人性化护理结合早期三阶段功能训练对肩袖损伤患者的影响

Arthroscopic rotator cuff injury under the implementation of three stages recovery postoperatively in patients with minimally invasive surgery training value discussion

目的分析术后人性化护理及早期三阶段功能训练对肩袖损伤关节镜下微创手术患者的影响。方法将104例行关节镜下微创手术的肩袖损伤患者按双盲法分为对照组（常规护理）和观察组（人性化护理和早期三阶段功能训练），每组52例。以术前和术后5、10、15、20周为观察时间点，对比2组Constant Murley肩关节评估中各项指标（疼痛、肌力、关节活动度、日常生活）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评分。结果2组术前疼痛、肌力、关节活动度、日常生活评分比较差异均无统计学意义（P〉0．05）。观察组术后10、15、20周疼痛评分分别为（4．32±0．17）、（2．20±0．39）、（1．01±0．24）分，均高于对照组的（4．61±0．21）、（3．36±0．38）、（1．76±0．14）分，差异有统计学意义（t=7．74、15．36、19．47，P〈0．01）。观察组术后5～20周肌力分别为（11．53±1．40）～（22．01±0_31）分，均高于对照组的（9．16±1．06）-（17．14±1．01）分，差异有统计学意义（t=8．97～33．24，P〈0．01）。观察组术后5～20周关节活动度分别为（74．96±4．39）～（150．01±2．34）分，均高于对照组的（69．01±2．63）-（120．15±2．36）分。差异有统计学意义（t=8．38～64．79，P〈0．01）。观察组术后10～20周日常生活评分分别为（13．05-±1．21）～（17．10±0．75）分，均高于对照组的（10．65±1．31）～（13．42±1．04）分，差异有统计学意义（t=9．70～20．70，P〈0．01）。干预后观察组HAMA及HAMD评分分别为（10．25±1．60）、（12．02±1．84）分，均低于对照组的（12．01±2．78）、（14．95±2．11）分，差异有统计学意义（t=3．25、6．19，P〈0．01）。结论人性化护理及早期三阶段功能训练用于肩袖损伤关节镜下微创术患者中具有以下作用：改善患者心理状态，使其积极接受治疗和康复；缓解疼痛，利于功能训练顺利进行；早期进行功能训练，从而提高肌力和关节活动度，改善日常生活能力。

Objective To analyze humanized nursing and postoperative function of early stage training under arthroscopic rotator cuff injury minimally invasive surgery in patients with application value. Methods A total of 104 routine under arthroscopy of minimally invasive surgery in patients with rotator cuff injury by double-blind controls （usual care） and observation group （phase humanized nursing and early function training）. With preoperative and postoperative week 5, 10, 15 weeks, 20 weeks of observation point in time, compared two groups of Constant Murley shoulder joint assessment of the indicators （pain, muscle strength, joint mobility, daily life） score, compared two groups of Hamihon Anxiety Scale （HAMA）, Hamilton Depression Scale （HAMD） score. Results Preoperative, two groups of patients with pain, muscle strength, （range of motion, ROM）, comparison between daily life score group were no significant differences （P〉 0.05）. Observation group of 10, 15, 20 weeks postoperatively pain scores were （4.32±0.17）, （2.20±0.39）, （1.01±0.24） points, which were higher than （4.61±0.21）, （3.36±0.38）,（1.76±0.14） points of the control group, and there were significant differences （t=7.74, 15.36, 19.47, P〈 0.01）. All the observation time point strength postoperative observation group were （11.53± 1.40）-（22.01± 0.31）points, which werehigher than （9.16± 1.06）-（17.14± 1.01） points of control group, and there were significant differences （t=8.97- 33.24, P〈0.01）. Each time point ROM postoperative observation group were （74.96±4.39）-（150.01±2.34） points which were higher than （69.01 ±2.63）-（120.15±2.36）points of control group, and there were significant differences（t=8.38-64.79,P〈0.01）. The observation group of 10 - 20 weeks daily life score were （13.05± 1.21）-（17.10±0.75） points higher than （10.65± 1.31）-（13.42± 1.04） points of control group, and there were significant differences （t=9.70- 20.70, P 〈0.01 ）. HAMA and HAMD score after the intervention of observation group were （10.25 ± 1.60）, （12.02± 1.84） points which were lower than （12.01 ±2.78）, （14.95 ±2.11） points of the control group, and there were significant differences （t=3.25, 6.19, P〈 0.01）. Conclusions Humanized nursing and functional training for early stage in patients with rotator cuff injury under the arthroscope minimally invasive surgery; has the following functions： improve patients＇ psychological status, the positive application of treatment and rehabilitation; pain relief, and functional training smoothly; the early functional training to increase muscle strength and joint motion and improve everyday life.