成人膝关节恶性骨肿瘤全膝关节置换围手术期护理干预与近期效应分析
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摘要
目的:探讨行膝关节恶性骨肿瘤关节置换术围手术期的护理干预方式,提出减少全膝关节置换术后并发症,提高手术疗效,提高患者生活质量的临床护理策略。方法:将北京积水潭医院骨肿瘤科120例诊断为膝关节恶性骨肿瘤需行全膝关节置换术的患者按完全随机分组方式分成护理I组和护理II组,两组均接受膝关节肿瘤围术期常规临床护理,其中II组加用北京积水潭医院骨肿瘤科改进的全膝肿瘤患者护理干预措施,比较分析2组Ennking骨骼肌肉肿瘤下肢评分量表(musculoskeletal t u m o rr a t i n gs c a l e, M S T S)评分、术后并发症的发生率及护理前后抑郁自评量表(S e l f-R a t i n g Depression Scale,SDS)、焦虑自评量表(Self-Rating Anxiety Scale,SAS)、匹兹堡睡眠质量指数量表(Pittsburghsleepqualityindex,PSQI)评分。结果:II组MSTS评分明显优于I组(P<0.05),感染、深静脉血栓、膝关节强直、肌肉萎缩等并发症发生率显著低于I组(P<0.05);SDS,SAS,PSQI评分也优于I组(P<0.05)。结论:对膝关节恶性骨肿瘤需行全膝关节置换术的患者进行骨科术后临床护理,并在此基础上进行患者个性化心理疏导等综合护理干预,可有效减少置换术后并发症,提高术后疗效,改善骨肿瘤患者生活质量。
Objective: To investigate the perioperative nursing strategies of patients with malignant tumor of bone received total knee arthroplasty, and put forward nursing strategies in order to reduce complications after joint replacement, improve the surgical curative effect and to improve the life quality of patients. Methods: One hundred and twenty patients diagnosed with knee malignant bone tumors who need total knee arthroplasty in our hospital were completely randomly divided into I group and II group. The patients in the I/II group received conventional clinical nursing, while the patients in the II group received special nursing intervention. The Ennking Musculoskeletal Tumor Rating Scale(MSTS) score, the incidence of postoperative complications, SelfRating Depression Scale(SDS), Self-Rating Anxiety Scale(SAS), Pittsburgh sleep quality index(PSQI) score were evaluated. Results: In the II group, the MSTS score was better than I group, the incidence of complications including infection, deep vein thrombosis, knee joint stiffness, muscle atrophy was significantly lower than I group(P<0.05). SDS, SAS, PSQI score in the experimental group was superior to I group(P<0.05). Conclusion:The special perioperative nursing of patients with malignant tumor of bone received total knee arthroplasty can effectively reduce the incidence of complications, the curative effect and improve the patients' quality of life.
Objective: To investigate the perioperative nursing strategies of patients with malignant tumor of bone received total knee arthroplasty, and put forward nursing strategies in order to reduce complications after joint replacement, improve the surgical curative effect and to improve the life quality of patients. Methods: One hundred and twenty patients diagnosed with knee malignant bone tumors who need total knee arthroplasty in our hospital were completely randomly divided into I group and II group. The patients in the I/II group received conventional clinical nursing, while the patients in the II group received special nursing intervention. The Ennking Musculoskeletal Tumor Rating Scale(MSTS) score, the incidence of postoperative complications, SelfRating Depression Scale(SDS), Self-Rating Anxiety Scale(SAS), Pittsburgh sleep quality index(PSQI) score were evaluated. Results: In the II group, the MSTS score was better than I group, the incidence of complications including infection, deep vein thrombosis, knee joint stiffness, muscle atrophy was significantly lower than I group(P<0.05). SDS, SAS, PSQI score in the experimental group was superior to I group(P<0.05). Conclusion:The special perioperative nursing of patients with malignant tumor of bone received total knee arthroplasty can effectively reduce the incidence of complications, the curative effect and improve the patients' quality of life.
引文
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6 .吴晶,程淑平,吕春梅.恶性骨肿瘤患者希望水平和人格特征及其与生活质量的相关性[J].现代临床护理, 2015, 14(3):5-8.WU Jing, CHENG Shuping, LüChunmei. Influence of hope level and personality characteristics on quality of life of patients with malignant bone tumors[J]. Modern Clinical Nursing, 2015, 14(3):5-8.
7 .Aboulafia AJ, Buch R, Mathews J, et al. Reconstruction using the saddle prosthesis following excision of primary and metastatic periacetabular tumors[J]. Clin Orthop Relat Res, 1995(314):203-213.
8 .阎作勤,陈峥嵘,张光健.膝关节恶性骨肿瘤的保肢治疗[J].国际骨科学杂志, 2003, 24(3):179-180.YAN Zuoqin, CHEN Zhengrong, ZHANG Guangjian. Limb salvage for malignant tumors of the knee[J]. Foreign Medical Sciences?Section of Orthopaedics, 2003, 24(3):179-180.
