胸腰椎骨折术后患者发生便秘的影响因素分析

Influencing Factor Analysis of Constipation Occurrence After Thoracolumbar Fractures Surgery

目的了解胸腰椎骨折术后患者便秘发生现状及其影响因素,建立术后患者便秘发生的函数概率模型,为制定相关护理对策提供依据。方法采用自行设计的胸腰椎骨折术后患者便秘问卷,对温州市5所公立三级甲等医院119例行内固定术后的胸腰椎骨折患者进行调查,采用Logistic回归模型分析相关影响因素,并得出术后便秘发生的函数概率模型。结果骨折前患者便秘发生率为14.3%,骨折后围术期手术前、后便秘的发生率为63.0%和82.3%,三者差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,是否习惯床上排便、床上活动量、进食量及术后使用镇静止痛药为术后便秘发生的独立影响因素;术后便秘发生的函数概率模型为P=1/[1+e(-1.935X1-1.686X2-1.203X3+0.658X4)]。结论胸腰椎骨折术后患者便秘发生率高,临床护士可运用函数概率模型预测患者的便秘发生率,并对高危人群给予卧床排便指导、床上活动指导、饮食指导、用药指导等预见性护理干预,以降低术后患者便秘的发生率。

Objective To understand the current status and its influencing factors of postoperative constipation in patients accepted thoracolumbar fractures surgery,to establish the prediction model of constipation occurrence after surgery,and to provide evidence for relevant nursing interventions establishment.Methods Totally 119 cases of thoracolumbar fractures patients were selected and investigated by using self-designed thoracolumbar fractures of postoperative constipation related questionnaire.Related influencing factors were analyzed by logistic regression model and prediction model of constipation occurrence was concluded.Results The incidence of constipation was 14.3% before fracture,the incidence of constipation were 63.0% and 82.3% in perioperation after fracture（ P〈0.05）.Unconditioned multiple factors Logistic regression analysis showed that whether used to defecate in bed,postoperative bed activity,food intake and sedatives and painkillers usage after surgery were the independent impact factors of postoperative constipation; Prediction function probability model of postoperative constipation occurrence was P = 1 / [（ 1 ＋ e（-1.935X1- 1.686X2- 1.203X3＋ 0.658X4）].Conclusion There was a high incidence of constipation in patients with thoracolumbar fractures after surgery,and nursing staffs can use the established function model to predict the occurrence of the postoperative constipation,to guide the high risk patients about defecate in bed,postoperative bed activity,food intake,medication and other predicable nursing intervention,and to reduce the incidence of postoperative constipation.