目的 验证基于循证的颅脑创伤患者肢体功能障碍康复护理干预对住院患者自理能力的改善效果。 方法 选取桂林市和济南市两所三级甲等医院的180名颅脑创伤患者为研究对象，按照阶梯整群随机试验设计，干预措施在3个时间段内依次推广到两所医院的神经外科，第1阶段两所医院都不进入阶梯，仍按照常规护理干预方法进行干预，主要包括常规的宣教和护理，第2阶段，其中一所医院进入，开始应用本研究的干预方案，第3阶段，另一所医院进入，干预组采用循证康复护理干预，比较两组患者的自理能力。 结果 使用广义线性混合模型进行多因素分析，修正后的模型有统计学意义（F=25.286,P＜0.001）。两组患者的生活自理能力得分比较，差异在干预前无统计学意义（P＞0.05），在干预后有统计学意义（P＜0.01），且干预后干预组得分高于对照组（P＜0.05）。 结论 本研究证明了基于循证的颅脑创伤患者住院期间的康复护理方案对患者自理能力改善的有效性,证明了康复护理对颅脑创伤患者的意义。

Objective To verify the effectiveness of the evidence-based rehabilitation nursing care program for limb dysfunction of traumatic brain injury (TBI) patients on the self-care ability of those inpatients. Methods A total of 180 TBI patients were selected from two tertiary hospitals in Guilin and Jinan City.The design of stepped wedge cluster randomized trial was adopted.Intervention measures were successively promoted to the Department of Neurosurgery in the two hospitals over three periods.In the first period,the two hospitals did not enter the step,and conventional nursing interventions were carried out,mainly including routine education and nursing.In the second period,one hospital entered and the evidence-based intervention was performed.In the third period,the other hospital entered,and the evidence-based rehabilitation nursing care program was carried out in the intervention group.The self-care ability of patients in the two groups were compared. Results The generalized linear mixture model was used for multivariate analysis.The modified model was statistically significant (F=25.286,P＜0.001).The difference in the score of self-care ability between the two groups before intervention was not statistically significant(P＞0.05),but the difference after intervention was statistically significant (P＜0.01).The score of the intervention group was higher than that of the control group after intervention (P＜0.05). Conclusions This study proves the effectiveness of the evidence-based rehabilitation nursing care program for TBI inpatients on improving their self-care ability,as well as the significance of rehabilitation nursing on TBI patients.

R473;R823

军队护理创新与培育专项 (2021HL021)