行动研究法在血友病患者膝关节置换术后功能锻炼策略制定中的应用
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摘要
目的 :构建血友病患者膝关节置换术后功能锻炼策略,以期减少出血发生率和改善膝关节活动度,提高护理质量。方法 :以行动研究法为理论框架,综合应用文献研究、专家会议等方法收集、分析资料。便利选取2015年至2017年收治的132例血友病患者为研究对象,采用出血发生率和膝关节活动度对行动研究的效果进行评价。结果 :通过对第1个阶段持续被动关节活动器(CPM)辅助锻炼法的优化,患者出血发生率明显下降,膝关节活动度明显增加,与之前比较差异均具有统计学意义(P<0.05);通过第2个阶段三期主动运动法的构建,患者膝关节活动度明显增加,与第一阶段CPM辅助锻炼法比较差异具有统计学意义(P<0.05)。结论 :行动研究法是解决多学科合作、复杂问题的有效方法,本研究基于行动研究法形成了血友病患者膝关节置换术后功能锻炼策略,该方法可适用于临床实践,以提高护理质量。
Objective: To develop the rehabilitation strategy and improve bleeding and range of motion(ROM) in hemophilia patients with Total Knee Arthroplasty(TKA). Methods: The action research method was performed as the framework. The literature research, expert meetings were applied to collect and analyze data. Totally 132 hemophilia patients were included. The incidence of bleeding and the ROM were analyzed. Results: After the application of optimization of CPM program, the incidence of bleeding was significantly reduced and the ROM was significantly increased(P<0.05). After the application of construction of 3 phases active exercise, the ROM was significantly increased(P<0.05). Conclusion: Action research is an effective method to solve multidisciplinary cooperation and complex problems. Based on action research, rehabilitation strategy for hemophilia patients with TKA are developed. It is expected to apply the rehabilitation strategy to clinical practice to improve the quality of nursing care.
Objective: To develop the rehabilitation strategy and improve bleeding and range of motion(ROM) in hemophilia patients with Total Knee Arthroplasty(TKA). Methods: The action research method was performed as the framework. The literature research, expert meetings were applied to collect and analyze data. Totally 132 hemophilia patients were included. The incidence of bleeding and the ROM were analyzed. Results: After the application of optimization of CPM program, the incidence of bleeding was significantly reduced and the ROM was significantly increased(P<0.05). After the application of construction of 3 phases active exercise, the ROM was significantly increased(P<0.05). Conclusion: Action research is an effective method to solve multidisciplinary cooperation and complex problems. Based on action research, rehabilitation strategy for hemophilia patients with TKA are developed. It is expected to apply the rehabilitation strategy to clinical practice to improve the quality of nursing care.
引文
[1]中国血友病协作组中华医学会血液学分会血栓与止血学组.血友病诊断与治疗中国专家共识(2017年版).中华血液学杂志,2017(5):364-370.Blood Clot and Hemostasis of Hematology Branch of Chinese Medical Association.Chinese expert consensus on diagnosis and treatment of hemophilia(2017 edition).Chinese Journal of Hematology,2017(5):364-370.
[2]Mortazavi SM,Haghpanah B,Ebrahiminasab MM,et al.Functional outcome of total knee arthroplasty in patients with haemophilia.Haemophilia,2016,22(6):919-924.
[3]Kubes R,Salaj P,Hromadka R,et al.Range of motion after total knee arthroplasty in hemophilic arthropathy.BMC Musculoskelet Disord,2018,19(1):162.
[4]Rahme M,Ehlinger M,Faradji A,et al.Total knee arthroplasty in severe haemophilic patients under continuous infusion of clotting factors.Knee Surg Sports Traumatol Arthrosc,2012,20(9):1781-1786.
[5]翟吉良,翁习生,林进,等.全膝关节置换术治疗血友病性膝关节炎的远期疗效.中华骨科杂志,2017(23):1490-1497.Zhai JL,Weng XS,Lin J,et al.Long-term outcomes of total knee arthroplasty in patients with hemophilic arthropathy.Chinese Journal of Orthopaedics,2017(23):1490-1497.
