膝关节置换术后患者出院随访的最佳证据总结

doi:10.3761/j.issn.0254-1769.2019.12.022

摘要/Abstract

摘要：

目的总结膝关节置换术后患者出院随访的最佳证据,为临床实践提供参考。方法计算机检索美国指南网、英国卫生与临床优化研究所、苏格兰学院间指南网、加拿大临床医学实践网、国际指南网、澳大利亚国家卫生和医学研究委员会网站、加拿大安大略注册护士协会网、Cochrane Library、Joanna Briggs Institute（JBI）循证卫生保健中心数据库、护理累积索引数据库、UpToDate、BMJ best practice、Embase、PubMed、中国知网数据库、万方数据库、中国生物医学文献数据库、维普数据库关于膝关节置换术后患者出院随访的所有证据,包括指南、系统评价、证据总结、推荐实践以及随机对照试验。结果共纳入文献9篇,包括临床决策1篇、指南2篇、系统评价3篇、随机对照试验1篇、专家共识2篇,总结最佳证据包括随访时间和方式、身体评估、药物管理、出院康复、健康教育5个主题,共17条。结论本研究总结了膝关节置换术后出院随访的最佳证据,护理人员应接受相关培训,将最佳证据真正应用于临床,但在应用最佳证据时,还应考虑患者意愿和具体临床情况,结合专业判断,形成有效、可行的随访策略,从而提高护理质量。

关键词: 关节成形术, 置换, 膝, 出院后医疗, 随访, 康复护理, 循证护理学

Abstract:

Objective To summarize the best available evidence of discharge follow-up of patients after knee arthroplasty,and to provide reference for clinical practice. Methods We searched National Guideline Clearinghouse,National Institute for Health and Care Excellence,the Scottish Intercollegiate Guidelines Network,Canadian Medical Association Infobase（CMA）,Guidelines International Network（GIN）,and National Health And Medical Research Council（NHMRC）,Registered Nurses’Association of Ontario（RNAO）,Cochrane Library,JBI Library,CINAHL,Uptodate,BMJ best practice,Embase,Pubmed,CNKI,Wanfang Data,China Biology Medicine disc（CBM） and the VIP Database（VIP） for all evidence of discharge follow-up of patients who underwent knee arthroplasty,including guidelines,systematic reviews,evidence summary,recommended practices,and original studies. Results A total of 9 articles were selected in the literature,including 1 clinical decision,2 guidelines,3 systematic reviews,1 randomized controlled trial,2 expert consensuses. Finally 17 items of best evidence were summarized and categorized into 5 dimensions of recommendations,including follow-up time and method,physical assessment,drug management,discharge rehabilitation,and health education. Conclusion This study summarized the best evidence of discharge follow-up after knee arthroplasty,and nurses should receive relevant training to apply the best evidence to clinical practice. When applying the best evidence,medical staff should consider the patient’s wishes and specific clinical conditions,and combine professional judgment to form an effective and feasible follow-up strategy to improve the quality of nursing quality.

Key words: Arthroplasty, Replacement, Knee, Aftercare, Follow-up, Rehabilitation Nursing, Evidence-Based Nursing

周萌, 林川, 贾晶丽, 高洁. 膝关节置换术后患者出院随访的最佳证据总结[J]. 中华护理杂志, 2019, 54(12): 1877-1880.

ZHOU Meng, LIN Chuan, JIA Jingli, GAO Jie. Evidence summary for discharge follow-up of patients after knee arthroplasty[J]. Chinese Journal of Nursing, 2019, 54(12): 1877-1880.

