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目的观察无痛临床护理路径对老年股骨骨折患者围术期疼痛及术后康复的影响。方法 90例符合入组标准的老年股骨骨折患者作为研究对象,将患者随机分为观察组和对照组,各45例。对照组给予常规护理,观察组按照无痛临床护理路径进行护理,入院时、手术当日、术后第1 d、术后第3 d、术后第5 d、出院时采用视觉模拟评分法(VAS)进行疼痛评估,记录术后并发症发生情况、首次功能锻炼时间、首次下床活动时间,出院时采用不记名形式调查患者对于护理的满意度,术后3个月进行Harris髋关节评分,评价髋关节功能优良率。结果观察组术后第1 d、术后第3 d、术后第5 d、出院时的VAS评分均明显低于对照组,差异具有统计学意义(P<0.05)。观察组术后并发症发生率为0(0/45),低于对照组的20.00%(9/45),差异具有统计学意义(χ~2=10.000,P<0.05),观察组和对照组首次功能锻炼时间分别为(30.4±3.5)h和(41.3±6.4)h,首次下床活动时间分别为(7.0±0.4)d和(12.9±0.8)d,两组比较差异均具有统计学意义(t=10.024、44.250,P<0.05)。观察组出院时护理满意率为95.56%高于对照组的80.00%,差异具有统计学意义(χ~2=5.075,P<0.05);观察组术后3个月髋关节功能优良率为86.67%高于对照组的68.89%,差异具有统计学意义(χ~2=4.114,P<0.05)。结论无痛临床护理路径能有助于减轻老年股骨骨折患者围术期疼痛,减少并发症的发生,提高患者满意度,加快术后康复速度,值得临床推广使用。
Objective To observe the effect of painless clinical nursing on perioperative pain and postoperative recovery in elderly patients with femoral fracture. Methods Ninety elderly patients with femoral fractures were enrolled in this study. The patients were randomly divided into observation group and control group, with 45 cases in each group. The control group was given routine nursing care. The observation group was treated according to the painless clinical nursing pathway. At the time of admission, the day of surgery, the first day after operation, the third day after operation and the fifth day after operation, visual analogue scale (VAS ) To assess the pain, record the incidence of postoperative complications, the first functional exercise time, the first time to get out of bed activities, discharged at the hospital to investigate the satisfaction of patients with care, postoperative 3 months Harris hip score, evaluation Hip function excellent rate. Results The VAS scores of the observation group at the first day after operation, the third day after operation, the fifth day after operation and the discharge from the hospital were significantly lower than those in the control group (P <0.05). The incidence of postoperative complications was 0 (0/45) in observation group and 20.00% (9/45) in control group, with statistical significance (χ ~ 2 = 10.000, P <0.05). The observation group and control group The first functional exercise time was (30.4 ± 3.5) h and (41.3 ± 6.4) h respectively, and the time to first bed ambulation was (7.0 ± 0.4) d and (12.9 ± 0.8) d, respectively, and the differences between the two groups were statistically significant Significance (t = 10.024, 44.250, P <0.05). The nursing satisfaction rate of the observation group was 95.56% when discharged from hospital, which was significantly higher than that of the control group (χ ~ 2 = 5.075, P <0.05). The excellent and good rate of hip function in the observation group was 86.67% 68.89% higher than the control group, the difference was statistically significant (χ ~ 2 = 4.114, P <0.05). Conclusion The painless clinical nursing pathway can help reduce perioperative pain and reduce the incidence of complications in elderly patients with femoral fractures, improve patient satisfaction and speed up postoperative rehabilitation, worthy of clinical promotion.