9 .Mason JB, Fehring TK, Odum SM, et al. The value of white blood cell counts before revision total knee arthroplasty[J]. J Arthroplasty, 2003,18(8):1038-1043.
10 .PietschT,Dav idJ,VergaraF.Integrativerev iewforpatients withbilateraltotalkneereplacement:Acallfornursingpractice guidelines[J]. Orthop Nurs, 2018, 37(4):237-243.
11 .Kimball CC, Nichols CI, Nunley RM, et al. Skilled nursing facility star rating, patient outcomes, and readmission risk after total joint arthroplasty[J]. J Arthroplasty, 2018, 33(10):3130-3137.
12 .Otten C, Dunn KS. The efficacy of regional anesthesia techniques to control postoperative pain after total knee arthroplasty[J]. Orthop Nurs, 2018, 37(3):177-182.
13 .Boland L, Taljaard M, Dervin G, et al. Effect of patient decision aid was influenced by presurgical evaluation among patients with osteoarthritis of the knee[J]. Can J Surg, 2018, 61(1):28-33.
14 .Lockwood R, Kable A, Hunter S. Evaluation of a nurse‐led intervention to improve adherence to recommended guidelines for prevention of venous thromboembolism for hip and knee arthroplasty patients:A quasi‐experimental study[J]. J Clin Nurs. 2018, 27(5/6):e1048-e1060.
15 .Sz?ts K, Konradsen H, Solgaard S, et al. Telephone follow-up by nurse after total knee arthroplasty[J]. Orthop Nurs, 2016, 35(6):411-420.
16 .McCann-SpryL,PeltonJ,GrandyG,etal.Aninterdisciplinary approach to reducing length of stay in joint replacement patients[J].Orthop Nurs, 2016, 35(5):279-298.
17 .ArgensonJN,HustedH,LombardiAJr,etal.Globalforum:an internationalperspectiveonoutpatientsurgicalproceduresfor adult hip and knee reconstruction[J]. J Bone Joint Surg Am, 2016,98 (13):e55.
18 .李九群,伍晓,肖银贵,等.全膝关节置换患者医康护一体化临床路径与护理临床路径的管理效果随机对照研究[J].齐齐哈尔医学院学报, 2017, 38(2):220-223.LI Junqun, WU Xiao, XIAO Yingui, et al. A randomized controlled study on the management effect of clinical pathway and nursing clinical pathway in patients with total knee arthroplasty[J]. Journal of Qiqihar Medical University, 2017, 38(2):220-223.
19 .Patel NK, Kim E, Khlopas A, et al. What influences how patients rate their hospital stay after total hip arthroplasty?[J]. Surg Technol Int,2017, 30:405-410.
20 .Strickland LH, Kelly L, Hamilton TW, et al. Early recovery following lowerlimbarthroplasty:Qualitativeinter viewswithpatients undergoing elective hip and knee replacement surgery. Initial phase in the development of a patient‐reported outcome measure[J]. J Clin Nurs, 2018, 27(13/14):2598-608.
21 .王雷,陈金安,胡志为,等.围手术期糖尿病足患者管理的研究进展[J].临床与病理杂志. 2018, 38(8):1785-1790.WANG Lei, CHEN Jin’an, HU Zhiwei, et al. Research progress in management of diabetic foot patients during perioperative period[J].Journal of Clinical and Pathological Research, 2018, 38(8):1785-1790.
2 .张巧娥,赵芳玲.四肢恶性骨肿瘤保肢术病人的护理[J].护理学杂志, 2003, 18(11):826-827.ZHANG Qiao’e, ZHAO Fangling. Nursing care of the patients with malignant tumor of bone in extremities for limb salvage operation[J].Journal of Nursing Science, 2003, 18(11):826-827.
3 .盘雪梅,蒙小燕.旋转铰链型人工膝全膝关节置换治疗胫骨近端侵袭性骨肿瘤的护理[J].中国实用护理杂志, 2005, 21(8):15-16.PANXuemei,MENGXiaoyan.Nursingoftreatinginvasivebone tumor at the proximal end of tibia with rotary hinged artificial knee transplantation[J]. Chinese Journal of Practical Nursing, 2005, 21(8):15-16.
4 .付成叶,刘春宁,赵守美.护理干预对人工关节假体治疗膝关节周围骨肿瘤患者的应用效果[J].中国肿瘤临床与康复, 2016,23(7):880-882.FU Chengye, LIU Chunning, ZHAO Shoumei. Application effect of nursing intervention in the treatment of bone tumors around knee joint with artificial joint prosthesis[J]. Chinese Journal of Clinical Oncology and Rehabilitation, 2016, 23(7):880-882.