[6]Shan L,Shan B,Suzuki A,et al.Intermediate and long-term quality of life after total knee replacement:a systematic review and metaanalysis.J Bone Joint Surg Am,2015,97(2):156-168.
[7]刘颖,赵金玲,张建平,等.严重血友病性关节炎患者的康复治疗:1例报告.中国康复医学杂志,2017(12):1410-1411.Liu Y,Zhao JL,Zhang JP,et al.Rehabilitation of patients with severe haemophiliac arthritis:1 case report.Chinese Journal of Rehabilitation Medicine,2017(12):1410-1411.
[8]孙建华,张青,赵明曦,等.基于行动研究法提高超声引导下空肠营养管置管成功率.护理学杂志,2018(2):45-47.Sun JH,Zhang Q,Zhao MX,et al Improving the success rate of ultrasound-guided jejunum feeding tube placement based on action research.Journal of Nursing Science,2018(2):45-47.
[9]胡雁.论行动研究在护理研究中的应用.中华护理杂志,2004,39(2):158-160.Hu Y.On the application of action research in nursing research.Chinese Journal of Nursing,2004,39(2):158-160.
[10]Feng B,Weng XS,Lin J,et al.Outcome of total knee arthroplasty combined patelloplasty for end-stage type A hemophilic arthropathy.Knee,2012,19(2):107-111.
[11]王学锋,冯建民,孙竞,等.中国血友病骨科手术围术期处理专家共识.中华骨与关节外科杂志,2016(5):361-370.Wang XF,Feng JM,Sun J,et al.Expert consensus in perioperative management in hemophilia patients undergoing orthopedic surgery in China.Chinese Journal Bone and Joint Surgery,2016(5):361-370.
[12]Chiang CC,Chen PQ,Shen MC,et al.Total knee arthroplasty for severe haemophilic arthropathy:long-term experience in Taiwan.Haemophilia,2008,14(4):828-834.
[13]Sr ivastava A,Brewer A K,MauserBunschoten EP,et al.Guidelines for the management of hemophilia.Haemophilia,2013,19(1):e1-e47.
[14]陈丽霞,华宝来,刘颖,等.41例血友病患者髂腰肌出血的临床特征及康复治疗.中华血液学杂志,2012,33(5):406-408.Chen LX,Hua BL,Liu Y,et al.Clinical characteristics and rehabilitation treatment of illiopsoas hemorrage in 4l patients with hemophilia.Chinese Journal of Hematology,2012,33(5):406-408.
[15]张伟英,倪逸倩,沈美芳,等.行动研究法构建胸外科专科护士培训效果评价模式的实践.解放军护理杂志,2017(17):64-66,70.Zhang WY,Ni YQ,Shen MF,et al.Practice of action research method in constructing the thoracic surgery specialty nurses training effect evaluation model.Nursing Journal of Chinese People's Liberation Army,2017(17):64-66,70.
[16]陈骊,陈向荣,章洁,等.行动研究用于老年干部病房陪护管理的效果.解放军护理杂志,2016(15):62-64.Chen L,Chen XR,Zhang J,et al.Effect of the nursing staff management of cadre's ward for the elderly through action research.Nursing Journal of Chinese People's Liberation Army,2016(15):62-64.
[17]田华,陈帅,尹华,等.行动研究法在脑梗死患者功能康复训练中的应用.解放军护理杂志,2018(5):53-55.Tian H,Chen S,Yin H,et al.Application of action research in functional rehabilitation training for patients with cerebral infarction.Nursing Journal of Chinese People's Liberation Army,2018(5):53-55.
[2]Mortazavi SM,Haghpanah B,Ebrahiminasab MM,et al.Functional outcome of total knee arthroplasty in patients with haemophilia.Haemophilia,2016,22(6):919-924.
[3]Kubes R,Salaj P,Hromadka R,et al.Range of motion after total knee arthroplasty in hemophilic arthropathy.BMC Musculoskelet Disord,2018,19(1):162.
