| Objective:1.Through the retrospective analysis to identify the risk factors of hyponatremia in patients with craniocerebral injury,and then find out the risk factors associated with moderate intensity;2.Based on the risk factors associated with the moderate correlation intensity in the retrospective study to establish the early warning score of hyponatremia in patients with craniocerebral injury,to determine the risk of hyponatremia in patients with craniocerebral injury as early as possible,and screening high-risk patients as the focus of observation of nurses;3.Based on the early warning score of hyponatremia in patients with craniocerebral injury,different systematic nursing intervention measures were adopted for low-risk patients and high-risk patients and then evaluate its application effect,to provide reference for clinical nursing to prevent hyponatremia in patients with craniocerebral injury.Methods:The study is divided into three stages,the first stage: from one hospital in Shanxi province from January 2015 to December 2015 were in patients with craniocerebral injury were retrospectively analyzed the clinical data,firstly,single factor analysis,find the relative risk of hyponatremia in patients with craniocerebral injury,P<0.05,the difference was statistically significant,according to whether the occurrence of hyponatremia is variable,the related risk factors with statistical significance as independent variables,multivariate Logistic regression analysis(α入=0.05,α出=0.10),determine the effect of independent risk factors of hyponatremia,and to determine the risk factors associated with moderate intensity;The second stage: to extract the risk factors and the Logistic regression analysis results of the first phase of the study identified as more than moderate intensity and establish Logistic regression model.According to the regression coefficient of Logistic regression model,the risk factors were assigned and the early warning score ofV hyponatremia in patients with craniocerebral injury was established,then evaluate the effectiveness of the early warning score table by case diagnosis test and ROC analysis.the risk classification was carried out,and the reliability of the classification criteria was tested by chi square test;The third stage: through the historical control study to evaluate the clinical application and effect of systematic nursing intervention program,selection of one hospital in Shanxi province from April 2016 to October 2016 in craniocerebral injury patients hospitalized in the department of neurosurgery as the intervention group,patients from January 2015 to December 2015 were craniocerebral injury as the control group,collected and compared two groups of patients with hyponatremia the prognosis,the average hospitalization time and cost etc..Application of SPSS17.0 software package was used for statistical analysis,measurement data were compared by two independent samples t test,count data using chi square test,generally does not meet the normal distribution of data,by rank sum test,P<0.05 the difference was statistically significant.Results:(1)The risk factors analysis showed that in strict accordance with the inclusion and exclusion criteria,a total of 343 cases of craniocerebral injury patients with clinical data,199 cases of patients with hyponatremia,60 years of age or older,GCS score less than 12 points,acute epidural hematoma,contusion and laceration of brain,cerebral hernia,diffuse axonal injury,intracranial hematoma,hematoma,drilling drainage,infection,fever,fasting,vomiting,use furosemide or mannitol may increase the risk of brain injury patients with hyponatremia,60 years of age or older,GCS score less than 12 points,acute epidural hematoma,cerebral contusion,infection,high fever,use mannitol is an independent risk factor in patients with craniocerebral injury hyponatremia,OR range between 2.079-3.518,the strength of the correlation is above the average;(2)According to the medium strength of association more risk factors and logistic regression analysis results to establish logistic regression model P=ey/(1+ey),e=2.718,y=0.815 * age +0.867 * GCS score +1.243 * acute epidural hematoma+0.732 * brain contusion +1.258 * infection +0.987 * high fever +1.207 * use mannitol,establishment of early warning score table based on regression model: age more than or equal to 60 years old was 0.8 points,GCS score less than 12 points was 0.9 points,acute epidural hematoma was 1.2 points,brain contusion and laceration was 0.7 points,infection was 1.3 points,high fever was 1.0 points,use mannitol was 1.2 points,the totalscore is 7.1 points,less than 1.8 is divided into low risk group,more than 1.8 classified as high risk group,area of ROC curve of the early warning score was 0.861,the sensitivity and specificity were 79.4% and 80.6%,The results of chi square test,χ2=109.008,P<0.05,risk classification is reliable;(3)In strict accordance with the inclusion and exclusion criteria included a total of 98 cases of craniocerebral injury patients in the implementation of the system of nursing intervention,the intervention group of hyponatremia in 43 cases,the incidence of hyponatremia was 43.88%,significantly lower than the control group(58.02%,)(P<0.05);In the control group,9 patients died,the intervention group of 3 patients died,the mortality rate between the two groups was not statistically significant(P>0.05);The average length of stay in the intervention group was 10.0±9.0 days,and the average length of stay in the control group was 15.0±13.0 days,the average length of stay in the control group was less than that of the control group(P<0.05);The total cost of hospitalization in the intervention group was 31300.18±37727.48 yuan,the average hospitalization cost was2287.36±1732.35 yuan,total cost in the control group was 33431.35±47920.02 yuan,and the average hospitalization cost was 2418.26±1713.20 yuan,there was no significant difference between the intervention group and the control group(P>0.05).Conclusion:1.The incidence of hyponatremia was higher in patients with craniocerebral injury,60 years of age or older,GCS score of 12 or less,with anxious traumatic epidural hematoma may be an independent risk factor for hyponatremia in patients with craniocerebral injury,nurses should pay more attention to these patients in clinical work.2.The early warning score of hyponatremia in patients with craniocerebral injury is simple and practical,which can provide the basis for clinical evaluation of hyponatremia.3.Systematic nursing intervention program can reduce the incidence of hyponatremia in patients with craniocerebral injury and shorten the hospitalization time of patients with craniocerebral injury. |
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