NNN-链接护理模式对髋膝置换患者自我感受负担、术后康复及生活质量的影响

Effects of NNN-linked nursing model on self-perceived burden, postoperative rehabilitation and quality of life in patients undergoing hip-knee replacement

目的:探讨围手术期应用NNN-链接护理模式对髋膝置换患者自我感受负担、术后康复情况及生活质量的影响。方法:采用分层抽样法选取2018年7月—2019年7月连云港市第一人民医院收治的100例拟行骨性关节炎人工髋膝关节置换术患者,按照密封信封法随机分为对照组和观察组,每组50例。对照组给予常规围手术期护理,观察组给予基于NNN-链接护理模式的围手术期护理。应用自我感受负担量表(SPBS)评价两组患者术前及术后3 d的自我感觉负担;应用美国膝关节协会评分(AKS)、测量膝关节主被动活动度和评估膝关节视觉模拟评分法(VAS)评价两组患者术后1 d及2周的膝关节康复情况;采用护理结局分类患者满意度调查量表对两组患者出院前的护理满意度进行调查;应用生活质量简表(SF-36)评估两组患者术前及术后3 d的生活质量。结果:术后3 d两组的SPBS评分较术前降低,观察组术后3 d的SPBS评分低于对照组(P<0.05)。观察组术后1 d及2周的AKS评分分别为(27.26±6.81)、(103.26±15.22)分,高于对照组的(24.28±5.68)、(95.32±10.83)分(P<0.05);观察组术后1 d及2周的膝关节主和被动活动范围分别为(47.66±9.22)°、(81.23±14.22)°和(64.23±12.22)°、(89.23±14.26)°,大于对照组的(42.25±8.59)°、(72.26±12.52)°和(58.26±10.12)°、(78.26±13.10)°(P<0.05);观察组术后1 d及2周的VAS评分分别为(5.29±0.82)、(3.46±0.77)分,低于对照组的(5.91±0.88)、(4.22±0.98)分(P<0.05);两组术后2周的AKS评分、膝关节主动和被动活动范围、VAS评分改善幅度大于术后1 d(P<0.05)。观察组对沟通、安全、护理技术、护理、指导、物理环境的满意度和满意度总分均高于对照组(P<0.05)。术后3 d两组患者SF-36中生理功能、生理职能、躯体疼痛、一般健康、活力、社会功能、情感职能精神健康维度的评分较术前提高(P<0.05),且观察组高于对照组(P<0.05)。结论:将NNN-链接护理模式应用于髋膝置换患者围手术期护理中能减轻患者的自我感觉负担,提高膝关节功能和主被动活动范围,减轻膝关节疼痛,提高患者的护理满意度和生活质量。

Objective To explore effects of perioperative application of NNN-linked nursing model on self-perceived burden,postoperative rehabilitation and quality of life in patients undergoing hip-knee replacement.Methods A total of 100 patients with osteoarthritis who were scheduled to undergo artificial hip-knee replacement in the First People's Hospital of Lianyungang from July 2018 to July 2019 were selected by stratified sampling method and they were randomly divided into the control group and the observation group according to the sealed envelope method,with 50 patients in each group.The control group was given routine perioperative nursing while the observation group was given perioperative nursing based on NNN-linked nursing model.Self-Perceived Burden Scale(SPBS)was used to evaluate self-perceived burden before surgery and at 3 days after surgery,American Knee Society knee score(AKS)was used to measure the active and passive activity of knee joints and the knee visual analogue score(VAS)was used to evaluate the knee rehabilitation in the two groups at 1 day and 2 weeks after surgery.Nursing Outcomes Classification-Patient Satisfaction Survey Scale was used to investigate nursing satisfaction of patients before discharge in two groups.MOS 36-Item Short Form Health Survey(SF-36)was used to assess the quality of life in the two group before surgery and at 3 days after surgery.Results At 3 days after surgery,SPBS scores in the two groups were significantly decreased compared with those before surgery,and the score in the observation group were significantly lower than that in control group(P<0.05).AKS score at 1 day and 2 weeks after surgery in observation group were respectively(27.26±6.81)and(103.26±15.22),which were significantly higher than(24.28±5.68)and(95.32±10.83)in the control group(P<0.05).The active range of knee joint motion and passive range of knee joint motion at 1 day and 2 weeks after surgery in the observation group were respectively(47.66±9.22)°,(81.23±14.22)°and(64.23±12.22)°,(89.23±14.26)°,which were significantly greater than(42.25±8.59)°,(72.26±12.52)°and(58.26±10.12)°,(78.26±13.10)°in the control group(P<0.05).VAS scores at 1 day and 2 weeks after surgery in the observation group were respectively(5.29±0.82)and(3.46±0.77),which were significantly lower than(5.91±0.88)and(4.22±0.98)in the control group(P<0.05).The improvements in AKS score,active and passive knee motion range and VAS score at 2 weeks after operation in both groups were greater than 1 day after operation(P<0.05).The nursing satisfaction scores of communication,safety,nursing technology,nursing,guidance and physical environment and total score of satisfaction in observation group were significantly higher than those in the control group(P<0.05).At 3 days after surgery,scores of physical functioning,physical role,body pain,general health,vitality,social function,emotional function and mental health of SF-36 in the two groups were significantly increased compared with those before surgery(P<0.05),and the scores in observation group were higher than those in the control group(P<0.05).Conclusions Application of NNN-linked nursing model in perioperative nursing of patients with hip-knee replacement can reduce the self-perceived burden,improve knee function and active and passive range of motion,relieve knee pain and improve nursing satisfaction and quality of life.