临床护理路径对人工全膝关节置换术患者术后疼痛和功能康复的影响

Effects of clinical nursing pathway on postoperative pain and functional rehabilitation of patients with total knee arthroplasty

目的探讨临床护理路径在缓解人工全膝关节置换术(TKA)患者术后疼痛和促进功能康复中应用效果。方法80例行TKA治疗的患者随机分为对照组和研究组,各40例。对照组术后常规护理,研究组依据临床路径完成康复治疗和功能锻炼。对比2组术后功能锻炼完成和达标情况,记录2组术1 d、7 d和14 d时目测类比评分法(VAS)疼痛评分,以及术后14 d功能独立性评定量表(FIM)评分。观察2组住院期间并发症发生情况,采用自制护理满意度量表评价患者对护理服务满意情况。结果研究组术后功能锻炼的正确率、达标率显著高于对照组(P<0.05)。术后7 d和14 d,研究组VAS评分显著低于对照组(P<0.05或P<0.01);术后14 d,研究组FIM量表总评分显著高于对照组(P<0.01)。研究组护理满意度90.00%,显著高于对照组的67.50%(P<0.05);2组并发症发生率差异无统计学意义(P>0.05)。结论依据临床护理路径合理安排TKA患者术后各项功能锻炼,能有效促进患者膝关节功能康复,缓解术后疼痛,提高护理满意度。

Objective To investigate the effects of clinical nursing pathway on relieving post- operative pain and improving functional rehabilitation in patients with total knee arthroplasty （TKA）. Methods A total of 80 patients treated with TKA were randomly divided into control group and study group, 40 cases in each group. The control group was given conventional orthopedic nursing, and the study group was treated with rehabilitation program based on clinical nursing pathway. The accuracy and achieved rate of functional training were compared between two groups. The visual analogue scale （VAS） at 1,7 and 14 days after operations as well as functional independence evaluation （FIM） scale at 14 days after operation were compared between two groups. The incidence rate of complication and satisfaction degree to nursing service were observed before discharge. Results The accuracy and a- chieved rate of functional training were significantly higher in study group than those in the control group （ P 〈 0.05 ）. The VAS scale at 7 days and 14 days after operation were significantly lower in the study group than those in the control group （P 〈0.05 or P 〈0.01 ）, and overall FIM score was signif- icantly higher in the study group than those in the control group （ P 〈 0.01 ）. The satisfaction degree was 90.00% in the study group, which was significantly higher than 67.50% in the control group （ P 〈 0.05 ）. There was no significant difference in the incidence rate of complication between two groups （ P 〉 0.05 ）. Conclusion Rehabilitation nursing intervention based on clinical nursing pathway is ef- fective in improving the efficacy of postoperative functional training in patients with TKA. It is also helpful to relieve the postoperative pain and improve the nursing satisfaction degree.