关节镜下肩袖修补术患者围手术期护理流程优化及效果评价

Optimization and effect evaluation of perioperative nursing process for patients undergoing arthroscopic rotator cuff repair surgery

目的依托多学科团队合作,加速关节镜下肩袖修补术患者关节功能恢复。方法成立微创关节康复小组,借鉴快速康复外科理念,通过术前支具佩戴适应性训练及术前康复体验活动;术中液体管理与控制及术中保暖与体温控制;术后早期活动与分阶段系统康复功能锻练,实施专业化、系统化围手术期护理流程的优化,加速关节功能恢复。结果 30例患者患肩前屈、外展、中立位外旋、外展90°内旋、外展90°外旋等主动活动范围均较术前明显增加,术后12周美国肩肘外科医师评分由术前(66.52±2.33)分提高到(93.65±2.24)分,髋关节疼痛评分由术前(8.54±1.25)分,分别降低为术后第3天(4.32±0.56)分,术后1周(2.23±0.55)分。结论护理流程优化方案的实施融入了多个持续质量改进项目,综合了多科优质医疗护理资源,缩短了康复护理时间及平均住院日,有效提高了患者的肩关节活动度。

Objective To explore methods of accelerating joint function recovery for patients undergoing arthroscopic rotator cuff＇ repair surgery with multidisciplinary collaboration. Methods Minimally invasive joint rehabilitation team was established and the concept of rapid rehabilitation surgery was adopted. Professional and systematic optimization of perioperative nursing process was conducted,and the joint function recovery was promoted by：training of wearing braces and rehabilitation preoperatively;fluid management and temperature control intra- operatively;early activity and function rehabilitation exercise. Results Totally 30 patients were included. Active shoulder range of motion including flexion,abduction,external rotation from neutral side,internal rotation at 90~ abduction and external rotation at 90~ abduction were significantly increased after surgery. American Shoulder and Elbow Surgeons＇ scores improved from 66.52＋2.33 to 93.65＋2.24. VAS scores improved from 8.54＋1.25 to 4.32＋ 0.56 three days after surgery and 2.23：t：0.55 one week after surgery. Conclusion The implementation of nursing process optimization scheme integrating multiple continuous quality improvement projects and a plurality of high- quality medical care resources shortened rehabilitation nursing time and average day in hospital and improved patients＇ shoulder range of motion.