持续性植物状态患者护理的研究进展

doi:10.3761/j.issn.0254-1769.2020.10.027

摘要/Abstract

摘要：

持续性植物状态是患者脑严重损害后出现的一种没有感知的特殊意识状态,由于缺乏有效的治疗手段,给家庭、社会造成的负担极重。患者的照护主要依赖护理,难度大且问题繁杂,但是在临床实践中却缺乏相关指导,使得照护质量无法得到保证。该文从促醒护理、营养支持、并发症防治、家庭照顾者心理支持与健康教育方面综述了研究进展,为提高护理人员认知、构建临床护理规范和路径提供依据或参考。

关键词: 持续性植物状态, 康复护理, 营养支持, 健康教育, 综述

Abstract:

Persistent vegetative state（PVS） is a special state of unconsciousness after severe brain damage. Due to a lack of effective treatment methods,it imposes heavy burdens on both individuals and society. The care of PVS patients mainly relies on nursing care,which is difficult and complicated. However,there has been no clinical guideline to ensure the quality of care. The purpose of this article is to review the literature concerning nursing care on consciousness recovery,nutritional support,prevention of complications,psychological support and education for family caregivers of PVS patients. It was anticipated that this review will provide references to improve nurses’ knowledge on the care of PVS patients and to construct clinical guidelines and pathway on nursing care.

Key words: Persistent Vegetative State, Rehabilitation Nursing, Nutritional Support, Health Edu-cation, Review

高焱,赵敬璞,王玉龙,梁伟容,章静,周宜霞,周娟,东志远,王栋,文琼. 持续性植物状态患者护理的研究进展[J]. 中华护理杂志, 2020, 55(10): 1593-1597.

GAO Yan,ZHAO Jingpu,WANG Yulong,LIANG Weirong,ZHANG Jing,ZHOU Yixia,ZHOU Juan,DONG Zhiyuan,WANG Dong,WEN Qiong. Research progress on nursing care of patients in a persistent vegetative state[J]. Chinese Journal of Nursing, 2020, 55(10): 1593-1597.

