五位一体对预防老年髋部骨折术后便秘的临床研究

Clinical study on Five-in-One effect on preventing constipation after geriatric hip fracture

目的：探讨五位一体（医生、护士、康复师、患者、家属）模式对预防老年髋部骨折术后患者便秘的效果,为五位一体的模式深入推广到治疗护理老年髋关节专科疾病提供依据。方法实验组,2014年10月～2015年4月住院患者共39例,其中男11例,女28例,平均年龄75.6岁,髋关节置换术有12例,粗隆间骨折内固定术有27例,合并糖尿病8例、高血压13例、冠心病5例、胃炎4例、肺气肿2例,运用五位一体的模式对患者进行预防便秘。对照组,2013年1月～8月住院患者共40例,其中男12例,女28例,平均年龄76.1岁,髋关节置换术有15例,粗隆间骨折内固定术有25例,合并糖尿病9例、高血压20例、冠心病3例、肺气肿1例,采用常规护理的方法,护士每天观察患者排便情况,便秘者报告医生处理。通过总体疗效、首次排便时间、辅助通便率、患者满意度、并发症发生率,比较两组的临床疗效。结果实验组的总体疗效、满意度均高于对照组,实验组平均排便时间、辅助通便率、并发症发生率均低于对照组,两组在显效、有效、无效率方面对比有显著差异（P〈0.01）,总有效率对比有显著差异（χ^2=19.32,P〈0.01）。结论在五位一体模式下,医生、护士、康复师、患者、家属共同评估、制定、实施预防便秘方案,护士在团队中发挥着主导作用,取得较好的临床效果,值得推广。

Objective The objective of discussion on the five-in-one （ doctor, nurse, therapist, patient, fami-ly members） effect on preventing constipation after geriatric hip fracture lies in providing a basis for generalizing the five-in-one nursing model to geriatric hip fracture. Methods The experimental group incorporated 39 patients from October 2014 to April 2015 , 11 males and 28 females with average age of 75 . 6 . The diseases they suffered were 12 hip re-placements, 27 intertrochanteric fractures with internal fixation, 8 combined diabetes, 13 hypertension, 5 coronary heart diseases, 4 gastritis and 2 pulmonary emphysema. The five-in-one nursing model was applied to prevent their constipa-tion . The control group incorporated 40 patients from January to August 2013 , 12 males and 28 females with average age of 76. 1. The diseases they suffered were 15 hip replacements, 25 intertrochanteric fractures with internal fixation, 9 combined diabetes, 20 hypertension, 3 coronary heart diseases and 1 pulmonary emphysema. The routine nursing model was applied to observe their defecation. Once constipation was found, report it to the doctor. These two groups were compared in such aspects as overall therapeutic effect, the first defecation time, auxiliary defecation rate, satisfaction and incidence of complications. Results The experimental group was higher than the control group in overall curative effect and satisfaction, lower than the control group in average defecation time, auxiliary defecation rate and incidence of complications. Significant difference occurred on the both in marked therapeutic effect, effective therapy and ineffective therapy （ P〈0. 01 ） , as well as the total effective rate （χ^2=19. 32 , P〈0. 01 ） . Conclusions The five-in-one nursing allows the team made up of a doctor, nurse, therapist, patient, family members to jointly assess, draw up and imple-ment constipation-preventing scheme, where nurses are playing a pivotal role in this team. It brings nice clinical results and is worthy of generalization.