快速康复理念下早期下床活动对单侧全膝关节置换患者术后并发症的影响
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摘要
目的探讨快速康复理念下早期下床活动对全膝关节置换患者术后并发症的影响。方法选取100例行单侧全膝关节置换的患者,按入院时间分为观察组(53例)和对照组(47例)。观察组应用快速康复外科围手术期护理理念,术后6 h开始医护共同评估病情并实施早期下床活动;对照组采取常规围手术期护理方案,术后第1～3天下床活动。两组患者均由固定医生与专科康复护士进行资料收集。比较两组患者术后肺部感染、深静脉血栓形成、伤口愈合不良等并发症的发生率。结果观察组患者术后伤口愈合不良发生率与对照组无明显差异(P> 0. 05);观察组术后肺部感染、深静脉血栓形成等并发症的发生率明显低于对照组(P <0. 01)。结论快速康复理念下医护合作实施全膝关节置换患者早期下床活动可以降低并发症的发生率,提高护理质量,有较高的临床推广应用价值。
Objective To investigate the effect of early ambulation in patients on complications( TKA). Methods100 patients who underwent unilateral total knee arthroplasty were divided into observation group( n = 53) and control group( n = 47) according to admission time. The patients in observation group received the nursing which was combined with rapid recovery concept in the perioperative period. They were required to ambulate in 6 hours after surgery with doctor-nurse collaboration. The patients in control group received routine nursing and were required to ambulate in 1-3 days after surgery. The rate of lung infection,deep-vein thrombosis and poor wound healing were compared between two groups. Results There was no significant difference in the incidence of postoperative wound healing between the observation group and the control group( P > 0. 05). The incidence of postoperative pulmonary infection and deep vein thrombosis was significantly lower in the observation group than in the control group( P < 0. 01). Conclusion Under the concept of fast track surgery,doctor-nurse cooperation and early ambulation in patients after total knee arthroplasty can reduce the incidence of complications and improve the postoperative knee joint function of patients,which is of high clinical application value.
Objective To investigate the effect of early ambulation in patients on complications( TKA). Methods100 patients who underwent unilateral total knee arthroplasty were divided into observation group( n = 53) and control group( n = 47) according to admission time. The patients in observation group received the nursing which was combined with rapid recovery concept in the perioperative period. They were required to ambulate in 6 hours after surgery with doctor-nurse collaboration. The patients in control group received routine nursing and were required to ambulate in 1-3 days after surgery. The rate of lung infection,deep-vein thrombosis and poor wound healing were compared between two groups. Results There was no significant difference in the incidence of postoperative wound healing between the observation group and the control group( P > 0. 05). The incidence of postoperative pulmonary infection and deep vein thrombosis was significantly lower in the observation group than in the control group( P < 0. 01). Conclusion Under the concept of fast track surgery,doctor-nurse cooperation and early ambulation in patients after total knee arthroplasty can reduce the incidence of complications and improve the postoperative knee joint function of patients,which is of high clinical application value.
引文
[1]闫汝蕴.人工膝关节置换与围手术期系统康复[J].中国组织工程研究与临床康复,2008,12(17):3321.
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[9] WILMORE D W,KEHLET H. Fast track surgery[J]. Br J Surg,2005,92:3-4.
[10]李梅,董文,文双,等.系统化呼吸训练在开胸手术患者快速康复中的应用效果评价[J].实用医学杂志,2017,33(17):2956-2959.
[11]卢惠明,陈小萍.机器人辅助下肾部分切除术快速康复护理体会[J].实用医学杂志,2017,33(4):646-647.
[12]周桥灵,刘洪珍,赖晓红,等.急性等容血液稀释联合快速康复外科措施对肝叶切除术患者免疫功能的影响[J].实用医学杂志,2017,33(14):2315-2318.
[13]贾晗,陈嘉怡,陈红云.全膝关节置换术住院患者的不满因素调查分析[J].现代医院,2015,15(10):100,103.
