高龄髋部骨折患者早期活动管理方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2019.11.003

摘要/Abstract

摘要：

目的制订高龄髋部骨折患者早期活动的管理方案并评价其效果。方法基于英国南安普敦大学附属医院术后活动模型,结合北京市某三级甲等医院临床护理程序的思路和实践,形成高龄髋部骨折患者早期活动管理方案。选取2017年1月1日—2018年12月31日收治的高龄髋部骨折患者248例为试验组,接受早期活动管理方案干预;2014年1月1日—2016年12月31日收治的214例患者为对照组,使用常规护理。比较两组首次下地时间、术后第3天行走的最远距离、住院时间、日常生活活动能力、生活质量的差异。结果试验组首次下地活动时间为术后（1.84±0.73） d,对照组为（5.23±2.17） d;试验组术后第3天行走的最远距离为（82.55±23.12） m,对照组为（29.41±10.97） m;试验组住院时间为（9.27±1.71） d,对照组为（11.39±2.53） d;两组比较,差异均有统计学意义（P<0.05）。试验组实施出院时日常生活活动能力评分、出院3个月后生活质量评分均高于对照组（P<0.05）。结论实施高龄髋部骨折患者早期活动管理方案有助于患者早期下地,缩短住院时间,提高患者生活质量。

关键词: 老年人, 80以上, 髋骨折, 早期活动, 康复护理, 干预性研究

Abstract:

Objective To explore and evaluate the effects of the management scheme of early activity for elderly patients with hip fracture.Methods Based on the postoperative activity model of the Affiliated Hospital of Southampton University of England,combined with the thoughts and practice of our hospital’s clinical nursing procedure,the early activity management scheme for elderly patients with hip fracture was formed. Totally 248 elderly patients with hip fracture treated in our hospital from January 1st,2017,to December 31st,2018,were selected as the experimental group,receiving early activity management scheme. 214 patients from January 1st,2014,to December 31st,2016,were selected as the control group,receiving routine nursing scheme. The differences in the first ambulation time,the longest walking distance 3 days after surgery,length of hospitalization,activity of daily living ability,and quality of life between two groups were compared.Results The first time of ambulation was （1.84±0.73） days in the experimental group and（5.23±2.17） days in the control group;the longest distance of walking in the experimental group was（82.55±23.12） m on the 3rd day after surgery,and that in the control group was（29.41±10.97） m;the length of hospitalization in the experimental group was（9.27±1.71） days,and that in the control group was（11.39±2.53） days,and there was significant difference between the two groups（P<0.05）. The scores of activity of daily living at discharge in the experimental group and quality of life 3 months after discharge were higher than those in the control group（P<0.05）.Conclusion The early activity management scheme for elderly patients with hip fracture is helpful for early ambulation,to shorten length of hospitalization and improve quality of life.

Key words: Aged, 80 and over, Hip Fractures, Early Mobilization, Rehabilitation Nursing, Intervention Studies

张燕, 王婷婷, 车路, 马远, 王爽, 郭一峰, 杨秋玲, 邢颖, 张慧, 刘婧, 高娜. 高龄髋部骨折患者早期活动管理方案的构建及应用研究[J]. 中华护理杂志, 2019, 54(11): 1615-1620.

ZHANG Yan, WANG Tingting, CHE Lu, MA Yuan, WANG Shuang, GUO Yifeng, YANG Qiuling, XING Ying, ZHANG Hui, LIU Jing, GAO Na. Construction and application of early activity management scheme for elderly patients with hip fracture[J]. Chinese Journal of Nursing, 2019, 54(11): 1615-1620.

