集束化护理在高龄髋部骨折患者围手术期的应用

doi:10.3761/j.issn.0254-1769.2023.22.007

摘要/Abstract

摘要：

目的探讨集束化护理在高龄髋部骨折患者围手术期护理中的应用效果。方法通过便利抽样法，选择2020年1月—2021年12月广州市某三级甲等医院收治的47例高龄髋部骨折患者作为试验组，2018年1月—2019年12月收治的50例高龄髋部骨折患者作为对照组，试验组实施集束化护理，对照组在围手术期接受常规护理，出院时比较两组的疼痛干预有效率、功能锻炼依从性、并发症发生率。结果试验组疼痛干预有效率（χ²=5.922，P=0.015）及功能锻炼依从性中完全依从（χ²=9.685，P=0.008）高于对照组，试验组围手术期并发症发生率（χ²=7.600，P=0.006）低于对照组，差异具有统计学意义（P<0.05）。结论在围手术期应用集束化护理对高龄髋部骨折患者进行干预，有利于控制疼痛，提高功能锻炼的依从性，减少并发症的发生。

关键词: 集束化护理, 髋部骨折, 高龄, 围手术期护理

Abstract:

Objective To explore the application of cluster nursing mode in perioperative period of elderly patients with hip fracture. Methods A retrospective cohort study design was used.Through convenience sampling method，50 elderly patients admitted to the hospital for hip fractures from January 2018 to December 2019 were selected as the control group. Meanwhile，47 elderly patients admitted to hospital for hip fractures from January 2020 to December 2021 were selected as the experimental group. The experimental group received cluster nursing，while the control group received routine nursing measures. The outcomes compared between the 2 groups included the effective rate of pain intervention，functional exercise compliance，and the incidence of complications. Results The effective rate of pain intervention（χ²=5.922，P=0.015） and functional exercise compliance（χ²=9.685，P=0.008）in the experimental group were higher than those in the control group. The number of perioperative complications（χ²=7.600，P=0.006） in the experimental group were lower than those in the control group. Conclusion The application of cluster nursing mode in the perioperative period of elderly patients with hip fractures can effectively control pain，improve functional exercise compliance，and reduce complications.

Key words: Cluster Nursing, Hip Fractures, Elderly, Perioperative Nursing

肖万莲, 李娜, 陈晓玲, 桂自珍, 黄天雯. 集束化护理在高龄髋部骨折患者围手术期的应用[J]. 中华护理杂志, 2023, 58(22): 2734-2740.

XIAO Wanlian, LI Na, CHEN Xiaoling, GUI Zizhen, HUANG Tianwen. Application of cluster nursing mode in perioperative period of elderly patients with hip fracture[J]. Chinese Journal of Nursing, 2023, 58(22): 2734-2740.

图/表 3

表1 高龄髋部骨折患者围手术期各并发症风险评估及集束化护理措施

Table 1 Risk assessment and clustered care sheet for each complication in perioperative period of elderly patients with hip fracture

表2 两组一般资料的比较

Table 2 Comparison of general information between 2 groups

表3 两组疼痛干预有效率、功能锻炼依从性、并发症发生情况比较[例（百分率，%）]

Table 3 Comparison of effectiveness of pain intervention，functional exercise compliance and cases of complications between 2 groups[case（percent，%）]

