基于MDT协作理念的综合护理干预对膝关节置换患者康复的影响

Effect of comprehensive nursing intervention based on the concept of MDT writing on the rehabilitation of patients with knee replacement

目的探讨基于多学科协作(MDT)理念的综合护理干预对膝关节置换患者康复及临床对照研究。方法选择2019年1月—2020年4月在江苏省连云港市第一人民医院关节外科行人工全膝关节置换术(TKA)术后的94例患者,按照随机数字法将其分为A组(术后进行综合护理,47例)和B组(A组的基础上进行MDT护理,47例)。观察两组术后康复指标,术前,术后1、7 d及14 d美国特种外科医院(HSS)评分及视觉模拟评分(VAS),膝关节恢复指标、术后生活质量评分以及护理满意度。结果B组患者住院天数、首次下床时间短于A组,住院费用低于A组,差异有统计学意义(P<0.05)。两组HSS评分时间、组间及交互作用比较,差异有统计学意义(P<0.05)。进一步两两比较,两组术后1、7 d及14 d HSS评分高于术前,7 d及14 d高于术后1 d,差异有统计学意义(P<0.05)。B组术后7 d及14 d HSS评分低于A组,差异有统计学意义(P<0.05)。两组VAS时间、组间及交互作用比较,差异有统计学意义(P<0.05)。进一步两两比较,两组术后7 d及14 d VAS高于术前及术后1 d,差异有统计学意义(P<0.05)。B组术后7 d及14 d VAS高于A组,差异有统计学意义(P<0.05)。B组膝关节恢复指标中膝关节屈曲>90°所需时间短于A组,差异有统计学意义(P<0.05)。B组最大屈曲度、活动度及屈膝度大于A组,差异有统计学意义(P<0.05)。B组生理职能、躯体疼痛、精力、社会功能、情感职称、精神健康、健康状况及日常活动评分高A组,差异有统计学意义(P<0.05)。B组护理满意度高A组,差异有统计学意义(P<0.05)。结论基于MDT协作理念的综合干预能够提高术后OA患者膝关节功能,减少疼痛在术后7 d及14 d尤为显著,有效提高生活质量增加护理满意度。

Objective To explore the comprehensive nursing intervention based on the concept of multidisciplinary temwork(MDT) on the rehabilitation of patients with knee replacement and clinical controlled research. Methods From January 2019 to April 2020, a total of 94 patients underwent artificial total knee arthroplasty(TKA) were selected in the Joint Surgery Department of the First People’s Hospital of Lianyungang City, Jiangsu Province. According to the random number method, they were divided into group A(comprehensive nursing after operation, 47 cases) and group B(MDT nursing on the basis of group A, 47 cases). The postoperative rehabilitation indicators, preoperative, 1, 7 d and14 d postoperatively, American hospital of special surgery(HSS) score and visual analog scale(VAS), knee joint recovery index, postoperative quality of life score, and nursing satisfaction of two groups were observed. Results The number of days of hospitalization and the time of getting out of bed for the first time in group B were shorter than those in group A, while the hospitalization expenses were lower than those in group A, and the differences were statistically significant(P < 0.05). There were statistically significant differences in HSS scoring time, between groups and the interaction between the two groups(P < 0.05). Further pairwise comparisons showed that the HSS scores of the two groups were higher on 1, 7 d and 14 d after operation than before operation, and on 7 d and 14 d were higher than that on 1 d after operation, and the differences were statistically significant(P < 0.05). The HSS scores of group B were lower than those of group A at 7 d and 14 d after operation,and the differences were statistically significant(P < 0.05). There were statistically significant differences in the VAS time, between groups and the interaction between the two groups(P < 0.05). Further comparisons between the two groups showed that the VAS of the two groups were higher on the 7 d and 14 d after the operation than before and 1 d after the operation, and the differences were statistically significant(P < 0.05). The VAS of group B were higher than those of group A at 7 d and 14 d after operation, and the differences were statistically significant(P < 0.05). In the knee joint recovery index of group B, while the time required for knee flexion >90° was shorter than that of group A, and the differences were statistically significant(P < 0.05). The maximum flexion, range of motion and knee flexion in group B were greater than those in group A, and the differences were statistically significant(P < 0.05). The physiological function, physical pain, energy, social function, emotional title, mental health, health status and daily activities scores of group B were higher than those of group A, and the differences were statistically significant(P < 0.05). The nursing satisfaction of group B was high in group A, and the difference was statistically significant(P < 0.05). Conclusion The comprehensive intervention based on the MDT collaboration concept can improve the knee joint function of patients with postoperative OA, reduce pain especially at 7 and 14 d after surgery, effectively improve the quality of life and increase nursing satisfaction.