可调节角度式翻身枕在特发性脊柱侧凸患者脊柱侧凸矫形术后康复中的应用效果研究
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摘要
背景脊柱侧凸后路矫形内固定植骨融合术后患者需绝对卧床7～10 d,易导致压疮的发生,而行定时轴线翻身可有效预防压疮的发生,但以往的翻身枕仅有一种角度,无法满足不同患者不同时期对翻身角度的需求。护理人员设计了可以调节支起角度的可调节角度式翻身枕,能够根据患者不同需求设定相应角度。目的分析可调节角度式翻身枕对特发性脊柱侧凸患者脊柱侧凸矫形术后康复的应用效果。方法选取2015年1月—2016年6月南京大学医学院附属鼓楼医院脊柱外科收治的特发性脊柱侧凸患者61例,采用随机数字表法将其分为固定组(31例)和调节组(30例),固定组术后使用常规R型翻身枕进行轴线翻身,调节组使用可调节角度式翻身枕(实用新型专利号:ZL2014 2 0699793.6)。记录患者一般资料,采用视觉模拟评分法(VAS)评估疼痛程度,采用舒适状况量表(GCQ)评价舒适程度,记录术后72 h内翻身次数、压疮情况。结果两组患者性别、年龄、Braden评分比较,差异均无统计学意义(P>0.05);调节组术前Cobb角度大于固定组(P<0.05)。调节组患者的VAS评分低于固定组,GCQ评分高于固定组,翻身次数少于固定组(P<0.05)。两组均未发生压疮。结论脊柱侧凸患者术后使用可调节角度式翻身枕可减轻疼痛,减少翻身次数,提高舒适度,且不增加压疮的发生,从而促进患者康复。
Background Patients receiving spinal internal fixation and bone graft fusion need to stay in bed for 7 to10 days,which increases the risk of pressure ulcers. The axial turning can effectively prevent pressure ulcers,but the previous turning pillow has only one angle,which cannot meet the needs of different patients in different periods for turning angle. Designed adjustable pillow can adjust the angle of support,which can meet the different needs of patients. Objective To analyze the effect of adjustable turning pillows on the rehabilitation of patients with idiopathic scoliosis after scoliosis correction.Methods A total of 61 patients with idiopathic scoliosis admitted to Department of Spine Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January 2015 to June 2016 were selected.They were randomly divided into fixation group(31 cases) and adjustment group(30 cases) by random number table method.The fixation group used the conventional R-type turning pillow for axis turning,and the adjustment group used the adjustable turning pillow(utility model patent number:ZL2014 2 0699793.6) in the postoperative period.Patients' general data were recorded,pain was evaluated by Visual Analogue Scale(VAS),comfort level by General Comfort Questionnaire(GCQ),and body turning frequency and pressure ulcers were recorded within 72 h after surgery.Results The differences in gender,age and Braden score were not statistically significant(P>0.05).The angle of Cobb was greater in the adjustment group than that in the fixation group(P<0.05).The VAS score of patients in the adjustment group was lower than that in the fixation group,GCQ score was higher than that in the fixation group,and body turning frequency was less than that in the fixation group(P<0.05).There was no pressure ulcer in both groups.Conclusion After operation,patients with scoliosis can use adjustable turning pillow to alleviate pain,reduce body turning frequency,improve the comfort level,and lessen the occurrence of pressure sores,thus improving their recovery.
