延续护理服务在治疗老年骨质疏松症中的应用价值

Application value of continuing nursing care service in treating senile osteoporosis

目的探讨延续护理服务在治疗老年骨质疏松症（osteoporosis,OP）中的应用价值。方法本前瞻性研究对象为2013年6月至2015年1月在阳江市人民医院就诊或接受治疗的220例老年OP患者。所有患者均签署知情同意书,符合医学伦理学规定。采用随机数字表法将患者分为延续护理服务组（研究组）和常规随访处理组（对照组）。研究组110例,男43例,女67例;年龄（69±8）岁。对照组110例,男36例,女74例;年龄（67±6）岁。研究组在就诊或治疗后予骨质疏松症的延续护理服务,对照组予常规随访处理。延续护理服务包括采用各种远程联系方式对患者进行随访、定期知识宣教、24小时热线服务和定期家庭访视。随访12个月后比较两组患者骨密度值、服药依从性、脆性骨折发生率、OP认知评分、生活质量评分和护理满意度评分等指标。两组患者服药依从性的比较采用Spearman秩相关分析,脆性骨折发生率的比较采用χ~2检验,其它临床资料的比较采用t检验。结果随访12个月后,研究组的骨密度值为-1.5±0.7,明显高于对照组的-1.7±0.8（t=2.379,P〈0.05）;研究组的OP认知评分为（22±5）分,明显高于对照组的（16±6）分（t=6.745,P〈0.05）;研究组的生活质量评分为（71±18）分,明显高于对照组的（62±21）分（t=4.345,P〈0.05）;研究组的护理满意度评分为（8.9±0.7）分,明显高于对照组的（5.7±1.6）分（t=2.649,P〈0.05）;研究组的服药依从性等级明显高于对照组（χ~2=17.731,P〈0.05）;研究组的脆性骨折发生率为1.8%（2/110）,明显低于对照组的12.7%（14/110）（χ~2=8.657,P〈0.05）。结论延续护理服务在治疗老年骨质疏松症中的应用能使老年OP患者提高服药依从性,增加骨密度,提高患者对骨质疏松症的认知水平,减少脆性骨折的发生率,总体效用优于常规的随访处理。

Objective To investigate the applicative value of continuing nursing care service in treating senile osteoporosis （OP）.Methods A total of 220 patients with senile OP accepting the diagnosis or treatment in the People’s Hospital of Yangjiang from June 2013 to January 2015 were included in this prospective study. The informed consents were obtained from all the patients and the local ethical committee approval had been received. These patients were divided into the continuing care service group （the study group） and the routine follow-up visit group （the control group）. One hundred and ten patients were included into the study group, of whom 43 were males and 67 were females with an average age of （69±8） years old. One hundred and ten patients were included into the control group, of whom 36 were males and 74 were females with an average age of （67±6） years old. Continuing care service was offered to the study group after diagnosis and treatment, while the control group only accepted routine follow-up visit. Continuing care service included follow-up through various long-distance connection ways, regular knowledge education, 24-hour hotline service and regular home visit. The bone mineral density, medication adherence, fragility fracture incidence, the OP cognition score, the score of life quality and score of nursing satisfaction were compared between two groups at 12 months after operation. The comparison of medication adherence between the two groups was conducted using Spearman rank correlation analysis, the comparison of fragility fracture incidence was conducted usingχ2 test, and the comparisons of other clinical indexes were conducted usingt test.Results At 12 months after operation, the bone mineral density of the study group was-1.5±0.7, which was significantly higher than-1.7±0.8 of the control group （t=2.379, P〈0.05）; the OP cognition score of the study group was 22±5, which was significantly higher than 16±6 of the control group （t=6.745,P〈0.05）; the life quality score of the study group was 71±18, which was significantly higher than 62±21 of the control group （t=4.345,P〈0.05）; the score of nursing satisfaction was 8.9±0.7, which was significantly higher than 5.7±1.6 of the control group （t=2.649,P〈0.05）; the rank of medication adherence of the study group was significantly higher than that of the control group （χ2=17.731, P〈0.05）; the fragility fracture incidence of the study group was 1.8%（2/110）, which was significantly lower than 12.7%（14/110） of the control group （χ2=8.657,P〈0.05）.Conclusions Continuing care service can increase elder OP patients’ medication adherence, bone mineral density and OP cognitive level, as well as reduce the fragility fracture incidence; so its overall utility is superior to the routine follow-up visit.