人工髋关节置换术围术期行快速康复护理路径设计的研究进展
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摘要
快速康复护理路径围绕以医院为主体、以患者为核心、以疾病为目标,将快速康复外科理念应用于单侧人工髋关节置换术围术期中,旨在改进医疗工作水平,优化围术期护理方案,充分利用和开拓有限的医疗资源,使手术应激反应最小化,降低术后并发症发生率和再入院率,减少患者住院时间,以达到提高医疗工作效率和满意度的目的。本文就这一新型的快速康复护理路径的实施方法和步骤做一现状综述,以健全医疗护理服务体系,为医疗环境创造新型平台。
The therapeutic path of rapid rehabilitation nursing focuses on hospitals as the main treatment site,with patients at the core,and disease treatment as the goal.The concept of rapid rehabilitation nursing was applied during the perioperative period for unilateral hip joint replacement to improve the level of medical work,to optimize the perioperative care program,and to make full use of and further develop limited medical resources.The goals were to minimize the surgical stress response and to reduce the incidence of postoperative complications and readmissions,as well as hospitalization time for patients,and to improve the efficiency and satisfaction.This article reviewed the current implementation methods and steps of this new rapid rehabilitation nursing route to improve the health care service system as well as to create a new platform for the medical environment.
The therapeutic path of rapid rehabilitation nursing focuses on hospitals as the main treatment site,with patients at the core,and disease treatment as the goal.The concept of rapid rehabilitation nursing was applied during the perioperative period for unilateral hip joint replacement to improve the level of medical work,to optimize the perioperative care program,and to make full use of and further develop limited medical resources.The goals were to minimize the surgical stress response and to reduce the incidence of postoperative complications and readmissions,as well as hospitalization time for patients,and to improve the efficiency and satisfaction.This article reviewed the current implementation methods and steps of this new rapid rehabilitation nursing route to improve the health care service system as well as to create a new platform for the medical environment.
引文
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[2]毛宾尧,庞清江.髋关节外科学[M].2版.北京:人民卫生出版社,2013:680.MAO B Y,PANG Q J.Hip joint surgery[M].2nd ed.Beijing:People's Medical Publishing House,2013:680.
[3]TANG P,HU F,SHEN J,et al.Proximal femoral nail antirotation versus hemiarthroplasty:a study for the treatment of intertrochanteric fractures[J].Injury,2012,43(6):876-881.DOI:10.1016/j.injury.2011.11.008.
[4]KEHLET H,WILMORE D W.Multimodal strategies to improve surgical outcome[J].Am J Surg,2002,183(6):630-641.DOI:10.1016/S0002-9610(02)00866-8.
[5]江志伟,黎介寿.规范化开展加速康复外科几个关键问题[J].中国实用外科杂志,2016,36(1):44-46.DOI:10.7504/CJPS.ISSN1005-2208.2016.01.14.JIANG Z W,LI J S.Some key issues in standardizing accelerated rehabilitation surgery[J].Chinese Journal of Practical Surgery,2016,36(1):44-46.DOI:10.7504/CJPS.ISSN1005-2208.2016.01.14.
[6]鲁英,罗先正.203例股骨转子间骨折治疗分析[J].中国骨与关节损伤杂志,1991,6(1):7-9.LU Y,LUO X Z.Analysis of 203 cases of femoral intertrochanteric fractures[J].Chinese Journal of Bone and Joint Injury,1991,6(1):7-9.
[7]刘勇军,管向东.加速康复外科理念及其应用[J].新医学,2009,40(4):211.LIU Y J,GUAN X D.The concept of accelerating rehabilitation surgery and its application[J].New Materia Medica,2009,40(4):211.
[8]国家卫生计生委办公厅.国家卫生计生委办公厅关于实施有关病种临床路径的通知[EB/OL].(2016-12-08)[2017-07-18].http://www.nhfpc.gov.cn/yzygj/s7659/201612/e02b9324fc344f45979b6c20d7497b71.shtml.
[9]BANDURA A.Self-efficacy:the exercise of control[M].New York:WH Freeman and Company,1997:592.
[10]沈渔邨.精神病学[M].2版.北京:人民卫生出版社,1988:431-432.SHEN Y C.Psychiatry[M].2nd ed.Beijing:People's Medical Publishing House,1988:431-432.
[11]杨艳杰.护理心理学[M].3版.北京:人民卫生出版社,2012:106-107.YANG Y J.Nursing psychology[M].3rd ed.Beijing:People's Medical Publishing House,2012:106-107.
[12]HANSEN T B,BREDTOFT H K,LARSEN K.Preoperative physical optimization in fast track hip and knee arthroplasty[J].Dan Med J,2012,59(2):A4381.
[13]MITCHELL M.The future of surgical nursing and enhanced recovery programmes[J].Br J Nurs,2011,20(16):978-984.DOI:10.12968/bjon.2011.20.16.978.
[14]ABU HILAL M,DI FABIO F,BADRAN A,et al.Implementation of enhanced recovery programme after pancreatoduodenectomy:a single-centre UK pilot study[J].Pancreatology,2013,13(1):58-62.DOI:10.1016/j.pan.2012.11.312.