图/表 2

参考文献 24

[1]	马彬彬 . 老年髋部骨折患者临床特征分析[D]. 南京:东南大学, 2017.
[2]	王金强, 骆洪涛, 彭城 , 等. 极高龄髋部骨折患者术后一年病死的危险因素分析[J]. 中国骨与关节杂志, 2019,8(3):187-190.
[3]	Novoa-Parra CD, Hurtado-Cerezo J, Morales-Rodríguez J , et al. Factors predicting one-year mortality of patients over 80 years operated after femoral neck fracture[J]. Rev Esp Cir Ortop Trau-matol, 2019,63(3):202-208.
[4]	张保中, 常晓 . 股骨转子间骨折的个体化治疗[J]. 中国骨伤, 2011,24(5):357-361.
[5]	唐丽玫, 王慧萍, 王国芳 , 等. 老年髋部骨折患者术后静脉镇痛泵不同拔除时间效果观察[J]. 中华护理杂志, 2015,50(7):778-780.
[6]	张秀果, 丁俊琴, 井永敏 , 等. 老年髋部骨折患者呼吸系统并发症危险评估表及护理计划单的应用[J]. 中华护理杂志, 2012,47(10):875-877.
[7]	袁博, 程亮亮 . 80岁以上髋部骨折患者手术治疗的早期并发症[J]. 临床医药文献电子杂志, 2014,1(10):1748-1749,1751.
[8]	黄妙贤 . 快速康复在高龄髋部骨折患者围术期的应用及其效果观察[J]. 中国伤残医学, 2019,27(8):9-10.
[9]	罗翱翔, 张广清, 付秀珍 . 香港老年髋部骨折患者护理工作的启示[J]. 中华护理杂志, 2011,46(1):35-36.
[10]	Wang YY, Wang MS, Chen HD , et al. Early out-of-bed functional exercise benefits elderly patients following hip fracture:a retrospective cohort study[J]. Tohoku J Exp Med, 2018,246(4):205-212.
[11]	Bonewald LF, Kiel DP, Clemens TL , et al. Forum on bone and skeletal muscle interactions:summary of the proceedings of an ASBMR workshop[J]. J Bone Miner Res, 2013,28(9):1857-1865.
[12]	Collard RM, Boter H, Schoevers RA , et al. Prevalence of frailtyin community-dwelling older persons:a systematic review[J]. J Am Geriatr Soc, 2012,60(8):1487-92.
[13]	席晓莉 . 整体护理对老年多病共存患者的住院干预[J]. 解放军医院管理杂志, 2017,24(2):170-172.
[14]	Choi K, Ko Y . Characteristics associated with fear of falling and activity restriction in South Korean older adults[J]. J Aging Health, 2015,27(6):1066-1083.
[15]	Ramírez JM, Blasco JA, Roig JV , et al. Enhanced recovery in colorectal surgery:a multicentre study[J]. BMC Surg, 2011,11:9.
[16]	Abu HM, Di FF, Badran A , et al. Implementation of enhanced recovery programme after pancreas to duodenectomy:a sillgle-centre UK pilot study[J]. Pancreatology, 2013,13(1):58-62.
[17]	American Academy of Orthopaedic Surgeons. Management of hip fracture in elderly[EB/OL]. ( 2014-09-05)[2014-09-15]. .
[18]	Scott J, Huskisson EC . Graphic representation of pain[J]. Pain, 1976,2(2):175-184.
[19]	Dyck PJ, Hughes RAC, O’Brion PC . Quantitating overall neuropathic symptoms,impairments,and outcomes[M] //Peripheral Neuro-pathy. 4th. ed. Elsevier, 2005: 1031-1051.
[20]	Balas MC, Vasilevskis EE, Burke WJ , et al. Critical care nurses’ role in implementing the “ABCDE bundle” into practice[J]. Crit Care Nurse, 2012,32(2): 35-38,40-47.
[21]	Lawton MP, Brody EM . Assessment of older people:self-maintaining and instrumental activity of daily living[J]. Gerontologist, 1969,9(3):179-186.
[22]	邢亚彬, 马爱霞 . 欧洲五维健康量表EQ-5D-5L中文版的信效度研究[J]. 上海医药, 2013,( 9):40-43.
[23]	席小燕, 娄青, 刘彦麟 , 等. 老年下肢骨折病人家庭护理者的负荷与需求的调查分析[J]. 西南国防医药, 2011,21(12):1424-1425.
[24]	Brox WT, Roberts KC, Taksali S , et al. The American academy of orthopaedic surgeons evidence-based guideline on management of hip fractures in the elderly[J]. J Bone Joint Surg Am, 2015,97(14):1196-1199.