专案改善在全膝关节置换患者术后早期下床活动中的应用

Application of project improvement in early out-of-bed activity of patients after total knee arthroplasty

目的探讨专案改善在全膝关节置换患者术后早期下床活动中应用的效果。方法2018年6月-2019年3月在山东省某三级甲等医院骨关节科,成立专案改善小组,以专案改善实施前的56例全膝关节置换患者为改善前组,专案改善实施后的58例全膝关节置换患者为改善后组,应用专案改善方法分析,分别从制订并实施全膝关节置换患者术后早期下床活动标准化方案、完善集束化疼痛管理策略、完善科室引流管管理执行标准等方面进行改善。比较两组术后相关并发症发生率、膝关节功能恢复状况及术后住院时间。结果专案改善实施后,患者术后首次下床活动时间缩短至(21.49±4.94)h,患者术后直腿抬高时间缩短至(32.10±11.48)h、屈膝90°时间缩短至(23.08±5.93)h,术后住院时间缩短至(4.12±1.03)d,与改善前比较差异有统计学意义(t值分别为-26.06、-5.37、-6.88、-10.37;P<0.01)。专案实施前后伤口渗血的发生差异无统计学意义(P>0.05),患者术后便秘发生率由改善前的17.9%(10/56)下降至3.4%(2/58),患者术后直立不耐受由改善前5.4%(3/56)上升至20.7%(12/58),差异有统计学意义(χ^2值分别为6.28、4.36;P<0.05)。结论专案改善的实施,缩短了全膝关节置换术后患者早期下床活动时间,有利于降低术后便秘发生率,加快膝关节功能康复进程,缩短术后住院时间。

Objective To explore the effect of project improvement on improving early out-of-bed activity of patients after total knee arthroplasty(TKA).Methods From June 2018 to March 2019,a project improvement team was established in Department of Joint Surgery of a ClassⅢGrade A hospital in Shandong province.The 56 patients undergoing TKA before the implementation of the project improvement were set as the pre-improvement group,and 58 patients undergoing TKA after the implementation of the project improvement were set as the post-improvement group.Based on the analysis of project improvement methods,the improvement was made from the following aspects,including formulating and implementing the standardized plan of early postoperative out-of-bed activity plan for TKA patients,perfecting management strategy of cluster pain and perfecting the implementation standard of drainage tube management in the department.The incidence of postoperative complications,knee joint function recovery and postoperative hospital stay were compared between the two groups.Results After the implementation of project improvement,out-of-bed activity time for the first time was shortened to(21.49±4.94)h,the time for postoperative straight leg elevation was shortened to(32.10±11.48)h,time for 90°knee flexion was shortened to(23.08±5.93)h,and the postoperative hospital stay was shortened to(4.12±1.03)d.The differences were statistically significant(t=-26.06,-5.37,-6.88,-10.37;P<0.01).There was no statistically significant difference in the incidence of incision bleeding before and after the implementation of the project improvement(P>0.05).The incidence of postoperative constipation decreased from 17.9%(10/56)before improvement to 3.4%(2/58),and the postoperative erection intolerance increased from 5.4%(3/56)before improvement to 20.7%(12/58).The differences were statistically significant(χ^2=6.28,4.36;P<0.05).Conclusions The implementation of the project improvement can shorten early out-of-bed activity of patients after TKA,reduce the incidence of postoperative constipation,accelerate the rehabilitation process of knee function,and shorten the postoperative hospital stay.