基于生物钟规律的五感促醒护理模式对脑性昏迷住院患者意识状态的干预效果

doi:10.16138/j.1673-6087.2025.04.08

摘要/Abstract

摘要：

目的：探讨基于生物钟规律的五感促醒护理模式在脑性昏迷住院患者意识状态中的应用效果。方法：方便抽样法选取2023年5月—2024年4月上海交通大学医学院附属瑞金医院老年科收治的43例脑性昏迷患者，双号病区患者设为观察组（n=22），单号病区患者设为对照组（n=21）。对照组采用常规护理模式，观察组在常规护理的基础上采用五感促醒护理模式，比较2组在不同时期的格拉斯哥昏迷量表（Glasgow coma scale，GCS）评分、修订版昏迷恢复量表（coma recovery scale-revised ，CRS-R）评分、苏醒有效率及苏醒所需时间。结果：2组患者GCS评分和CRS-R评分的组别因素和时间因素存在交互作用（F=9.765，P<0.001；F=12.846，P<0.001）。干预后，2组不同时间点的GCS评分和CRS-R评分变化差异均有统计学意义（F=243.934，P<0.001；F=239.111，P<0.001）。2组间GCS评分和CRS-R评分变化差异均有统计学差异（F=5.040，P<0.05；F=7.779，P<0.05）。观察组的苏醒有效率显著高于对照组（P<0.05），苏醒所需时间显著短于对照组（P<0.01）。结论：基于生物钟规律的五感促醒护理模式能改善脑性昏迷患者的意识状态，促进患者苏醒。

关键词: 昼夜节律, 多感官刺激, 意识障碍, 脑性昏迷, 护理

Abstract:

Objective To explore the impact of five senses awakening nursing mode based on the circadian rhythm in conscious hospitalized patients with cerebral coma. Methods Using convenience sampling method, a total of 43 patients with cerebral coma admitted to the Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from May 2023 to April 2024 were selected. The patients in the even-numbered wards were set as the observation group (n=22), and those in the odd-numbered wards were set as the control group (n=21). The control group received routine nursing mode while the observation group received five-sense awakening nursing mode in addition to routine nursing. A comparison was made between the two groups at different periods regarding Glasgow coma score (GCS), coma recovery scale-revised (CRS-R), recovery efficiency and recovery time. Results There was an interaction between the group factor and the time factor in the GCS score and the CRS-R score in the two groups (F=9.765, P<0.001; F=12.846, P<0.001). After the intervention, there were significant differences in the changes of the GCS and the CRS-R score at different time points between the two groups (F=243.934, P<0.001; F=239.111, P<0.001). There were statistical differences in the changes of the GCS and the CRS-R score between the two groups (F=5.040, P<0.05;F=7.779, P<0.05).The recovery rate of the observation group was higher than that of the control group (P<0.05), and the recovery time was shorter than that of the control group (P<0.01). Conclusions The five- sensory stimulation nursing approach based on the circadian rhythm, can improve the consciousness state of patients with cerebral coma and facilitate their awakening.

Key words: Circadian rhythm, Multisensory stimulation, Disorders of consciousness, Cerebral coma, Nursing

中图分类号:

R741

吕卓蓓, 朱琳, 荣岚, 吕晓琼, 储佳妮, 成志英. 基于生物钟规律的五感促醒护理模式对脑性昏迷住院患者意识状态的干预效果[J]. 内科理论与实践, 2025, 20(04): 306-311.

LYU Zhuobei, ZHU Lin, RONG Lan, LYU Xiaoqiong, CHU Jiani, CHENG Zhiying. Intervention effect of five senses awakening nursing mode based on the circadian rhythm on the conscious state of hospitalized patients with cerebral coma[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(04): 306-311.

图/表 2

表1

2组患者一般资料比较[$\bar{x} \pm s$/n（%）]

项目	对照组（n=21）	观察组（n=22）	t/ $χ 2$	$P$
年龄（岁）	63.24±6.49	66.68±8.01	1.545	0.130
性别			0.650	0.420
男性	15（71.4）	18（81.8）
女性	6（28.6）	4（18.2）
疾病类型			1.564	0.668
颅脑损伤	1（4.8）	2（9.1）
脑出血	9（42.8）	10（45.5）
脑梗死	11（52.4）	9（40.9）
心肺复苏后	0（0）	1（4.5）
治疗方式			0.043	0.835
保守治疗	14（66.7）	14（63.6）
手术治疗	7（33.3）	8（36.4）

表1

表2

2组患者干预前后GCS和CRS-R量表评分（分，$\bar{x} \pm s$）

项目	对照组（n=21）	观察组（n=22）	t	$P$
GCS
干预前	4.62 ± 1.24	4.59 ± 1.44	0.069	0.946
干预第1周	5.33 ± 1.49^1）	5.68 ± 1.86^1）	0.675	0.504
干预第2周	6.38 ± 1.50^1）2）	7.55 ± 2.04^1）2）	2.124	0.040
干预第3周	7.90 ± 1.64^1）2）3）	9.23 ± 1.95^1）2）3）	2.401	0.021
干预第4周	9.10 ± 1.30^{1）2）3）4)}	11.41 ± 2.36^{1）2）3）4)}	3.950	<0.001
CRS-R
干预前	2.10 ± 1.92	2.05 ± 1.96	0.084	0.933
干预第1周	3.00 ± 2.24^1）	3.59 ± 2.50^1）	0.815	0.420
干预第2周	4.67 ± 2.08^1）2）	7.45 ± 3.78^1）2）	2.978	0.005
干预第3周	7.05 ± 3.23^1）2）3）	10.14 ± 3.69^1）2）3）	2.912	0.006
干预第4周	9.19 ± 2.96^{1）2）3）4)}	13.23 ± 3.16^{1）2）3）4)}	4.317	<0.001

表2

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