加速康复外科舒适护理在全膝关节置换患者围术期的应用研究

发布时间：2018-05-31 10:28

本文选题：加速康复外科 + 全膝关节置换　；参考：《青岛大学》2017年硕士论文

【摘要】：目的在加速康复外科护理基础上综合舒适护理措施,探讨加速康复外科舒适护理对人工全膝关节置换术患者围术期疼痛改善状况、膝关节功能恢复程度、舒适感及住院满意度的影响;为促进加速康复外科舒适护理在关节外科的应用提供临床实践经验。方法通过文献回顾、加速康复外科舒适护理小组讨论、预试验等方法确定加速康复外科舒适护理措施。采用目的抽样的方法,选择山东省青岛市某三级甲等医院2015.9~2016.4收治的行单侧人工全膝关节置换术的82例老年患者,使用一般资料调查表收集资料,收集患者术前一般资料、关节功能和疼痛评分等。将82例基线评估合格的患者纳入研究,其中2015.9.8~12.8符合纳入标准的41例患者为对照组,2015.12.10~2016.4.1符合纳入标准的41例患者为观察组。给与对照组患者研究所在医院的常规护理措施,观察组患者实施加速康复外科舒适护理措施。采集两组在入院时及术后3d、出院1个月的膝关节功能评分、入院时疼痛灾难化评分、连续采集术后4天的关节活动度及疼痛视觉模拟评分,记录两组患者术后勾脚开始时间、术后首次下床时间、住院满意度及平均术后住院天数及睡眠质量。结果1.两组患者在年龄、性别、体重指数、入院时膝关节评分、入院时疼痛灾难化评分及疼痛评分、入院时关节活动度、术前血红蛋白及白蛋白、手术时间等基本资料均无统计学意义(P0.05)。2.观察组术后勾脚开始时间(h)(2.56±1.25)早于对照组(11.48±4.48)、术后平均首次下床时间(d)(2.06±3.31)早于对照组(2.66±0.47)、术后12h VAS评分(4.7±1.01)低于对照组(6.57±1.19),差异有统计学意义(P0.05)。3.观察组术后3d HSS评分(34.21±1.65)高于对照组(31.23±1.83),出院1个月HSS(83.23±3.81)高于对照组(78.69±5.06)差异有统计学意义(P0.05)。4.重复测量方差分析结果显示,两组在关节活动度及疼痛评分的组间效应和时间效应差异有统计学意义(P0.05),关节活动度及疼痛评分与时间因素存在交互效应,差异有统计学意义(P0.05)。5.观察组术后平均住院天数(4.48±0.87)短于对照组(6.81±1.53)、住院满意度(97.71±2.78)高于对照组(94.16±6.81),观察组睡眠质量优良数(1.64±0.48)高于对照组(1.35±0.48),差异有统计学意义(P0.05)。结论1.将加速康复外科综合舒适护理的护理措施应用到全膝关节置换术患者围术期护理中,可缩短术后首次下床时间,增加患者每日运动量。2.将加速康复外科综合舒适护理的优化护理措施应用到全膝关节置换术患者围术期护理中,可有效缓解患者疼痛程度,缓解患者心理压力,提高患者生理舒适感和住院满意度。3.将加速康复外科综合舒适护理的优化护理措施应用到全膝关节置换术患者围术期护理中,可加快患者术后早期关节功能恢复,缩短术后住院时间,对全膝关节置换手术术后康复有明显的积极作用。
[Abstract]:Objective to explore the improvement of perioperative pain and the degree of knee joint function recovery in patients undergoing total knee arthroplasty with accelerated rehabilitation surgery on the basis of comprehensive comfort nursing measures. The effect of comfort and hospital satisfaction, and provide clinical experience for promoting the application of accelerated rehabilitation surgery comfort nursing in joint surgery. Methods through literature review, the group discussion of accelerated rehabilitation surgery comfort nursing, pre-test and other methods to determine the accelerated rehabilitation surgery comfort care measures. Objective to select 82 elderly patients who underwent unilateral total knee arthroplasty in a Grade 3A hospital in Qingdao, Shandong Province. The data were collected by general information questionnaire and general data were collected before operation. Joint function and pain score. Eighty-two patients with qualified baseline assessment were included in the study, of which 41 patients who met the inclusion criteria were the control group. 41 patients who met the inclusion criteria were the observation group. The patients in the control group were given routine nursing measures in hospital, while the patients in the observation group were given the comfort nursing measures of accelerated rehabilitation surgery. The knee joint function score at admission and 3 days after discharge, the pain disaster score on admission, the joint motion and visual analogue score of pain on 4 days after operation were collected. The first time of getting out of bed after operation, hospital satisfaction, average postoperative hospitalization days and sleep quality. Result 1. Age, sex, body mass index, knee joint score at admission, pain disaster score and pain score at admission, joint motion at admission, preoperative hemoglobin and albumin, The operation time and other basic data were not statistically significant P 0.05. 2. The onset time of foot hook in the observation group was 2.56 卤1.25) earlier than that in the control group (11.48 卤4.48), and the average first time of getting out of bed was 2.06 卤3.31) earlier than that in the control group (2.66 卤0.47), and the VAS score at 12 hours after operation was lower than that in the control group (6.57 卤1.19). The difference was statistically significant. The HSS score (34.21 卤1.65) in the observation group was higher than that in the control group (31.23 卤1.83), and the HSS(83.23 卤3.81 at one month after discharge in the observation group was significantly higher than that in the control group (78.69 卤5.06). The results of repeated measurement analysis of variance showed that there were significant differences in the effect and time effect between the two groups in the range of joint motion and pain score (P 0.05), and there was an interactive effect between joint motion and pain score and time factor, and the difference was statistically significant (P 0.05). The average postoperative hospitalization days in the observation group were less than that in the control group (6.81 卤1.53), the hospital satisfaction was 97.71 卤2.78) and the sleep quality in the observation group was higher than that in the control group (94.16 卤6.81), and the number of good sleep quality in the observation group was 1.64 卤0.48) higher than that in the control group (1.35 卤0.48), the difference was statistically significant (P 0.05). Conclusion 1. Applying the comprehensive comfortable nursing measures of accelerated rehabilitation surgery to the perioperative nursing care of the patients undergoing total knee arthroplasty can shorten the first time of getting out of bed after operation and increase the daily exercise amount of the patients. Applying the optimized nursing measures of comprehensive comfort nursing in rehabilitation surgery to the perioperative nursing care of patients undergoing total knee arthroplasty can effectively relieve the pain degree of the patients, relieve the psychological pressure of the patients, and improve the physiological comfort of the patients and the satisfaction degree of the patients in hospital. Applying the optimized nursing measures of comprehensive and comfortable nursing of accelerated rehabilitation surgery to perioperative nursing care of patients undergoing total knee arthroplasty can accelerate the recovery of early postoperative joint function and shorten the postoperative hospitalization time. It has a positive effect on postoperative rehabilitation of total knee arthroplasty.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6

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