床边神经检查频率不能解释昏迷和意识障碍患者的结果:治愈昏迷运动范围审查
Brooke Murtaugh1, DaiWai Olson2, Kartyva Sharma3
1Brooke Murtaugh, Occupational Therapist, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospitals, Lincoln, NE.
概括
在严重脑损伤患者中,神经学检查的频率几乎没有证据将其与结果联系起来. 过度的神经检查可能不会改善结果,并可能造成伤害.
科学领域:
- 神经学 神经学
- 关键护理医学 关键护理医学
- 神经科学研究 神经科学研究
背景情况:
- 严重获得性脑损伤 (ABI) 患者有意识障碍 (DoC) 的神经学检查频率是可变的.
- 有限的证据指导了关于神经检查在预测恶化,恢复或像妄想这样的不良影响中的作用的实践.
- 了解神经检查频率在受伤后7天内对临床结果的影响至关重要.
研究的目的:
- 在受伤后的前7天内,探索床边神经学检查的频率.
- 评估神经检查频率对成人ABI患者临床结果的影响.
- 调查与死亡率,神经系统恶化,长期功能和妄想的关联.
主要方法:
- 在PubMed,CINAHL,Medline和EMBASE数据库 (2003-2023) 中进行了全面的文献搜索.
- 包括的研究集中在患有严重创伤性/非创伤性脑损伤或中风的成年患者身上.
- 符合条件的研究涉及入院后7天内床边神经学检查的频率.
主要成果:
- 20项研究 (超过16000名患者) 符合纳入标准,显示了各种评估工具,但普遍使用格拉斯哥昏迷表.
- 神经检查的频率从每小时到每天不等;一些研究表明,每小时检查超过48小时没有益处.
- 在一些发现中,过度评估与患者增加的压力或妄想有关.
结论:
- 很少有证据支持神经检查频率与功能结果,死亡率,停留时间或妄想之间存在联系.
- 早期评估可能有助于预后,但过度检查可能无法改善结果,并可能造成伤害.
- 异质性,缺乏证据和有限的标准化需要临床研究来指导未来的神经检查实践.
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