摘 要：
目的：探讨精准护理策略在经鼻垂体瘤切除术后脑脊液鼻漏患者中的应用效果。方法：对1例经鼻垂体瘤切除术后发生脑脊液鼻漏的患者实施"风险分层-路径触发-动态调整"精准护理方案，包括鼻漏量分级监测（轻度<50ml/d、中度50-100ml/d、重度>100ml/d）、炎症指标（体温/WBC/CRP）动态追踪、颅内感染预警及电解质平衡管理，结合个体化体位干预（头高15-30°半卧位）、营养支持（1.5g/kg/d高蛋白饮食）及多学科协作。结果：患者鼻漏量从术后第1天的95ml/d（中度）降至第10天的<20ml/d（轻度），第14天完全停止；体温、WBC及CRP分别在干预后48小时、72小时、5天恢复正常范围；未发生颅内感染，血钠水平维持在135-145mmol/L；住院15天顺利出院，格拉斯哥昏迷评分（GCS）持续15分，头痛视觉模拟评分（VAS）由6分降至1分。结论：基于动态评估的精准护理可有效缩短脑脊液鼻漏持续时间，降低感染风险，为神经外科术后并发症管理提供标准化护理路径。
关键词：垂体瘤切除术；术后；脑脊液鼻漏；护理
Abstract:
Objective: To explore the application effect of precise nursing strategies in patients with cerebrospinal fluid rhinorrhea after transnasal pituitary adenoma resection. Methods: A patient who developed cerebrospinal fluid rhinorrhea after transnasal pituitary adenoma resection was managed with a \"risk stratification-pathway triggering-dynamic adjustment\" precise nursing plan. This included graded monitoring of rhinorrhea volume (mild <50 mL/d, moderate 50-100 mL/d, severe >100 mL/d), dynamic tracking of inflammatory indicators (temperature/white blood cell count/C-reactive protein), intracranial infection warning, and electrolyte balance management. It also incorporated individualized positional intervention (semi-recumbent position with head elevated 15-30°), nutritional support (1.5 g/kg/d high-protein diet), and multidisciplinary collaboration. Results: The patient's rhinorrhea volume decreased from 95ml/d (moderate) on postoperative day 1 to <20 mL/d (mild) on day 10, and completely stopped on day 14; temperature, white blood cell count, and C-reactive protein returned to normal ranges within 48 hours, 72 hours, and 5 days of intervention, respectively; no intracranial infection occurred, and serum sodium levels were maintained between 135-145 mmol/L; the patient was discharged smoothly after 15 days of hospitalization with a Glasgow Coma Scale (GCS) score consistently at 15, and headache Visual Analog Scale (VAS) score decreased from 6 to 1. Conclusion: Precise nursing based on dynamic assessment can effectively shorten the duration of cerebrospinal fluid rhinorrhea, reduce infection risk, and provide a standardized nursing pathway for the management of postoperative.
Keywords: Pituitary tumor resection; Postoperative; Cerebrospinal fluid rhinorrhea; Nursing care
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