Intervention effect of five senses awakening nursing mode based on the circadian rhythm on the conscious state of hospitalized patients with cerebral coma

doi:10.16138/j.1673-6087.2025.04.08

Abstract

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

CLC Number:

R741

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.

Figures/Tables 2

Table 1

Comparison of general information of the two groups of patients[$\bar{x} \pm s$/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）

Table 1

Table 2

Scores of GCS and CRS-R scales before and after intervention in two groups of patients（score, $\bar{x} \pm s$）

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

Table 2

References 20

[1]	曹丽, 彭粉花. 多感官促醒护理模式对脑性昏迷患者觉醒意识及预后的影响[J]. 护士进修杂志, 2019, 34(7):630-634.
	Cao L, Peng FH. Effect of a multi-sensory arousal nursing mode on arousal consciousness and prognosis in patients with cerebral coma[J]. Journal of Nurses Training, 2019, 34(7): 630-634.
[2]	黄春敏, 孙剑虹. 基于脑性昏迷患者感知水平的唤醒干预对其觉醒意识及预后的影响[J]. 中华护理杂志, 2016, 51(1):29-34.
	Huang CM, Liu JH. The impacts of nursing intervention based on level of perception on consciousness and prognosis in cerebral coma patients[J]. Clin J Nurs, 2016, 51(1): 29-34.
[3]	Bender A, Eifert B, Rubi-Fessen I, et al. The neurological rehabilitation of adults with coma and disorders of consciousness[J]. Dtsch Arztebl Int, 2023, 120(37):605-612.
[4]	顾洋洋, 朱迎, 夏辉, 等. 家庭亲情疗法对脑性昏迷患者促醒和神经功能的干预效果[J]. 河北医药, 2023, 45(18):2870-2873.
	Gu YY, Zhu Y, Xia H, et al. Effects of family affection therapy on awakening and neurological function in cerebral coma patients[J]. Hebei Medical Journal, 2023, 45(18):2870-2873.
[5]	Norwood MF, Lakhani A, Watling DP, et al. Efficacy of multimodal sensory therapy in adult acquired brain injury: a systematic review[J]. Neuropsychol Rev, 2023, 33(4):693-713.
[6]	Di Sarno L, Curatola A, Cammisa I, et al. Non-pharmacologic approaches to neurological stimulation in patients with severe brain injuries: a systematic review[J]. Eur Rev Med Pharmacol Sci, 2022, 26(18):6856-6870.
[7]	邱欢欢, 葛中林, 王园园, 等. 基于时间管理的护理模式在行脑血管支架植入术的脑梗死患者中的应用效果[J]. 实用心脑肺血管病杂志, 2024, 32(4):137-140.
	Qiu HH, Ge ZL, Wang YY, et al. Application effect of nursing mode based on time management in brain infarction patients undergoing cerebrovascular stent implantation[J]. Pract J Cardiac Cereb Pneum Vasc Dis, 2024, 32(4):137-140.
[8]	Nowakowski ACH, Sumerau JE. Reframing health and illness: a collaborative autoethnography on the experience of health and illness transformations in the life course[J]. Sociol Health Illn, 2019, 41(4):723-739.
[9]	兰丽梅, 彭惠兰, 杨秋菊, 等. 时间护理联合唇舌功能训练在脑卒中运动性失语患者早期康复中的应用[J]. 广东医学, 2012, 33(22):3508-3510.
	Lan L M, Peng HL, Yang QJ, et al. Application of chronological nursing combined with lip-tongue function training in the early rehabilitation of stroke patients with motor aphasia[J]. Guangdong Medical Journal, 2012, 33(22): 3508-3510.
[10]	Chaturvedi J, Mudgal SK, Venkataram T, et al. Coma recovery scale: key clinical tool ignored enough in disorders of consciousness[J]. Surg Neurol Int. 2021,12:93.
[11]	Vyas N, Gugnani A, Sidiq M, et al. Effect of multimodal stimulation along with music therapy after traumatic head injury: a case study[J]. HIV Nurs, 2023, 23(2):1304-1308.
[12]	Faozi E, Fadlilah S, Dwiyanto Y, et al. Effects of a multimodal sensory stimulation intervention on glasgow coma scale scores in stroke patients with unconsciousness[J]. Korean J Adult Nurs, 2021, 33(6): 649-656.
[13]	金少君, 袁东海. 重度颅脑损伤患者外周血lncRNA-17A表达与机体Th1/Th2平衡及患者预后的相关性[J]. 中国医师杂志, 2020, 22(12):1840-1843.
	Jin SJ, Yuan DH. Correlation between lncRNA-17A in peripheral blood and Th1/Th2 balance and prognosis in patients with severe craniocerebral injury[J]. Chinese Journal of Traumatology, 2020, 23(6): 341-347.
[14]	He B, Mo BR, Meng SY, et al. Decreasing the incidence of delirium via multi-sensory stimulation in patients receiving mechanical ventilation in the intensive care unit: a protocol for a randomized feasibility study[J]. Contemp Clin Trials Commun, 2024, 38:101263.
[15]	Kjeldsen SS, Brunner I, Nielsen JF, et al. Estimating day-to-day circadian rhythm in patients with severe acquired brain injury at the beginning of in-hospital rehabilitation[J]. J Integr Neurosci, 2022, 21(2):58. doi: 10.31083/j.jin2102058 pmid: 35364646
[16]	张金利, 路楷. 多感官促醒护理模式应用于高血压性脑出血术后昏迷病人的临床实践[J]. 护理研究, 2018, 32(3):430-432.
	Zhang JL, Lu K. Clinical practice of multi-sensory awakening nursing mode applied on postoperative coma patients with hypertensive cerebral hemorrhage[J]. Chinese Nursing Research, 2018, 32(3): 430-432.
[17]	Schofield PW, Doty RL. The influence of head injury on olfactory and gustatory function[J]. Handb Clin Neurol, 2019, 164:409-429. doi: B978-0-444-63855-7.00023-X pmid: 31604560
[18]	Zuo J, Tao Y, Liu M, et al. The effect of family-centered sensory and affective stimulation on comatose patients with traumatic brain injury: a systematic review and meta-analysis[J]. Int J Nurs Stud, 2021, 115:103846.
[19]	马梦凡, 戴艺, 郭蔚蔚, 等. 公立医院住院患者护理服务满意度影响因素的质性研究[J]. 中国老年保健医学, 2024, 22(1):160-164.
	Ma MF, Dai Y, Guo WW, et al. Qualitative study on influencing factors of in public hospital patients’ nursing service satisfaction[J]. Chinese Journal of Geriatric Care, 2024, 22(1):160-164.
[20]	仲悦萍, 张云, 陈晓艳, 等. 护士和家属实施感觉刺激对重型创伤性颅脑损伤昏迷患者促醒作用的比较[J]. 中华现代护理杂志, 2018, 24(31):3793-3797.
	Zhong YP, Zhang Y, Chen XY, et al. Comparing effects of sensory stimulation by nurses and family members on unconscious patients with severe traumatic brain injury[J]. Chinese Journal of Modern Nursing, 2018, 24(31): 3793-3797.