综合性复温措施在老年股骨转子间骨折病人术后护理中的应用

Application of comprehensive rewarming measures in elderly patients with femoral intertrochanteric fractures

目的探讨综合性复温措施在老年股骨转子间骨折病人术后临床护理工作中的应用效果。方法选取2014年2月至2016年1月我院收治的86例老年股骨转子间骨折手术病人,根据随机数字表法分为综合复温组和常规复温组,每组43例。常规复温组实行常规复温法(液体加温),综合复温组采取综合性复温措施(升高环境温度、加热床上用品、运送过程中保暖、营养支持等)。比较两组病人的复温速度、髋关节Harris评分、感染率、首次活动时间、完全负重时间、住院时间及应激程度。结果根据髋关节Harris评分标准,综合复温组的优良率为79.07%(34/43),常规复温组为74.42%(32/43),差异无统计学意义(χ2=0.260,P=0.182);综合复温组的感染率为2.33%(1/43),明显低于常规复温组的16.28%(7/43),差异有统计学意义(χ~2=4.960,P=0.029)。综合复温组病人的复温速度、首次活动时间、完全负重时间及住院时间分别为(0.53±0.19)℃/h、(4.21±1.45)h、(4.95±1.26)周、(5.03±1.39)d,均优于常规复温组,差异均有统计学意义(P均<0.05);综合复温组术后的肾上腺素、去甲肾上腺素、肾素值分别为(105.39±38.14)μg/L、(126.89±26.22)μg/L、(3.24±1.48)μg/L,明显低于常规复温组,差异均有统计学意义(P均<0.05)。结论老年股骨转子间骨折手术病人采用综合性复温措施不但复温速度更快,且能有效降低感染发生率,减轻应激反应,缩短恢复时间。

Objective To discuss the application of comprehensive rewarming measures in elderly patients with femoral intertrochanteric fractures.Methods Eighty-six elderly patients with femoral intertrochanteric fractures treated in our hospital during February2014to January2016were collected,and equally divided into comprehensive rewarming group(receiving comprehensive rewarming measures)and conventional rewarming group(receiving routine rewarming methods).The rewarming rate,hip Harris score,infection rate,first active time,full weight-bearing time,hospital stay and the level of stress factors were compared between two groups.Results According to the Harris scoring system of hip joint,the excellent and good rate in the comprehensive rewarming group was79.07%(34/43),and that in conventional rewarming group was74.42%(32/43),with the difference being not statistically significant(χ2=0.260,P=0.182).The infection rate in the comprehensive rewarming group was2.33%(1/43),which was obviously lower than that in the conventional rewarming group(χ2=4.960,P=0.029).The rewarming rate,first active time,full weight-bearing time and hospital stay the comprehensive rewarming group were(0.53±0.19)℃/h,(4.21±1.45)h,(4.95±1.26)weeks,(5.03±1.39)days,significantly better than those in the conventional rewarming group with the differences being statistically significant(P<0.05for all).The levels of epinephrine,norepinephrine and rennin in the comprehensive rewarming group were(105.39±38.14),(126.89±26.22),(3.24±1.48)μg/L,significantly lower than those in the conventional rewarming group respectively,with the difference being statistically significant(P<0.05for all).Conclusion The application of comprehensive rewarming measures in elderly patients with intertrochanteric fractures not only can improve the rewarming rate,but also reduce the incidence of infection,relieve stress reaction and shorten the recovery time.