Background Patients receiving spinal internal fixation and bone graft fusion need to stay in bed for 7 to10 days,which increases the risk of pressure ulcers. The axial turning can effectively prevent pressure ulcers,but the previous turning pillow has only one angle,which cannot meet the needs of different patients in different periods for turning angle. Designed adjustable pillow can adjust the angle of support,which can meet the different needs of patients. Objective To analyze the effect of adjustable turning pillows on the rehabilitation of patients with idiopathic scoliosis after scoliosis correction.Methods A total of 61 patients with idiopathic scoliosis admitted to Department of Spine Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January 2015 to June 2016 were selected.They were randomly divided into fixation group(31 cases) and adjustment group(30 cases) by random number table method.The fixation group used the conventional R-type turning pillow for axis turning,and the adjustment group used the adjustable turning pillow(utility model patent number:ZL2014 2 0699793.6) in the postoperative period.Patients' general data were recorded,pain was evaluated by Visual Analogue Scale(VAS),comfort level by General Comfort Questionnaire(GCQ),and body turning frequency and pressure ulcers were recorded within 72 h after surgery.Results The differences in gender,age and Braden score were not statistically significant(P>0.05).The angle of Cobb was greater in the adjustment group than that in the fixation group(P<0.05).The VAS score of patients in the adjustment group was lower than that in the fixation group,GCQ score was higher than that in the fixation group,and body turning frequency was less than that in the fixation group(P<0.05).There was no pressure ulcer in both groups.Conclusion After operation,patients with scoliosis can use adjustable turning pillow to alleviate pain,reduce body turning frequency,improve the comfort level,and lessen the occurrence of pressure sores,thus improving their recovery.
引文
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[9]朱丽霞,高凤莉,罗虹辉,等.舒适状况量表的信效度测试研究[J].中国实用护理杂志,2006,22(5):57-59.DOI:10.3760/cma.j.issn.1672-7088.2006.13.034.ZHU L X,GAO F L,LUO H H,et al.The study of testing the content validity and the internal consistency of general comfort questionnaire[J].Chinese Journal of Practical Nursing,2006,22(5):57-59.DOI:10.3760/cma.j.issn.1672-7088.2006.13.034.
[10]李小寒,尚少梅.基础护理学[M].4版.北京:人民卫生出版社,2006:86.LI X H,SHANG S M.Fundamentals of nursing[M].4th ed.Beijing:People's Medical Publishing House,2006:86.
[11]MANZANO F,COLMENERO M,PéREZ-PéREZ A M,et al.Comparison of two repositioning schedules for the prevention of pressure ulcers in patients on mechanical ventilation with alternating pressure air mattresses[J].Intensive Care Med,2014,40(11):1679-1687.DOI:10.1007/s00134-014-3424-3.
[12]陈维英.基础护理学[M].南京:江苏科学技术出版社,1997:96.CHEN W Y.Fundamentals of nursing[M].Nanjing:Jiangsu Science and Technology Press,1997:96.
[13]BERGSTROM N,HORN S D,RAPP M P,et al.Turning for ulcer reduction:a multisite randomized clinical trial in nursing homes[J].J Am Geriatr Soc,2013,61(10):1705-1713.DOI:10.1111/jgs.12440.
[14]叶启彬.脊柱外科新手术[M].北京:北京医科大学中国协和医科大学联合出版社,1993:315-317.YE Q B.New spinal surgery[M].Beijing:Beijing Medical University China Union Medical University Joint Press,1993:315-317.
[15]张玉红,蒋琪霞,郭艳侠,等.使用减压床垫的压疮危险者翻身频次的meta分析[J].中华护理杂志,2015,50(9):1029-1036.DOI:10.3761/j.issn.0254-1769.2015.09.001.ZHANG Y H,JIANG Q X,GUO Y X,et al.A meta-analysis of repositioning frequency for preventing pressure ulcers among patients lying in pressure-relief mattress[J].Chinese Journal of Nursing,2015,50(9):1029-1036.DOI:10.3761/j.issn.0254-1769.2015.09.001.
[2]MOORE Z,COWMAN S,POSNETT J.An economic analysis of repositioning for the prevention of pressure ulcers[J].J Clin Nurs,2013,22(15/16):2354-2360.DOI:10.1111/j.1365-2702.2012.04310.x.
[3]CHEN H L,CAO Y J,ZHANG W,et al.Braden scale(ALB)for assessing pressure ulcer risk in hospital patients:a validity and reliability study[J].Appl Nurs Res,2017,33:169-174.DOI:10.1016/j.apnr.2016.12.001.
