部感染等并发症。应采取有针对性的护理措施，护理重点包括：加强心理护理；避免诱发脑血管痉挛及动脉瘤再破裂的诱因，并警惕两者先兆症状的观察及变化，控制患者血压；注重动态分析患者颅内压监护仪、红细胞压积、经颅多普勒、颅脑CT等检查结果，着重观察监测指标异常的患者，发现异常情况及时报告医生处理；并发症预防与护理。全组治疗结果根据Glasgow预后评分：Ⅰ级17例，Ⅱ级11例，Ⅲ级4例，Ⅳ级2例，Ⅴ级8例；病死率19%。
총결42례동맥류성주망막하강출혈후지발성결혈성신경공능장애（DIND）적림상특점급호리대책。인위동맥류성주망막하강출혈환자연지성결혈성신경공능장애적주요림상특점위긴장초필등심리장애、로내압증고、혈액점주도증고、뇌혈관경련、동맥류재파렬，이급중추성고열、수전해질평형실조、폐부감염등병발증。응채취유침대성적호리조시，호리중점포괄：가강심리호리；피면유발뇌혈관경련급동맥류재파렬적유인，병경척량자선조증상적관찰급변화，공제환자혈압；주중동태분석환자로내압감호의、홍세포압적、경로다보륵、로뇌CT등검사결과，착중관찰감측지표이상적환자，발현이상정황급시보고의생처리；병발증예방여호리。전조치료결과근거Glasgow예후평분：Ⅰ급17례，Ⅱ급11례，Ⅲ급4례，Ⅳ급2례，Ⅴ급8례；병사솔19%。
To summed up the clinical features and nursing interventions of 42 patients with delayed ischemic neurological dysfunction (DIND) after aneurysmal subarachnoid hemorrhage (aSAH). The clinical features of DIND included psychological disorders, complicated psychical factors, elevated intracranial pressure, increased blood viscosity, cerebral vasospasm, aneurysmal re-rupture and complications such as central high fever, water electrolyte imbalance and lung infection. To improve clinical efficacy, some distinctive nursing interventions should be implemented. These measures included valuing psychological nursing to prevent the cause of cerebral vasospasm and aneurysmal re-rupture; paying attention to the warning symptoms and controlling patients ’ blood pressure, monitoring closely and analyzing dynamicly the results of intracranial pressure, hematocrit, transcranial Doppler (TCD) and brain CT. The abnormal data should be reported to the doctor at once and precaution and nursing were inevitable for other complications. The clinical efficacy was evaluated by Glasgow Outcome Scale (GOS) and the results were as follow:17 cases had GOS scores 1, 11 had 2, 4 had 3, 2 had 4, 8 had 5 and the mortality was 19%.