预防老年髋部脆性骨折病人肺部感染的加速康复循证护理实践

Evidence-based nursing practice of accelerating rehabilitation to prevent pulmonary infection in elderly patients with hip brittle fracture

目的构建并实施基于加速康复的预防老年髋部脆性骨折病人肺部感染的循证护理方案,并评价其效果。方法选取2018年9月至2019年7月在兰州大学第一医院住院治疗的80例老年髋部脆性骨折病人为研究对象,采用随机数字表法分为研究组和对照组,每组各40例。研究组应用基于加速康复的循证护理,对照组应用常规护理。比较两组病人肺部感染的发生率、首次下床活动时间、住院天数、术后第7天生活自理能力(ADL)评分。结果研究组无肺部感染病例发生,对照组发生6例肺部感染,发生率为15%,组间比较差异有统计学意义(P<0.05);研究组首次下床时间[(43.26±11.91)h]和住院天数[(10.50±1.55)d]均明显小于对照组[(49.63±12.28)h、(12.36±5.42)d](均P<0.05),研究组术后第7天生活自理能力(ADL)评分[(55.88±3.56)分]明显高于对照组[(47.63±5.43)分](P<0.05)。结论基于加速康复的循证护理能有效预防和降低老年髋部脆性骨折病人肺部感染的发生,提高其生活自理能力,促进病人早日下床,缩短住院时间。

Objective To construct and implement evidence-based nursing scheme based on accelerated rehabilitation to prevent pulmonary infection in elderly patients with hip brittle fracture,and to evaluate its effect.Methods Eighty elderly patients with brittle hip fractures hospitalized in The First Hospital of Lanzhou University from September 2018 to July 2019 were selected as the research objects.The randomized digital table method was used to assign them into study group and control group,40 cases in each group.The study group received evidence-based care based on accelerated rehabilitation,and the control group used routine care.The incidence of pulmonary infection,the first time to get out of bed,hospital stay,and activity of daily living(ADL)score at 7th day after surgery were compared between the two groups.Results There were no cases of pulmonary infection in the study group but 6(15%)cases in the control group.The difference between the two groups was statistically significant(P<0.05).The first time to get out of bed[(43.26±11.91)h]and the length of hospital stay[(10.50±1.55)d]in the study group were significantly shorter than those in the control group[(49.63±12.28)h and(12.36±5.42)d](both P<0.05).The ADL score[(55.88±3.56)points]on the 7th day after operation in the study group was significantly higher than that in the control group[(47.63±5.43 points](P<0.05).Conclusion Evidence-based nursing based on accelerated rehabilitation can effectively prevent and reduce the incidence of pulmonary infection in elderly patients with hip fracture,improve their activity of daily living,help patients to get out of bed as early as possible,and shorten the length of hospital stay.