[4]Rahme M,Ehlinger M,Faradji A,et al.Total knee arthroplasty in severe haemophilic patients under continuous infusion of clotting factors.Knee Surg Sports Traumatol Arthrosc,2012,20(9):1781-1786.
[5]翟吉良,翁习生,林进,等.全膝关节置换术治疗血友病性膝关节炎的远期疗效.中华骨科杂志,2017(23):1490-1497.Zhai JL,Weng XS,Lin J,et al.Long-term outcomes of total knee arthroplasty in patients with hemophilic arthropathy.Chinese Journal of Orthopaedics,2017(23):1490-1497.
[6]Shan L,Shan B,Suzuki A,et al.Intermediate and long-term quality of life after total knee replacement:a systematic review and metaanalysis.J Bone Joint Surg Am,2015,97(2):156-168.
[7]刘颖,赵金玲,张建平,等.严重血友病性关节炎患者的康复治疗:1例报告.中国康复医学杂志,2017(12):1410-1411.Liu Y,Zhao JL,Zhang JP,et al.Rehabilitation of patients with severe haemophiliac arthritis:1 case report.Chinese Journal of Rehabilitation Medicine,2017(12):1410-1411.
[8]孙建华,张青,赵明曦,等.基于行动研究法提高超声引导下空肠营养管置管成功率.护理学杂志,2018(2):45-47.Sun JH,Zhang Q,Zhao MX,et al Improving the success rate of ultrasound-guided jejunum feeding tube placement based on action research.Journal of Nursing Science,2018(2):45-47.
[9]胡雁.论行动研究在护理研究中的应用.中华护理杂志,2004,39(2):158-160.Hu Y.On the application of action research in nursing research.Chinese Journal of Nursing,2004,39(2):158-160.
[10]Feng B,Weng XS,Lin J,et al.Outcome of total knee arthroplasty combined patelloplasty for end-stage type A hemophilic arthropathy.Knee,2012,19(2):107-111.
[11]王学锋,冯建民,孙竞,等.中国血友病骨科手术围术期处理专家共识.中华骨与关节外科杂志,2016(5):361-370.Wang XF,Feng JM,Sun J,et al.Expert consensus in perioperative management in hemophilia patients undergoing orthopedic surgery in China.Chinese Journal Bone and Joint Surgery,2016(5):361-370.
[12]Chiang CC,Chen PQ,Shen MC,et al.Total knee arthroplasty for severe haemophilic arthropathy:long-term experience in Taiwan.Haemophilia,2008,14(4):828-834.
[13]Sr ivastava A,Brewer A K,MauserBunschoten EP,et al.Guidelines for the management of hemophilia.Haemophilia,2013,19(1):e1-e47.
[14]陈丽霞,华宝来,刘颖,等.41例血友病患者髂腰肌出血的临床特征及康复治疗.中华血液学杂志,2012,33(5):406-408.Chen LX,Hua BL,Liu Y,et al.Clinical characteristics and rehabilitation treatment of illiopsoas hemorrage in 4l patients with hemophilia.Chinese Journal of Hematology,2012,33(5):406-408.
[15]张伟英,倪逸倩,沈美芳,等.行动研究法构建胸外科专科护士培训效果评价模式的实践.解放军护理杂志,2017(17):64-66,70.Zhang WY,Ni YQ,Shen MF,et al.Practice of action research method in constructing the thoracic surgery specialty nurses training effect evaluation model.Nursing Journal of Chinese People's Liberation Army,2017(17):64-66,70.
[16]陈骊,陈向荣,章洁,等.行动研究用于老年干部病房陪护管理的效果.解放军护理杂志,2016(15):62-64.Chen L,Chen XR,Zhang J,et al.Effect of the nursing staff management of cadre's ward for the elderly through action research.Nursing Journal of Chinese People's Liberation Army,2016(15):62-64.
[17]田华,陈帅,尹华,等.行动研究法在脑梗死患者功能康复训练中的应用.解放军护理杂志,2018(5):53-55.Tian H,Chen S,Yin H,et al.Application of action research in functional rehabilitation training for patients with cerebral infarction.Nursing Journal of Chinese People's Liberation Army,2018(5):53-55.