加速康复外科理念下的改良延续性护理方案对手外伤病人的护理效果

Application effect of enhanced recovery after surgery-based modified continuous nursing care for hand trauma patients

目的探讨基于加速康复外科(enhanced recovery after surgery, ERAS)理念下的改良延续性护理方案对手外伤病人的护理效果。方法选取2016年7月至2018年6月收治的118例单侧手外伤病人,采用随机数字表法分为观察组和对照组,每组59例。观察组采用ERAS理念下的改良延续性护理方案,对照组采用常规护理方案。术后第1天、出院时和术后6个月采用视觉模拟疼痛量表(visual analogue scale, VAS)评价病人疼痛情况;出院时和术后6个月采用国际手外科学会总主动活动度(total active motion, TAM)和国家专业手指功能评定标准评价病人患手功能恢复情况。观察两组病人住院时间、护理服务满意度、康复锻炼依从性,以及出院后并发症发生情况。结果观察组术后第1天、出院时及术后6个月的VAS评分均明显优于对照组[(2.69±1.59)分vs.(5.03±1.50)分;(1.42±1.21)分vs.(2.58±1.23)分;(0.22±0.56)分vs.(1.02±1.11)分],差异均有统计学意义(P均<0.05)。术后6个月,观察组患手TAM、肌力及感觉、灵巧性及协调性分别为74.51°±7.65°、(110.56±7.78)分、(2.51±1.14)分,均明显优于对照组的58.47°±5.03°、(94.37±3.85)分、(4.02±1.14)分,差异均有统计学意义(P均<0.05)。观察组住院时间较对照组明显缩短[(7.31±2.12)d vs.(12.02±2.33)d],差异有统计学意义(P<0.05)。观察组护理服务满意度和康复锻炼依从性优良率分别为98.31%(58/59)和98.31%(58/59),明显优于对照组的83.05%(49/59)和86.44%(51/59),差异均有统计学意义(P均<0.05)。结论基于ERAS理念下的改良延续性护理方案能有效促进单侧手外伤病人术后手功能的恢复,减少并发症的发生,有助于建立良好的医患关系。

Objective To explore the applied efficacy of enhanced recovery after surgery(ERAS)-based modified continuous nursing care for hand trauma patients. Methods One hundred and eighteen casesof hand trauma were selected from July 2016 to June 2018 in our hospital. They were randomly divided intoobservation group and control group. The observation group was given ERAS-based modified continuousnursing care, and the control group was subjected to the routine nursing plan. The visual analogue scale(VAS)was used to evaluate the patients. pain, and the total active motion(TAM) and the professional finger functionevaluation standard were used to evaluate the patients. hand function recovery. The hospitalization time,complications, satisfaction with nursing service, and compliance with treatment were recorded. Results TheVAS scores of the first day, discharge and 6 months after operation in the observation group were significantlyreduced as compared with those in the control group(2.69±1.59 vs. 5.03±1.50;1.42±1.21 vs. 2.58±1.23;0.22±0.56 vs. 1.02±1.11)(P<0.05). At 6 th month after operation, TAM, muscle strength and sensation, dexterity andcoordination of the affected hand in the observation group were 74.51°±7.65°, 110.56±7.78, and 2.51±1.14 respectively, which were significantly better than those in the control group(58.47°±5.03°, 94.37±3.85 and4.02±1.14)(P<0.05). The hospitalization time of observation groups was shorter than control group(P<0.05).The satisfaction rate and compliance rate of nursing service in the observation group were 98.31% and 98.31%respectively, which were significantly higher than those in the control group(83.05% and 86.44%)(P<0.05).Conclusion The ERAS-based modified continuous nursing care can promote the recovery of hand function,reduce the occurrence of complications, and help to establish a better doctor-patient relationship.