住院精神病患者锥体外系副反应的观察及舒适护理效果评价

住院精神病患者锥体外系副反应的观察及舒适护理效果评价

摘要目的觀察和评价舒适护理对住院精神病患者锥体外系副反应的护理效果。方法61例发生锥体外系副反应的精神病患者为研究对象，随机分为研究组（31例）和对照组（30例）。两组患者均按医嘱给予相应药物对症治疗和（或）减量观察及基础护理，对照组给予常规护理，研究组在常规护理的基础上给予舒适护理。比较两组患者锥体外系副反应的发生情况、锥体外系副反应量表（RESES）评分、社会功能缺陷筛选量表（SDSS）评分、护理满意度。结果护理4周末，两组患者的锥体外系副反应发生率及RESES总分均较本组护理前降低，且研究组锥体外系副反应发生率9.7%显著低于对照组36.7%，研究组RESES总分（11.4±1.2）分显著低于对照组（12.8±1.4）分，差异均具有统计学意义（P＜0.05或0.01）。护理4周末，研究组SDSS总分及与病友交往退缩、生活自理能力较差、护理兴趣活动贫乏、无责任心因子分均低于对照组，差异均具有统计学意义（P＜0.05或0.01）。两组患者的较少参与护理康复训练因子分比较，差异无统计学意义（P>0.05）。研究组患者满意度为96.8%，家属满意度为93.6%，均高于对照组的76.7%、73.3%，差异均具有统计学意义（P＜0.05）。结论在对症治疗的基础上，舒适护理对减轻症状、改善社会功能和提高满意度有较好的效果。

关键词住院精神病患者；锥体外系副反应；心理护理；舒适护理

【Abstract】Objective To observe and evaluate the nursing effect of comfort nursing on extrapyramidal side effects in hospitalized psychiatric patients. Methods A total of 61 psychiatric patients with extrapyramidal side effects as study subjects were randomly divided into research group （31 cases）and control group （30 cases）. Both groups received corresponding drugs for symptomatic treatment and/ or decrement observation and basic care，and the control group received conventional nursing. The research group also received comfort nursing. Comparison were made on occurrence of extrapyramidal side effects，rating scale for extrapyramdal side effects （RESES）score，social disability screening schedule （SDSS）score and nursing satisfaction in two groups. Results At the end of 4 weeks of nursing，both groups had lower incidence of extrapyramidal side effects and total RESES score than before nursing，and the research group had significantly lower incidence of extrapyramidal side effects as 9.7% than 36.7% in the control group. The research group had significantly lower total RESES score as （11.4±1.2）points than （12.8±1.4）points in the control group，and the difference had difference had statistical significance （P＜0.05 or 0.01）. At the end of 4 weeks of nursing，the research group had lower total SDSS score，social withdrawal，poor self-care ability，lack of interest in nursing activities and irresponsible factor points than the control group，and their difference had statistical significance （P＜0.05 or 0.01）. Both groups had no statistically significant difference in less participation in nursing rehabilitation training factor points （P>0.05）. The research group had higher satisfaction degree as 96.8% and family satisfaction as 93.6% than 76.7% and 73.3%

in the control group，and their difference had statistical significance （P＜0.05）. Conclusion On the basis of symptomatic treatment，comfort nursing shows good effect in reducing symptoms，improve social function and satisfaction degree.【Key words】Hospitalized psychiatric patients；Extrapyramidal side effects；Psychological nursing；Comfort nursing

住院精神病患者在治疗过程中，常可观察到药物副反应，其中，锥体外系副反应较常见，特别是应用典型抗精神病药物者和既往未曾用过抗精神病药者较易发生[1，2]。但由于患者对药物的敏感度存在个体差异，加上患者反应迟钝、对不良反应常缺乏主诉，增加了护理的难度。探讨新的护理干预措施和提高对不良反应的观察力度，是精神科护理人员努力的方向。本研究以发生锥体外系副反应的患者为研究对象，开展舒适护理，取得较好的效果，现报告如下。

1 资料与方法

1. 1 一般资料以2016年3～12月在本院两个病区住院治疗过程中发生锥体外系副反应的精神病患者61例为研究对象，锥体外系副反应符合下列3项中最少1项：①急性肌张力障碍；②静坐不能；③帕金森综合征。排除严重躯体疾病、脑器质性疾病、老年性痴呆、帕金森氏病、成瘾物质依赖、严重自杀者。61例患者随机分为研究组（31例）和对照组（30例）。

1. 2 锥体外系副反应的观察观察步态是否刻板僵直，手臂摆动是否不自然；观察头颈部是否僵硬，是否手指震颤或肢体震颤，是否因为口涎过多而说话困难，是否面部有不自主运动，有无吞咽困难和肌张力改变，有无动作迟钝僵硬；观察有无出现静坐不能、坐卧不宁，站立时左右摇晃身躯；应及早报告医生，并作相应对症处理。

1. 3 锥体外系副反应的护理方法两组患者均按医嘱给予相应药物（苯海索片口服或东莨菪碱肌内注射）对症治疗和（或减量观察或换药治疗和基础护理，并分别实施不同的护理措施，对照组采用常规护理，研究组在常规护理的基础上给予舒适护理。

1. 3. 1 常规护理[3，4]

1. 3. 1. 1 早期发现、及时报告医生、按医嘱处理按药物副反应的护理常规进行护理，遵照医嘱的药物及用法用量给患者用药治疗，并注意观察、早期发现用药后的反应。观察锥体外系副反应的变化，及时报告医生给予对症处理和落实相应的护理措施。

1. 3. 1. 2 开展健康教育通过问题解答、专题讲座、个别谈心等形式，向患者及家属介绍有关疾病的预防和治疗常识，有针对性地介绍药物可能发生的副反应及防治措施，让患者了解有关药物知识；让患者认识到锥体外系副反应是可防可治的，消除患者的紧张和恐惧心理。