参考文献 35

[1]	Jennett B, Plum F. Persistent vegetative state after brain damage,A syndrome in search of a name[J]. Lancet, 1972,1:734-737. DOI URL PMID
[2]	中华医学会急诊医学学会意识障碍研究专业组. 持续性植物状态(PVS)的命名、定义及诊断标准[J]. 现代临床医学生物工程学杂志, 1996,2(3):232.
	Research group for disorders of consciousness of Chinese Society of Emergency Medicine. Definition,conception,and Diagnostic criteria for persistent vegetative state[J]. J Mode Clin Med Bioengin, 1996,2(3):232.
[3]	杨艺, 何江弘, 焦辉, 等. 国际植物状态流行病学调查的历史与现状[J]. 中华神经外科杂志, 2015,31(2):1279-1281.
	Yang Y, He JH, Jiao H, et al. A review of epidemiology in vegetative state[J]. Chin J Neurosurg, 2015,31(2):1279-1281.
[4]	乔德才, 张琴珠, 封茂滋, 等. 神经病病人持续性植物状态临床诊断标准的探讨[J]. 中华医学杂志, 1998,78(3):167-168.
	Qiao DC, Zhang QZ, Feng MZ, et al. Diagnostic criteria for psychiatric patients in persistent vegetative state[J]. Natl Med J Chin, 1998,78(3):167-168.
[5]	梁秀龄, 谢秋幼. 持续性植物状态的概念、名称转变及有关问题[J]. 临床神经病学杂志, 2013,26(2):81-83.
	Liang XL, Xie QY. Conception and definition issues about persistent vegetative state[J]. Journal of Clinical Neurology, 2013,26(2):81-83.
[6]	Laureys S. The neural correlate of(un) awareness:lessons from the vegetative state[J]. Trends CognSci, 2005,9(12):556-559.
[7]	Boly M, Garrido MI, Gosseries O, et al. Preserved feed forward but impaired top-down processes in the vegetative state[J]. Sci-ence, 2011,332:858-862. DOI URL
[8]	Bernat JL. Chronic disorders of consciousness[J]. Lancet, 2006,367:1181-1192. DOI URL PMID
[9]	Schnakers C, Vanhaudenhuyse A, Giacino J, et al. Diagnostic accuracy of the vegetative and minimally conscious state:clinical consensus versus standardized neurobehavioral assessment[J]. BMC Neurol, 2009,9(1):35. DOI URL
[10]	Van Erp WS, Lavrijsen JC, Van De Laar FA, et al. The vegetative state/unresponsive wakefulness syndrome:a systematic review of preval ence studies[J]. Eur J Neurol, 2014,21(11):1361-1368. DOI URL PMID
[11]	武桥, 骆飞飞, 高励. 植物状态与最小意识状态的意识评估和预后判断[J]. 中华行为医与脑科学杂志, 2013,22(11):1051-1053.
	Wu Q, Luo FF, Gao L. The persistent vegetative state and minimally conscious state:assessment in disorders of consciousness and prognosis[J]. Chin J Behavi Medi Brain Sci, 2013,22(11):1051-1053.
[12]	Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised:measurement characteristics and diagnostic utility[J]. Arch Phys Med Rehabil, 2004,85(12):2020-2029. DOI URL PMID
[13]	Lovstad M, Froslie KF, Giacino JT, et al. Reliability and diagnostic characteristics of the JFK coma recovery scale-revised:exploring the influence of rater’s level of experience[J]. J Head Trauma Rehabil, 2010,25(5):349-356. DOI URL PMID
[14]	张瑛, 何敏慧, 赵发林, 等. 中文版CRS-R量表的信效度研究[J]. 护理与康复, 2013,12(8):715-717,721.
	Zhang Y, He MH, Zhao FL, et al. The reliability and validity of Chinese version of the Coma Recovery Scale Revised(CRS-R)[J]. Nurs Rehabil J, 2013,12(8):715-717,721.
[15]	李乐之, 路潜. 外科护理学[M]. 北京: 人民卫生出版社, 2018.
	Li LZ, Lu Q. Surgical Nursing[M]. Beijing: Peosple’s Medical Publishing House, 2018.
[16]	邓新, 刘嘉胜, 王璐, 等. 三种意识量表对植物状态患者意识障碍程度的敏感性分析[J]. 实用预防医学, 2017,24(4):465-467.
	Deng X, Liu JS, Wang L, et al. Sensitivities of 3 different consciousness scale in evaluating the degree of distribution of consciousness in patients in the persistent vegetative state[J]. Practi Prevent Medi, 2017,24(4):465-467.
[17]	The Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state(Second of Two Parts)[J]. N Engl J Med, 1994,330(22):1572-1579. DOI URL PMID
[18]	Claassen J, Doyle K, Matory A, et al. Detection of brain activation in unresponsive patients with acute brain injury[J]. N Engl J Med, 2019,380(26):2497-2505. DOI URL PMID
[19]	De Tanti A, Saviola D, Basagni B, et al. Recovery of consciou-sness after 7 years in vegetative state of non-traumatic origin:a single case study[J]. Brain Inj, 2016,30(8):1029-1034. DOI URL PMID
[20]	蔡文智, 赵莉, 赵卫青. 脑外伤后持续植物状态患者的促醒康复护理[J]. 中华护理杂志, 1999,34(12):709-711.
	Cai WZ, Zhao L, Zhao WQ. Promoting rehabilitation of patients with persistent vegetative state after brain injury[J]. Chin J Nurs, 1999,34(12):709-711.
[21]	孔磊, 宋献丽, 黎艳. 刺激性康复护理对脑外伤后持续性植物状态患者促醒作用的观察[J]. 护士进修杂志, 2008,23(17):1603-1605.