图/表 3

参考文献 22

[1]	中华医学会骨科学分会关节外科学组. 骨关节炎诊疗指南(2018年版)[J]. 中华骨科杂志, 2018,38(12):705-715.
[2]	Litwic A, Edwards MH, Dennison EM , et al. Epidemiology and burden of osteoarthritis[J]. Br Med Bull, 2013,105:185-199. DOI URL PMID
[3]	Tang X, Wang SF, Zhan SY , et al. The prevalence of symptomatic knee osteoarthritis in China:results from the China health and retirement longitudinal study[J]. Arthritis Rheumatol, 2016,68(3):648-653. DOI URL PMID
[4]	王精明, 王爱平 . 膝关节骨性关节炎患者运动治疗护理方案的研究进展[J]. 中华护理杂志, 2019,54(3):458-462.
[5]	Cavaignac E, Pailhé R, Laumond G , et al. Evaluation of the accuracy of patient-specific cutting blocks for total knee arthroplasty:a meta-analysis[J]. Int Orthop, 2015,39(8):1541-1552. DOI URL PMID
[6]	Szöts K, Konradsen H, Solgaard S , et al. Telephone follow-up by nurse after total knee arthroplasty:results of a randomized clinical trial[J]. Orthop Nurs, 2016,35(6):411-420. DOI URL PMID
[7]	吴素琴, 张细顺, 陈燕芹 , 等. 全膝关节置换术患者延续性护理需求调查分析[J]. 临床医学工程, 2017,24(10):1479-1481.
[8]	曹琼雅 . 基于微信提高全膝关节置换术患者居家功能锻炼依从性的干预效果研究[D]. 北京:北京协和医学院, 2017.
[9]	刘延锦, 蔡立柏, 王秀霞 , 等. 全膝关节置换术患者基于微信公众平台健康教育的效果观察[J]. 护理学报, 2017,24(7):65-68.
[10]	韦当, 王聪尧, 肖晓娟 , 等. 指南研究与评价(AGREEⅡ)工具实例解读[J]. 中国循证儿科杂志, 2013,8(4):316-319.
[11]	余文静, 肖瑶, 胡娟娟 , 等. 预防围手术期患者低体温最佳证据总结[J]. 中华护理杂志, 2019,54(4):589-594.
[12]	米元元, 沈月, 郝彬 , 等. ICU患者肠内营养支持并发腹泻的循证护理实践[J]. 中华护理杂志, 2017,52(11):1291-1298.
[13]	Martin GM, Thornhill TS, Katz JN , et al. Total knee arthroplasty[EB/OL].( 2019 -03-12)[2019-05-30]. https://www.uptodate.com/contents/total-knee-arthroplasty?search=%E8%86%9D%E5%85%B3%E8%8A%82%E7%BD%AE%E6%8D%A2%E6%9C%AF&source=Out%20of%20date%20-%20zh-Hans&selectedTitle=1~100%20.
[14]	Holbrook A, Schulman S, Witt DM , et al. Evidence-based management of anticoagulant therapy:antithrombotic therapy and prevention of thrombosis,9th Ed:American college of chest physicians evidence-based clinical practice guidelines[J]. Chest, 2012,141(2 Suppl):e152S-e184S. DOI URL PMID
[15]	McGrory BJ, Weber KL, Jevsevar DS , et al. Surgical management of osteoarthritis of the knee:evidence-based guideline[J]. J Am Acad Orthop Surg, 2016,24(8):e87-e93. DOI URL PMID
[16]	Khan F, Ng L, Gonzalez S , et al. Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy[J]. Cochrane Database Syst Rev, 2008(2):CD004957. DOI URL PMID
[17]	Vogel LA, Carotenuto G, Basti JJ , et al. Physical activity after total joint arthroplasty[J]. Sports Health, 2011,3(5):441-450. DOI URL PMID
[18]	Tilbury C, Schaasberg W, Plevier JW , et al. Return to work after total hip and knee arthroplasty:a systematic review[J]. Rheumatology(Oxford), 2014,53(3):512-525. DOI URL PMID
[19]	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.
[20]	Westby MD, Brittain A, Backman CL . Expert consensus on best practices for post-acute rehabilitation after total hip and knee arthroplasty:a Canada and United States Delphi study[J]. Arthritis Care Res (Hoboken), 2014,66(3):411-423. DOI URL PMID
[21]	Chen MC, Li PH, Lin FO . Influence of structured telephone follow-up on patient compliance with rehabilitation after total knee arthroplasty[J]. Patient Prefer Adherence, 2016,10:257-264. DOI URL PMID
[22]	Winther SB, Foss OA, Wik TS , et al. 1-year follow-up of 920 hip and knee arthroplasty patients after implementing fast-track[J]. Acta Orthop, 2015,86(1):78-85. DOI URL PMID