加速康复外科理念下信息化延续护理在老年髋部脆性骨折患者中的应用

Effects of information continuing nursing under the concept of enhanced recovery after surgery in elderly patients with hip fragility fracture

目的探讨基于加速康复外科(ERAS)理念的信息化延续护理在老年髋部脆性骨折患者中的应用效果。方法采用便利抽样法,选择2018年5—12月北京积水潭医院收治的186例老年髋部脆性骨折患者为对照组,采用ERAS理念下常规延续护理,选择2019年5—12月北京积水潭医院收治的193例老年髋部脆性骨折患者为试验组,采用ERAS理念下信息化延续护理,依托微信多元化、信息化平台,组建ERAS多学科协作团队,实施多元化、精准化、连续性的信息化延续护理。采用t检验、χ^(2)检验和Fisher精确检验比较干预后两组患者延续护理依从性和延续护理效率指标。结果试验组主动寻求建议、康复训练、按时复诊、规范用药及合理饮食依从率均高于对照组,差异均有统计学意义(χ^(2)值分别为50.846、37.408、6.916、14.108、17.111;P<0.01)。出院6个月后试验组患者Harris髋关节功能评分量表得分为(89.3±5.1)分、骨质疏松药物正确使用率为99.0%(191/193)、患者满意度为97.9%(189/193),均高于对照组,差异均有统计学意义(t/χ^(2)值分别为29.598、50.746、11.017;P<0.01);试验组患者二次骨折发生率为1.6%(3/193)、并发症发生率为5.2%(10/193),均低于对照组,差异有统计学意义(χ^(2)值为4.177、9.369;P<0.05)。结论基于ERAS理念的信息化延续护理能提高老年髋部脆性骨折患者居家护理的依从性,利于患者加速康复。

Objective To explore the effect of information continuing nursing based on the concept of enhanced recovery after surgery(ERAS)in elderly patients with hip fragility fractures.Methods Convenience sampling method was used.From May to December 2018,186 elderly hip fragility fracture patients admitted to Beijing Jishuitan Hospital were selected as control group,and routine continuing nursing under the concept of ERAS was adopted.From May to December 2019,193 elderly patients with hip fragility fractures admitted to Beijing Jishuitan Hospital were selected as experimental group,and the ERAS concept was adopted to information continuing nursing.Relying on the diversified and information platform of WeChat,we formed the ERAS multidisciplinary team and implemented the diversified,precise and continuous information continuing nursing.After intervention,the two groups of patients were compared with continuing nursing compliance and the efficiency of continuing care indicators using t test,χ2 test and Fisher exact test.Results The compliance rates of active seeking advice,rehabilitation training,regular follow-up visits,standardized medication and reasonable diet in experimental group were all higher than those in control group,and the differences were statistically significant(χ^(2)=50.846,37.408,6.916,14.108,17.111;P<0.01).Six months after discharge from the hospital,the score of Harris Hip Score,correct use rate of osteoporosis drugs and patient satisfaction were(89.3±5.1),99.0%(191/193)and 97.9%(189/193)respectively of patients in experimental group,all higher than those in control group,the differences were statistically significant(t/χ^(2)=29.598,50.746,11.017;P<0.01).The incidence of secondary fractures in experimental group was 1.6%(3/193),and the incidence of complications was 5.2%(10/193),which were lower than those in control group,and the differences were also statistically significant(χ^(2)=4.177,9.369;P<0.05).Conclusions Information continuing nursing based on the concept of ERAS can improve the compliance of elderly patients with hip fragility fractures in home care and help accelerate their recovery.