	Kong L, Song XL, Li Y. Observation for the consciousness recovery acceleration effect by combined nursing intervention oriented to stimulant rehabilitation on persistent vegetable state post cerebral trauma[J]. J Nurs Training, 2008,23(17):1603-1605.
[22]	中华医学会肠外肠内营养学分会神经疾病营养支持学组. 神经系统疾病肠内营养支持操作规范共识(2011版)[J]. 中华神经科杂志, 2011,44(11):787-791.
	Nutrition Support Group in Neurological disease of Chinese Society for Parenteral and Enteral Nutrition. A consensus statement on the application of enteral nutrition support in patients with neurological disease(2011 Edition)[J]. Chin J Neurol, 2011,44(11):787-791.
[23]	中华医学会肠外肠内营养学分会神经疾病营养支持学组. 神经系统疾病营养支持适应证共识(2011版)[J]. 中华神经科杂志, 2011,44(11):785-787.
	Nutrition Support Group in Neurological disease of Chinese Society for Parenteral and Enteral Nutrition. A consensus statement on nutrition support indications in patients with neurological disease(2011 Edition)[J]. Chin J Neurol, 2011,44(11):785-787.
[24]	孙丽娟, 赵长海. 重型颅脑损伤后营养支持研究[J]. 中华神经外科疾病研究杂志, 2009,8(5):478-480.
	Sun LJ, Zhao CH. Nutrition support in patients with severe brain injury[J]. Chin J Neurosurgi Dis Res, 2009,8(5):478-480.
[25]	赖晓全, 刘虹. 持续植物状态患者的营养疗法[J]. 中国康复, 2004,19(4):222-223.
	Lai XQ, Liu H. Nutritional therapy in patients in persistent vegetative state[J]. Chin J Rehabili, 2004,19(4):222-223.
[26]	中华医学会肠外肠内营养分会神经疾病营养支持学组. 神经系统疾病经皮内镜下胃造口喂养中国专家共识[J]. 肠外与肠内营养, 2015,22(3):129-132.
	Nutrition Support Group in Neurological disease of Chinese Society for Parenteral and Enteral Nutrition. A consensus statement on percutaneous endoscopic gastrostomy feeding in patients with neurological disease[J]. Parenteral & Enteral Nutrition, 2015,22(3):129-132.
[27]	Saout V, Ombredane MP, Mouillie JM, et al. Patients in a permanent vegetative state or minimally conscious state in the Maine-et-Loire county of France:a cross-sectional,descriptive study[J]. Ann Phys Rehabil Med, 2010,53(2):96-104. DOI URL
[28]	宋鲁平, 王强, 张通. 从康复医学看颅脑创伤早期康复的重要性[J]. 中华医学杂志, 2017,97(21):1604.
	Song LP, Wang Q, Zhang T. From the perspective of rehabilitation medicine:the importance of early rehabilitation for brain trauma[J]. Natl Med J Chin, 2017,97(21):1604.
[29]	张全兵, 周云, 钟华璋, 等. 关节挛缩的发病机制和治疗进展[J]. 中华创伤骨科杂志, 2017,19(6):548-552.
	Zhang QB, Zhou Y, Zhong HZ, et al. Pathogenesis and progressing treatment of joint contracture[J]. Chinese Journal of Orthopaedic Trauma, 2017,19(6):548-552.
[30]	姜曼, 敖薪. 人工气道管理标准的研究与应用现状[J]. 中华护理杂志, 2016,51(12):1479-1482.
	Jiang M, Ao X. Review of standard of care in artificial airway management[J]. Chin J Nurs, 2016,51(12):1479-1482.
[31]	“卧床患者常见并发症规范化护理干预模式的构建”项目组, 中华护理学会行政管理专业委员会. 卧床患者常见并发症护理专家共识[J]. 中国护理管理, 2018,18(6):740-747.
	Project Team of the Constructions of Standardized Nursing Intervention Model for the Common Complications among Be-dridden Patients, Administrative Committee of Chinese Nursing Association. A consensus statement on nursing care of major immobility complications among bed ridden patients[J]. Chin Nurs Manag, 2018,18(6):740-747.
[32]	Leonardi M, Giovannetti AM, Pagani M, et al. Burden and needs of 487 caregivers of patients in vegetative state and in minimally conscious state:results from a national study[J]. Brain Inj, 2012,26(10):1201-1210. DOI URL PMID
[33]	张芳, 吴月峰, 马兰, 等. 持续植物状态及最小意识状态患者照顾者负性情绪的影响因素[J]. 中国康复理论与实践, 2017,23(9):1104-1107.
	Zhang F, Wu YF, Ma L, et al. The influence factors of negative emotions in caregivers of patients in persistent vegetative state and minimally conscious state[J]. Chin J Rehabil Theo Pract, 2017,23(9):1104-1107.
[34]	张建凤, 李志菊, 王芳云, 等. 家庭访视对脑卒中患者照顾者负担及积极体验的影响研究[J]. 中华护理杂志, 2017,52(7):830-834.
	Zhang JF, Li ZJ, Wang FY, et al. Effects of home visiting on care burden and positive experience in caregivers of cerebral apoplexy patients[J]. Chin J Nurs, 2017,52(7):830-834.
[35]	马海萍, 卢慧娟, 姚剑英, 等. 脊髓损伤患者照顾者照顾负担与应对方式的调查分析[J]. 中华护理杂志, 2013,48(10):906-909.
	Ma HP, Lu HJ, Yao JY, et al. The caregivers burden and coping styles in caregivers of patients with spinal cord injuries[J]. Chin J Nurs, 2013,48(10):906-909.