5 .曹凤英,祖桂君,史素丽,等.临床护理路径模式应用于人工全膝全膝关节置换术患者的疗效评价[J].中国煤炭工业医学杂志.2013, 16(6):1003-1004.CAO Fengying, ZU Guijun, SHI Suli, et al. Clinical nursing pathway applied to the evaluation of patients with total knee arthroplasty[J].Chinese Journal of Coal Industry Medicine, 2013, 16(6):1003-1004.
6 .吴晶,程淑平,吕春梅.恶性骨肿瘤患者希望水平和人格特征及其与生活质量的相关性[J].现代临床护理, 2015, 14(3):5-8.WU Jing, CHENG Shuping, LüChunmei. Influence of hope level and personality characteristics on quality of life of patients with malignant bone tumors[J]. Modern Clinical Nursing, 2015, 14(3):5-8.
7 .Aboulafia AJ, Buch R, Mathews J, et al. Reconstruction using the saddle prosthesis following excision of primary and metastatic periacetabular tumors[J]. Clin Orthop Relat Res, 1995(314):203-213.
8 .阎作勤,陈峥嵘,张光健.膝关节恶性骨肿瘤的保肢治疗[J].国际骨科学杂志, 2003, 24(3):179-180.YAN Zuoqin, CHEN Zhengrong, ZHANG Guangjian. Limb salvage for malignant tumors of the knee[J]. Foreign Medical Sciences?Section of Orthopaedics, 2003, 24(3):179-180.
9 .Mason JB, Fehring TK, Odum SM, et al. The value of white blood cell counts before revision total knee arthroplasty[J]. J Arthroplasty, 2003,18(8):1038-1043.
10 .PietschT,Dav idJ,VergaraF.Integrativerev iewforpatients withbilateraltotalkneereplacement:Acallfornursingpractice guidelines[J]. Orthop Nurs, 2018, 37(4):237-243.
11 .Kimball CC, Nichols CI, Nunley RM, et al. Skilled nursing facility star rating, patient outcomes, and readmission risk after total joint arthroplasty[J]. J Arthroplasty, 2018, 33(10):3130-3137.
12 .Otten C, Dunn KS. The efficacy of regional anesthesia techniques to control postoperative pain after total knee arthroplasty[J]. Orthop Nurs, 2018, 37(3):177-182.
13 .Boland L, Taljaard M, Dervin G, et al. Effect of patient decision aid was influenced by presurgical evaluation among patients with osteoarthritis of the knee[J]. Can J Surg, 2018, 61(1):28-33.
14 .Lockwood R, Kable A, Hunter S. Evaluation of a nurse‐led intervention to improve adherence to recommended guidelines for prevention of venous thromboembolism for hip and knee arthroplasty patients:A quasi‐experimental study[J]. J Clin Nurs. 2018, 27(5/6):e1048-e1060.
15 .Sz?ts K, Konradsen H, Solgaard S, et al. Telephone follow-up by nurse after total knee arthroplasty[J]. Orthop Nurs, 2016, 35(6):411-420.
16 .McCann-SpryL,PeltonJ,GrandyG,etal.Aninterdisciplinary approach to reducing length of stay in joint replacement patients[J].Orthop Nurs, 2016, 35(5):279-298.
17 .ArgensonJN,HustedH,LombardiAJr,etal.Globalforum:an internationalperspectiveonoutpatientsurgicalproceduresfor adult hip and knee reconstruction[J]. J Bone Joint Surg Am, 2016,98 (13):e55.
18 .李九群,伍晓,肖银贵,等.全膝关节置换患者医康护一体化临床路径与护理临床路径的管理效果随机对照研究[J].齐齐哈尔医学院学报, 2017, 38(2):220-223.LI Junqun, WU Xiao, XIAO Yingui, et al. A randomized controlled study on the management effect of clinical pathway and nursing clinical pathway in patients with total knee arthroplasty[J]. Journal of Qiqihar Medical University, 2017, 38(2):220-223.
19 .Patel NK, Kim E, Khlopas A, et al. What influences how patients rate their hospital stay after total hip arthroplasty?[J]. Surg Technol Int,2017, 30:405-410.
20 .Strickland LH, Kelly L, Hamilton TW, et al. Early recovery following lowerlimbarthroplasty:Qualitativeinter viewswithpatients undergoing elective hip and knee replacement surgery. Initial phase in the development of a patient‐reported outcome measure[J]. J Clin Nurs, 2018, 27(13/14):2598-608.
21 .王雷,陈金安,胡志为,等.围手术期糖尿病足患者管理的研究进展[J].临床与病理杂志. 2018, 38(8):1785-1790.WANG Lei, CHEN Jin’an, HU Zhiwei, et al. Research progress in management of diabetic foot patients during perioperative period[J].Journal of Clinical and Pathological Research, 2018, 38(8):1785-1790.