损害控制在90岁以上超高龄患者髋部骨折围术期护理中的应用

发布时间：2018-08-17 19:21

【摘要】：目的探讨损害控制在90岁以上超高龄患者髋部骨折围术期护理中的可行性与效果。方法对2010年1月至2014年12月该科收治的53例90岁以上髋部骨折患者实施手术损害控制(DCS)。采用改良生理学和手术严重性评分系统及大坪医院骨科老年患者手术风险评分系统术前对患者进行风险评估,患者均接受了1~4次风险评估。评估后35例患者72h内手术,为早期手术组;18例患者5~10d手术,为延迟手术组。对两组患者进行分组护理,早期手术组采用第一时间的疼痛控制,医护一体化的期望值管理,快速康复理念的功能锻炼;延迟手术组采用多学科模式营养支持,积极的心肺功能锻炼,力所能及的功能锻炼。比较两组患者术后住院时间、ICU住院时间、住院期间并发症发生率,观察分组护理的效果。结果两组术后住院时间、术后ICU住院时间、住院期间并发症发生率差异无统计学意义(P0.05)。53例患者均达到了手术目的,出院前能借助助行器下床行走。结论对90岁以上髋部骨折患者在围术期护理中实施手术损害控制是有效的。
[Abstract]:Objective to explore the feasibility and effect of damage control in perioperative nursing of hip fracture in patients over 90 years old. Methods from January 2010 to December 2014, 53 patients with hip fracture over 90 years old were treated with surgical damage control (DCS). The patients were evaluated before operation by using the modified physiological and surgical severity scoring system and the surgical risk scoring system of the elderly patients in the orthopedic department of Daping Hospital. All the patients received 1 or 4 risk assessments. After evaluation, 35 patients were operated within 72 hours, 18 patients in the early operation group and 18 patients in the early operation group were treated with delayed operation for 5 to 10 days. Two groups of patients were divided into two groups: the early operation group was treated with first-time pain control, the expectant value management of medical and nursing integration, the functional exercise of the concept of rapid rehabilitation, and the delayed operation group was supported by multi-disciplinary nutrition model. Active cardiopulmonary exercise, as far as possible. The length of stay in ICU and the incidence of complications during hospitalization were compared between the two groups, and the effect of group nursing was observed. Results there was no significant difference between the two groups in postoperative hospitalization time, postoperative ICU hospitalization time and the incidence of complications during hospitalization (P0.05). 53 patients achieved the purpose of operation, and could walk out of bed with a walking aid before discharge. Conclusion the perioperative nursing of hip fracture patients over 90 years old is effective.
【作者单位】：第三军医大学大坪医院野战外科研究所关节四肢外科;
【分类号】：R473.6

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