延续性护理对骨质疏松性椎体压缩骨折患者术后服药依从性的影响

Effect of continual care on postoperative medication compliance of patients with osteoporotic vertebral compression fractures

目的探讨延续性护理对骨质疏松性椎体压缩骨折(OVCF)行椎体成形术患者术后服药依从性的效果。方法采用回顾性病例对照研究分析2016年1月-2017年5月贵州省人民医院行椎体成形术治疗的150例OVCF患者临床资料,其中男38例,女112例;年龄47~88岁,平均67.5岁。75例给予电话回访、家庭随访等延续性护理(延续护理组),75例在出院时给予常规健康宣教(常规护理组)。比较两组患者术前和术后1d及术后1,3,6,12个月视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI),术后1,3,6和12个月服药依从率和椎体再骨折情况。结果常规护理组术前VAS为6(6~7)分,术后1d及术后1,3,6,12个月分别为1(0~1)分、1(1~3)分、2(1~3)分、3(2~5)分;术前ODI为21(18~27),术后1d及术后1,3,6,12个月分别为0、2(1~4)、5(3~7)、7(5~10)、10(7~14)。延续护理组术前VAS为7(6~7)分,术后1d及术后1,3,6,12个月分别为0(0~1)分、1(0~1)分、1(0~2)分、2(1~3)分,术前ODI为18(22~28),术后1d及术后1,3,6,12个月分别为0(0~1)、2(0~4)、4(1~5)、4(3~6)、6(4~9)。两组VAS和ODI均低于术前(P<0.01),术后1d及术后1,3,6,12个月延续护理组评分均低于对照组(P<0.05或0.01)。延续护理组术后1,3,6和12个月服药依从率分别为93%、89%、91%、84%,常规护理组则分别为44%、40%、47%、40%(P<0.01)。延续护理组术后1,3,6和12个月椎体再骨折发生率分别为1%、1%、3%、3%,常规护理组则分别为3%、5%、5%、7%(P<0.05或0.01)。结论延续性护理能提高OVCF行椎体成形术患者术后服药的依从性,缓解疼痛,改善生活质量,降低椎体再骨折发生率,值得临床推广。

Objective To investigate the effect of continual care on postoperative medication compliance of patients with osteoporotic vertebral compression fractures (OVCF) after vertebroplasty. Methods A retrospective case control study was performed to analyze the clinical data of 150 patients with OVCF who underwent vertebroplasty in Guizhou People's Hospital from January 2016 to May 2017. There were 38 males and 112 females, aged 47-88 years, with an average of 67.5 years. Seventy-five patients were given continual care such as telephone follow-up and home visit(continual care group). Seventy-five patients were given routine health education (routine care group) when they were discharged from hospital. Visual analogue scale (VAS) and Oswestry dysfunction index (ODI) before operation, 1 day, 1, 3, 6 and 12 months after operation, as well as medication compliance and vertebral re-fracture at 1, 3, 6 and 12 months after operation were compared between the two groups. Results The preoperative VAS of the routine care group was 6 (6-7), 1 (0-1), 1 (1-3), 2 (1-3) and 3 (2-5) points at 1 day and 1, 3, 6 and 12 months after operation, respectively. The preoperative ODI was 21 (18-27), 0 (0-0), 2 (1-4), 5 (3-7), 7 (5-10), 10 (7-14) points at 1 day, 1, 3, 6 and 12 months after operation. In the continual care group, VAS was 7 (6-7) points before operation, 0 (0-1), 1 (0-1), 1 (0-2) and 2 (1-3) points at 1 day, 1, 3, 6 and 12 months after operation, respectively. ODI of the continual care group was 18 (22-28) points before operation, 0 (0-1), 2 (0-4), 4 (1-5), 4 (3-6) and 6 (4-9) at 1 day, 1, 3, 6 and 12 months after operation. The VAS and ODI of the two groups were lower than those before operation, and the scores of the continual care group were lower than those of the routine care group at 1, 3, 6 and 12 months after operation (P<0.05). The medication compliance rates of continual care group were 93%, 89%, 91% and 84% at 1, 3, 6 and 12 months after operation, while those of routine care group were 44%, 40%, 47% and 40% respectively (P<0.05). The incidence of vertebral re-fracture was 1%, 1%, 3% and 3% in continual care group and 3%, 5%, 5% and 7% in routine care group at 1, 3, 6 and 12 months after operation respectively (P<0.05). Conclusion Continual care can improve the medication compliance of OVCF patients after treatment with vertebroplasty, relieve pain, improve the quality of life, and reduce the incidence of vertebral re-fracture, which is worthy of clinical promotion.