[4]徐学武,李清波,刘骥,等.地佐辛与氟比洛芬酯在脊柱侧弯患者术后镇痛中作用的比较[J].中华临床医师杂志(电子版),2013,7(13):6155-6156.DOI:10.3877/cma.j.issn.1674-0785.2013.13.142.XU X W,LI Q B,LIU J,et al.Comparison of the effects of dizosin and flurbiprofen axetil on postoperative analgesia in patients with scoliosis[J].Chinese Journal of Clinicians(Electronic Edition),2013,7(13):6155-6156.DOI:10.3877/cma.j.issn.1674-0785.2013.13.142.
[5]苗玉良,钟京,方伟武,等.氟比洛芬酯复合芬太尼在脊柱侧弯术后镇痛中的应用[J].中华临床医师杂志(电子版),2012,6(1):224-225.DOI:10.3877/cma.j.issn.1674-0785.2012.01.057.MIAO Y L,ZHONG J,FANG W W,et al.Application of flurbiprofen axetil combined with fentanyl in analgesia after scoliosis surgery[J].Chinese Journal of Clinicians(Electronic Edition),2012,6(1):224-225.DOI:10.3877/cma.j.issn.1674-0785.2012.01.057.
[6]KOLCABA K Y.A taxonomic structure for the concept comfort[J].Image J Nurs Sch,1991,23(4):237-240.
[7]KOLCABA K Y,FISHER E M.A holistic perspective on comfort care as an advance directive[J].Crit Care Nurs Q,1996,18(4):66-76.
[8]KOLCABA K,TILTON C,DROUIN C.Comfort theory:a unifying framework to enhance the practice environment[J].J Nurs Adm,2006,36(11):538-544.
[9]朱丽霞,高凤莉,罗虹辉,等.舒适状况量表的信效度测试研究[J].中国实用护理杂志,2006,22(5):57-59.DOI:10.3760/cma.j.issn.1672-7088.2006.13.034.ZHU L X,GAO F L,LUO H H,et al.The study of testing the content validity and the internal consistency of general comfort questionnaire[J].Chinese Journal of Practical Nursing,2006,22(5):57-59.DOI:10.3760/cma.j.issn.1672-7088.2006.13.034.
[10]李小寒,尚少梅.基础护理学[M].4版.北京:人民卫生出版社,2006:86.LI X H,SHANG S M.Fundamentals of nursing[M].4th ed.Beijing:People's Medical Publishing House,2006:86.
[11]MANZANO F,COLMENERO M,PéREZ-PéREZ A M,et al.Comparison of two repositioning schedules for the prevention of pressure ulcers in patients on mechanical ventilation with alternating pressure air mattresses[J].Intensive Care Med,2014,40(11):1679-1687.DOI:10.1007/s00134-014-3424-3.
[12]陈维英.基础护理学[M].南京:江苏科学技术出版社,1997:96.CHEN W Y.Fundamentals of nursing[M].Nanjing:Jiangsu Science and Technology Press,1997:96.
[13]BERGSTROM N,HORN S D,RAPP M P,et al.Turning for ulcer reduction:a multisite randomized clinical trial in nursing homes[J].J Am Geriatr Soc,2013,61(10):1705-1713.DOI:10.1111/jgs.12440.
[14]叶启彬.脊柱外科新手术[M].北京:北京医科大学中国协和医科大学联合出版社,1993:315-317.YE Q B.New spinal surgery[M].Beijing:Beijing Medical University China Union Medical University Joint Press,1993:315-317.
[15]张玉红,蒋琪霞,郭艳侠,等.使用减压床垫的压疮危险者翻身频次的meta分析[J].中华护理杂志,2015,50(9):1029-1036.DOI:10.3761/j.issn.0254-1769.2015.09.001.ZHANG Y H,JIANG Q X,GUO Y X,et al.A meta-analysis of repositioning frequency for preventing pressure ulcers among patients lying in pressure-relief mattress[J].Chinese Journal of Nursing,2015,50(9):1029-1036.DOI:10.3761/j.issn.0254-1769.2015.09.001.