双重视角：一位护士-患者的亲身经历对听神经瘤围手术期整体护理与康复的启示

文献信息

中文摘要

背景： 听神经瘤（AN），即前庭神经鞘瘤，占颅内肿瘤的8%至10%，占桥小脑角肿瘤的80%。术后前庭症状常见，但研究在很大程度上未能整合医疗提供者和患者双方的视角。
方法： 本病例报告从护士-患者的双重视角，记录了一位被诊断为AN的护士的围手术期经历，包括心理变化、症状进展和康复。
结果： 患者表现为眩晕和步态不稳，被诊断为位于左侧桥小脑角的AN。通过乙状窦后入路进行了显微外科切除术，术后无重大并发症。结构化的康复计划和分阶段的职业适应促进了完全康复，并于术后4个月重返工作岗位。
结论： 这一反思性的护士-患者病例叙述提供了关于先前未被充分认识现象的新信息：具有临床知识的的前庭神经鞘瘤患者会经历增强的躯体过度警觉和自我诊断认知偏差，从而加剧围手术期痛苦，然而他们的医学训练并未消除临床医生评定的面部结局与患者自报面部结局之间的感知差距。双重视角的内省产生了一个新颖的三管齐下的感觉-心理-社会康复框架——整合客观面部评估、患者报告结局采集、早期前庭康复、认知应对策略以及分阶段职业重返。

英文摘要

BACKGROUND: Acoustic neuroma (AN), or vestibular schwannoma, accounts for 8% to 10% of intracranial neoplasms and 80% of cerebellopontine angle tumors. Postoperative vestibular symptoms are common, yet research has largely failed to integrate the perspectives of both health care providers and patients.
METHOD: This case report documents the perioperative experiences of a nurse diagnosed with AN, including psychological changes, symptom progression, and rehabilitation, from a dual nurse-patient perspective.
RESULTS: The patient presented with vertigo and an unsteady gait and was diagnosed with AN located at the left pontocerebellar angle. Microsurgical resection via retrosigmoid approach was performed, with no major postoperative complications. A structured rehabilitation program and staged vocational adaptation facilitated full recovery and return to work 4 months postoperatively.
CONCLUSION: This reflective nurse-patient case narrative provides new information on a previously underrecognized phenomenon: clinically literate vestibular schwannoma patients experience heightened somatic hypervigilance and self-diagnostic cognitive bias that intensify perioperative distress, yet their medical training does not eliminate the perceptual gap between clinician-graded and self-reported facial outcomes. The dual-perspective introspection yields a novel three-pronged sensory-psychological-social rehabilitation framework-integrating objective facial assessment, patient-reported outcome capture, early vestibular rehabilitation, cognitive coping strategies, and phased vocational re-entry.