参考文献 28

[1]	Fang EF, Xie C, Schenkel JA, et al. A research agenda for ageing in China in the 21st century(2nd edition):focusing on basic and translational research,long-term care,policy and social networks[J]. Ageing Res Rev, 2020, 64:101174. DOI URL
[2]	United Nations,Department of Economic and Social Affairs,Population Division. The world population prospects:2015 revision[EB/OL]. (2015-07-29)[2023-09-30]. https://www.un.org/en/development/desa/publications/world-population-prospects-2015-revision.html.
[3]	Alexiou KI, Roushias A, Varitimidis SE, et al. Quality of life and psychological consequences in elderly patients after a hip fracture:a review[J]. Clin Interv Aging, 2018, 13:143-150. DOI URL
[4]	Boddaert J, Cohen-Bittan J, Khiami F, et al. Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture[J]. PLoS One, 2014, 9(1):e83795. DOI URL
[5]	常晓, 范彧, 张保中, 等. 超高龄髋部骨折患者的临床特点和手术安全性分析[J]. 中华骨与关节外科杂志, 2021, 14(5):414-419.
	Chang X, Fan Y, Zhang BZ, et al. Clinical characteristics and surgical safety of super elderly patients with hip fracture[J]. Chin J Bone Joint Surg, 2021, 14(5):414-419.
[6]	Kottner J, Cuddigan J, Carville K, et al. Prevention and treatment of pressure ulcers/injuries:the protocol for the second update of the international clinical practice guideline 2019[J]. J Tissue Viability, 2019, 28(2):51-58. DOI PMID
[7]	Crandall M, Duncan T, Mallat A, et al. Prevention of fall-related injuries in the elderly:an eastern association for the surgery of trauma practice management guideline[J]. J Trauma Acute Care Surg, 2016, 81(1):196-206. DOI PMID
[8]	周萌, 苏莉, 叶晶, 等. 老年住院患者跌倒预防措施的证据总结[J]. 中华现代护理杂志, 2019, 25(36):4704-4708.
	Zhou M, Su L, Ye J, et al. Summary of evidences for fall prevention in elderly inpatients[J]. Chin J Mod Nurs, 2019, 25(36):4704-4708.
[9]	Aubrun F, Nouette-Gaulain K, Fletcher D, et al. Revision of expert panel’s guidelines on postoperative pain management[J]. Anaesth Crit Care Pain Med, 2019, 38(4):405-411. DOI URL
[10]	Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism:treatment of deep vein thrombosis and pulmonary embolism[J]. Blood Adv, 2020, 4(19):4693-4738. DOI URL
[11]	胡雯, 邱贵兴, 裴福兴, 等. 骨科大手术加速康复围手术期营养管理专家共识[J]. 中华骨与关节外科杂志, 2022, 15(10):763-767.
	Hu W, Qiu GX, Pei FX, et al. Expert consensus on periopera-tive nutrition management in major orthopaedic surgery in enhanced recovery after surgery program[J]. Chin J Bone Joint Surg, 2022, 15(10):763-767.
[12]	李秀云, 孟玲. 吞咽障碍康复护理专家共识[J]. 护理学杂志, 2021, 36(15):1-4.
	Li XY, Meng L. Expert consensus on dysphagia rehabilitation care[J]. J Nurs Sci, 2021, 36(15):1-4.
[13]	中华预防医学会医院感染控制分会第四届委员会重点部位感染防控学组. 术后肺炎预防和控制专家共识[J]. 中华临床感染病杂志, 2018, 11(1):11-19.
	Group of Key Site Infection Control,Nosocomial Infection Control Commission, Chinese Preventive Medicine Association. Expert consensus on prevention and control of postoperative pneumonia[J]. Chin J Clin Infect Dis, 2018, 11(1):11-19.
[14]	黄天雯, 陈晓玲, 谭运娟, 等. 疼痛护理质量指标的建立及在骨科病房的应用[J]. 中华护理杂志, 2015, 50(2):148-151.
	Huang TW, Chen XL, Tan YJ, et al. Effect of pain manage-ment quality indicators on improving quality of pain management in the orthopedic department[J]. Chin J Nurs, 2015, 50(2):148-151.
[15]	肖萍, 黄天雯, 方丽璇, 等. 脊柱外科患者术后功能锻炼的依从性改善研究[J]. 华西医学, 2017, 32(9):1343-1346.
	Xiao P, Huang TW, Fang LX, et al. Compliance improvement of rehabilitation exercise for patients after spine surgery[J]. West China Med J, 2017, 32(9):1343-1346.
