全髋关节置换患者48小时全程护理模式的研究

Construction and application of 48-hour whole-course management and nursing model for patients with total hip arthroplasty

目的构建全髋关节置换患者48 h全程护理模式并探讨其应用效果。方法组建研究团队,通过文献检索结合医院实际流程,构建全髋关节置换患者48 h全程护理模式。采用便利抽样方法,选取浙江省某三级甲等医院骨关节科2020年6月—2021年3月入院的髋关节置换患者52例作为试验组;2020年1月—5月入院的髋关节置换患者73例作为对照组。试验组采用全髋关节置换患者48 h全程护理模式,对照组采用科室常规护理模式。比较两组住院总费用、平均住院日、术后首次进食时间、术后首次下床活动时间、术后最高疼痛评分、手术并发症发生率、15 d再入院发生率的差异。结果干预后,试验组住院总费用(t=8.593,P<0.001)、平均住院日(t=31.374,P<0.001)、术后首次进食时间(t=31.374,P<0.001)、术后首次下床活动时间(t=19.620,P<0.001)均低于对照组;两组术后最高疼痛评分差异无统计学意义(t=0.276,P=0.783);两组均未发生手术并发症、15 d再入院。结论全髋关节置换患者48 h全程护理模式在加速患者康复的同时可缩短住院时间,降低住院费用,并不增加手术并发症发生率和15 d再入院率,是一种安全、可行、科学的护理管理模式。

Objective To construct a“48-hour whole-process management”nursing model and explore its application effect for patients with total hip arthroplasty.Methods Based on the experience of literature retrieval and the actual process of the hospital,we set up a research team and constructed a“48-hour whole-process management”nursing model.Using the convenience sampling method,we selected 73 cases as the control group from January 2020 to May 2020,52 cases as the experimental group from June 2020 to March 2021 who performed total hip replacement surgery in the Department of Orthopedics and Arthritis of a tertiary hospital in Zhejiang Province.The experimental group adopts the“48-hour whole-process management”nursing mode,while the control group adopts the routine nursing mode.The differences in the total hospitalization cost,average hospitalization days,time of first eating after operation,time of first getting out of bed after operation,highest postoperative pain score,incidence of surgical complications,and incidence of 15-day readmission were compared between the experimental group and the control group.Results After the intervention,the average hospitalization cost(t=6.523,P<0.01),average length of stay(t=31.374,P<0.01),the time of first eating after operation(t=8.593,P<0.01),and the time of first getting out of bed after operation(t=19.620,P<0)in the experimental group were lower than those in the control group;there was no significant difference in the highest postoperative pain score between the 2 groups(t=0.276,P=0.783);the incidence of surgical complications and the incidence of 15-day readmission between the 2 groups are both 0.Conclusion The 48-hour whole-process management nursing mode of total hip replacement can accelerate the recovery of patients,shorten the hospitalization time,and reduce the hospitalization cost,while it does not increase the incidence of surgical complications and the 15-day readmission rate.It is a safe,feasible and scientific nursing management mode.