临床护理路径在腰椎间盘突出症患者围术期的应用价值研究

Application value of clinical nursing p ath in perioperative patients with lumbar disc protrusion

目的 研究临床护理路径在腰椎间盘突出症患者围术期的应用价值.方法 选择2010年1月～2012年12月解放军总医院骨科收治的腰椎间盘突出症患者130例,随机分为观察组和对照组,每组各65例;观察组患者给予临床护理路径进行干预,对照组患者给予常规护理方式.采用自我护理能力测量量表（ESCA）观察患者围术期自我护理能力;采用汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）、焦虑自评量表（SAS）、抑郁自评量表（SDS）对患者心理状态进行评估;采用生活质量核心量表（QOL-30）对患者生活质量进行评估.结果 ①护理前两组患者自我护理能力差异无统计学意义（P＞0.05）.护理后两组患者自我护理能力评分均高于护理前,差异有统计学意义（P＜0.05）,且观察组患者健康知识[（47.3±9.4）分]、自我概念[（21.5±5.6）分]、自护责任感[（16.8±4.4）分]、自我护理技能[（27.7±7.1）分]及自我护理能力总评分[（113.3±21.5）分]均高于对照组[（43.2±8.2）、（16.9±5.1）、（13.2±3.8）、（23.8±6.8）、（97.1±18.3）分],差异均有统计学意义（P＜0.05）.②护理前两组患者心理状态差异无统计学意义（P＞0.05）.护理后两组患者负面情绪评分均低于护理前,差异有统计学意义（P＜0.05）;且观察组患者的HAMA[（6.8±1.4）分]、HAMD[（6.3±1.7）分]、SAS[（41.2±9.4）分]、SDS[（40.8±10.5）分]评分均低于对照组[（9.7±2.9）、（9.3±3.1）、（50.3±12.1）、（51.8±12.7）分],差异有统计学意义（P＜0.05）.③护理前两组患者生活质量差异无统计学意义（P＞0.05）.护理后两组患者生活质量均高于术前,差异有统计学意义（P＜0.05）;且观察组患者躯体功能[（75.1±11.3）分]、心理功能[（65.3±9.3）分]、社会功能[（71.8±11.3）分]、认知功能[（62.8±7.7）分]及生活总质量评分[（88.84±8.3）分]均高于对照组[（68.4±9.1）、（59.8±7.3）、（63.3±9.4）、（56.3±8.9）、（81.31±6.9）分],差异有统计学意义（P＜0.05）.结论 临床护理路径能够改善患者的心理状态、生活质量以及自我护理能力,具有积极的临床价值.

Objective To study the application value of clinical nursing path in perioperative patients with lumbar disc protrusion.Methods 130 patients with lumbar disc protrusion in the Department of Orthopedics,General Hospital of PLA from January 2010 to December 2012 were enrolled and randomly divided into observation group and control group with 65 cases in each group.Patients in observation group were treated with clinical nursing path,patients in control group were treated with conventional methods.ESCA scale was used to observe the perioperative self-care ability; HAMA,HAMD,SAS,SDS scale were used to evaluate the psychological states; QOL-30 scale was used to evaluate the living quality.Results ①The differences of perioperative self-care ability of the two groups before the nursing was not statistically significant （P ＞ 0.05）.Perioperative self-care ability of the two groups after the nursing were higher than those before the nursing,the differences were statistically significant （P ＜ 0.05）; health knowledge,self-concept,responsibility sense,nursing skill,total score selfcare ability in observation group [（47.3±9.4）,（21.5±5.6）,（16.8±4.4）,（27.7±7.1）,（113.3±21.5） scores] were higher than those in control group [（43.2±8.2）,（16.9±5.1）,（13.2±3.8）,（23.8±6.8）,（97.1±18.3） scores],the differences were statistically significant （P ＜ 0.05）.②The differences of psychological states of the two groups before the nursing was not statistically significant （P ＞ 0.05）.The negative sentiment scores of the two groups after the nursing were lower than those before the nursing,the difference was statistically significant （P ＜ 0.05）; HAMA,HAMD,SAS,SDS scores in observation group [（6.8±1.4）,（6.3±1.7）,（41.2±9.4）,（40.8±10.5） scores] were lower than those in control group [（9.7±2.9）,（9.3±3.1）,（50.3±12.1）,（51.8±12.7） scores],the differences were statistically significant （P ＜ 0.05）.③The differences of living quality of the two groups before the nursing was not statistically significant （P ＞ 0.05）.The living quality scores of the two groups after the nursing were higher than those before the nursing,the difference was statistically significant （P ＜ 0.05）; physical functioning,mental function,social function,cognitive function,total life quality score in observation group [（75.1±11.3）,（65.3±9.3）,（71.8±11.3）,（62.8±7.7）,（88.84±8.3） scores]were higher than those in control group [（68.4±9.1）,（59.8±7.3）,（63.3±9.4）,（56.3±8.9）,（81.31±6.9） scores],the differences were statistically significant （P ＜ 0.05）.Conclusion Clinical nursing path can improve the psychological status,quality of life and self care ability,it has positive clinical value.