[16]	McDonough CM, Harris-Hayes M, Kristensen MT, et al. Physical therapy management of older adults with hip fracture[J]. J Orthop Sports Phys Ther, 2021, 51(2):CPG1-CPG81.
[17]	陆小香, 徐迪, 林强, 等. 早期阶段性康复干预对老年膝关节骨性关节炎患者全关节置换术后下肢疼痛及功能的影响[J]. 中国康复医学杂志, 2019, 34(3):273-279.
	Lu XX, Xu D, Lin Q, et al. Effects of early stage rehabilitation intervention on the pain and function of lower limb after total joint replacement in elderly patients with knee OA[J]. Chin J Rehabil Med, 2019, 34(3):273-279.
[18]	沈奕新, 鲍莉莉, 周迎杏. 集束化疼痛护理干预应用于改善多发性骨髓瘤病人的疼痛及生活质量的效果评价[J]. 全科护理, 2020, 18(20):2556-2558.
	Shen YX, Bao LL, Zhou YX. Evaluation of the effect of cluster pain nursing intervention on improving pain and quality of life in patients with multiple myeloma[J]. Chin Gen Prac Nurs, 2020, 18(20):2556-2558.
[19]	要亚仙. 老年髋部骨折患者围术期死亡和严重并发症的危险因素[D]. 保定: 河北大学, 2021.
	Yao YX. Risk factors of perioperative death and severe complications in elderly patients with hip fracture[D]. Baoding: Hebei University, 2021.
[20]	顾敏琴, 顾敏静, 陈利勤, 等. 骨折患者围术期疼痛管理循证实践的现状及影响因素分析[J]. 重庆医学, 2018, 47(11):1495-1497.
	Gu MQ, Gu MJ, Chen LQ, et al. Analysis of status quo and influencing factors of evidence-based practice of perioperative pain management in fracture patients[J]. Chongqing Med J, 2018, 47(11):1495-1497.
[21]	徐慧萍, 赵辉, 李东哲, 等. 腰椎术后患者疼痛管理智能化方案的制订及应用[J]. 中华护理杂志, 2020, 55(10):1465-1470. DOI
	Xu HP, Zhao H, Li DZ, et al. Formulation and application study on intelligent pain management program of patients after lumbar spine surgery[J]. Chin J Nurs, 2020, 55(10):1465-1470. DOI
[22]	马琴, 余茴香, 李善玲, 等. 格林模式联合微信平台对老年髋部骨折患者康复的影响[J]. 护理学杂志, 2018, 33(13):80-83.
	Ma Q, Yu HX, Li SL, et al. Efficacy of the PRECEDE-PRO-CEED model combining WeChat platform on recovery of older patients after hip fracture[J]. J Nurs Sci, 2018, 33(13):80-83.
[23]	张真, 田洁. 多元化疼痛护理管理对跟骨骨折患者术后疼痛控制及功能锻炼依从性的影响[J]. 山西医药杂志, 2022, 51(5):593-595.
	Zhang Z, Tian J. Effect of diversified pain nursing management on postoperative pain control and rehabilitation exercise compliance in patients with calcaneal fracture[J]. Shanxi Med J, 2022, 51(5):593-595.
[24]	杜秀莲, 王孔专. 激励式心理护理联合舒适护理对老年骨盆骨折患者功能锻炼依从性的影响[J]. 山西医药杂志, 2020, 49(14):1906-1908.
	Du XL, Wang KZ. Effect of incentive psychological nursing combined with comfortable nursing on rehabilitation exercise compliance of elderly patients with pelvic fracture[J]. Shanxi Med J, 2020, 49(14):1906-1908.
[25]	张咪, 周春兰, 吴艳妮, 等. 老年髋部骨折术后患者家庭康复护理的最佳证据总结[J]. 中华护理杂志, 2022, 57(22):2777-2783. DOI
	Zhang M, Zhou CL, Wu YN, et al. Evidence summary for postoperative home rehabilitation nursing in elderly patients with hip fracture[J]. Chin J Nurs, 2022, 57(22):2777-2783. DOI
[26]	陈旭娟, 朱晓萍, 田梅梅, 等. 老年髋部骨折术后患者肺部感染预测模型的构建及验证[J]. 中华护理杂志, 2021, 56(5):659-666. DOI
	Chen XJ, Zhu XP, Tian MM, et al. Construction and validation of a prediction model for pulmonary infection in elderly patients with hip fracture after surgery[J]. Chin J Nurs, 2021, 56(5):659-666. DOI
[27]	Deschodt M, Laurent G, Cornelissen L, et al. Core components and impact of nurse-led integrated care models for home-dwelling older people:a systematic review and meta-analysis[J]. Int J Nurs Stud, 2020, 105:103552. DOI URL
[28]	陈梦霞, 牟园芬, 陈艳玲, 等. 集束化策略在机械通气患者中的应用效果评价[J]. 中华护理杂志, 2020, 55(9):1292-1296. DOI
	Chen MX, Mou YF, Chen YL, et al. The application effects of ABCDEF bundle care in ICU patients with mechanical ventilation[J]. Chin J Nurs, 2020, 55(9):1292-1296. DOI