[14] Auyong D B,Allen C J,Pahang J A,et al. Reduced Length of Hospitalization in Primary Total Knee Arthroplasty Patients Using an Updated Enhanced Recovery After Orthopedic Surgery(ERAS)Pathway[J]. J Arthroplasty,2015,30(10):1705-1709.
[15]袁美宁,李丽霞,刘彩虹.运动疗法对膝关节置换术后关节功能恢复的效果[J].护理实践与研究,2016,13(12):62-63.
[16]国家卫生计生委公益性行业科研专项《关节置换术安全性与效果评价》项目组,中华医学会骨科学分会关节外科学组,中国医疗保健国际交流促进会骨科分会关节外科委员会,等.中国髋、膝关节置换术加速康复———围术期管理策略专家共识[J].中华骨与关节外科杂志,2016,9(1):1-9.
[2]孙建梅.临床护理路径对人工膝关节置换术患者术后并发症及满意度的影响[J].世界最新医学信息文摘,2017,17(41):200-201.
[3] LABRACA N S,CASTRO-S?NCHEZ A M,MATAR?N-PE ARROCHA GA,et al. Benefits of starting rehabilitation within 24hours of primary total knee arthroplasty:randomized clinical trial[J]. Clin Rehabil,2011,25(6):557-566.
[4]张浩,沙强,宁凯,等.全膝关节置换术后早期并发症的原因分析[J].中华全科医学,2015,13(1):27-29.
[5] KEHLET H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth,1997,78(5):606-617.
[6] JAKOBSEN D H,SOME E,ANDREASEN J,et al. Convalescence after colonic surgery with fast-track vs conventional care[J]. Colorectal Dis,2008,8(8):683-687.
[7] FEARON K C,LJUNGQVIST O,VON MEYENFELDT M,et al.Enhanced recovery after surgery:A consensus review of clinical care for patients undergoing colonic resection[J]. Clin Nutr,2005,24(3):466-477.
[8] WICHMANN M W,EBEN R,ANGLE M K,et al. Fast-track rehabilitation in elective colorectal surgery patients:a prospective clinical and immunological single-centre study[J]. Anz J Surg,2007,77(7):502-507.
[9] WILMORE D W,KEHLET H. Fast track surgery[J]. Br J Surg,2005,92:3-4.
[10]李梅,董文,文双,等.系统化呼吸训练在开胸手术患者快速康复中的应用效果评价[J].实用医学杂志,2017,33(17):2956-2959.
[11]卢惠明,陈小萍.机器人辅助下肾部分切除术快速康复护理体会[J].实用医学杂志,2017,33(4):646-647.
[12]周桥灵,刘洪珍,赖晓红,等.急性等容血液稀释联合快速康复外科措施对肝叶切除术患者免疫功能的影响[J].实用医学杂志,2017,33(14):2315-2318.
[13]贾晗,陈嘉怡,陈红云.全膝关节置换术住院患者的不满因素调查分析[J].现代医院,2015,15(10):100,103.
[14] Auyong D B,Allen C J,Pahang J A,et al. Reduced Length of Hospitalization in Primary Total Knee Arthroplasty Patients Using an Updated Enhanced Recovery After Orthopedic Surgery(ERAS)Pathway[J]. J Arthroplasty,2015,30(10):1705-1709.
[15]袁美宁,李丽霞,刘彩虹.运动疗法对膝关节置换术后关节功能恢复的效果[J].护理实践与研究,2016,13(12):62-63.
[16]国家卫生计生委公益性行业科研专项《关节置换术安全性与效果评价》项目组,中华医学会骨科学分会关节外科学组,中国医疗保健国际交流促进会骨科分会关节外科委员会,等.中国髋、膝关节置换术加速康复———围术期管理策略专家共识[J].中华骨与关节外科杂志,2016,9(1):1-9.