[15]周宗科,翁习生,曲铁兵,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.DOI:10.3969/j.issn.2095-9985.2016.01.001.ZHOU Z K,WENG X S,QU T B,et al.Expert consensus in enhanced recovery after total hip and knee arthroplasty in China:perioperative management[J].Chinese Journal of Bone and Joint Surgery,2016,9(1):1-9.DOI:10.3969/j.issn.2095-9985.2016.01.001.
[16]MAKHIJA R.Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation[J].Br JSurg,2004,91(11):1125-1130.DOI:10.1002/bjs.4854.
[17]SOOP M,NYGREN J,THORELL A.Preoperative oral carbohydrate treatment attenuates glucose release 3 days after surgery[J].Clin Nutr,2004,23(4):733-741.DOI:10.1016/j.clnu.2003.12.007.
[18]MELIS G C,VAN LEEUWEN P A,VON BLOMBERG-VAN DERFLIER B M,et al.A carbohydrate-rich beverage prior to surgery prevents sergey-induced immunodepression:a randomized,controlled,clinical trial[J].JPEN J Parenter Enteral Nutr,2006,30(1):21-26.DOI:10.1177/014860710603000121.
[19]LUDWIG R B,PALUDO J,FERNANDES D,et al.Lesser time of preoperative fasting and early postoperative feeding are safe?[J].Arq Bras Cir Dig,2013,26(1):54-58.DOI:10.1590/S0102-67202013000100012.
[20]AGRAWAL D,MANZI S F,GUPTA R,et al.Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department[J].Ann Emerg Med,2003,42(5):636-646.DOI:10.1016/s0196-0644(03)00516-x.
[21]BRANDSTRUP B,TNNESEN H,BEIER-HOLGERSEN R,et al.Effects of intravenous fluid restriction on postoperative complications:comparison of two perioperative fluid regimens:a randomized assessor-blinded multicentre trial[J].Ann Surg,2003,238(5):641-648.DOI:10.1097/01.sla.0000094387.50865.23.
[22]ARIEFF A I.Fatal postoperative pulmonary edema:pathogenesis and literature review[J].Chest,1999,115(5):1371-1377.DOI:10.1378/chest.115.5.1371.
[23]BELLAMY M C.Wet,dry or something else?[J].Br J Anaesth,2006,97:755-757.DOI:10.1093/bja/ael290.
[24]BUNDGAARD-NIELSEN M,SECHER N H,KEHLET H."Liberal"vs"restrictive"perioperative fluid therapy-a critical assessment of the evidence[J].Acta Anaesthesiol Scand,2009,53(7):843-851.DOI:10.1111/j.1399-6576.2009.02029.x.
[25]SHOEMAKER W C,APPLE P,BLAND R.Use of physiologic monitoring to predict outcome and to assist in clinical decision in critically ill postoperative patients[J].Am J Surg,1983,146(1):43-50.DOI:10.1016/0002-9610(83)90257-x.
[26]周宗科,翁习生,向兵,等.中国髋、膝关节置换术加速康复--围术期贫血诊治专家共识[J].中华骨与关节外科杂志,2016,9(1):10-15.DOI:10.3969/j.issn.2095-9985.2016.01.002.ZHOU Z K,WENG X S,XIANG B,et al.Expert consensus in enhanced recovery after total hip and knee arthroplasty in China:diagnosis and treatment of perioperative anemia[J].Chinese Journal of Bone and Joint Surgery,2016,9(1):10-15.DOI:10.3969/j.issn.2095-9985.2016.01.002.
[27]MOHN A C,EGGE D,ROKKE O,et al.Risk of thromboembolic complications after fast-track abdominal surgery with thrombosisprophylaxis only during hospital stay[J].Gastroenterology Res,2011,4(3):107-113.DOI:10.4021/gr320e.
[28]GEERTS W H,BERGQVIST D,PINEO G F,et al.Prevention of venous thromboembolism:American college of chest physicians evidence-based clinical practice guidelines(8th edition)[J].C h e s t,2 0 0 8,1 3 3(6 S u p p l):3 8 1 S-4 5 3.D O I:10.1378/chest.08-0656.
[29]WANG Y,GAO F,SUN W,et al.The efficacy of periarticular drug infiltration for postoperative pain after total hip arthroplasty:a systematic review and meta-analysis[J].Medicine(Baltimore),2017,96(12):e6401.DOI:10.1097/md.0000000000006401.
[30]陈志,李金龙,宇浩达.快速康复外科理念用于初次全髋关节置换术的有效性评价[J].实用骨科杂志,2016,22(7):586-590.CHEN Z,LI J L,YU H D.The effectiveness of accelerating rehabilitation surgery in primary total hip arthroplasty[J].Journal of Practical Orthopedics,2016,22(7):586-590.
[31]FUJITA K,XIA Z,LIU X,et al.Lifestyle and health-related quality of life in Asian patients with total hip arthroplasties[J].Nurs Health Sci,2014,16(3):365-372.DOI:10.1111/nhs.12114.
[32]WALD H L,MA A,BRATZLER D W,et al.Indwelling urinary catheter use in the postoperative period:analysis of the national surgical infection prevention project date[J].Arch Surg,2008,143(6):551-557.DOI:10.1001/archsurg.143.6.551.
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