循证护理模式用于下颌骨骨折患者术后护理的临床观察

Observe on the clinical effect of evidence-based nursing model for postoperative nursing of patients with mandibular fracture

目的观察循证护理模式用于提高下颌骨骨折患者术后康复水平的临床效果。方法选择2018年1月—2021年6月温州医科大学附属衢州医院和浙江大学医学院附属第二医院收治的120例下颌骨骨折患者为研究对象,按照入院时间将患者分为对照组(60例)和研究组(60例),2组患者均进行小型钛板颌骨内固定术治疗,对照组患者术后实施常规护理干预,研究组患者实施循证护理干预。记录患者手术时间、术中出血量、住院时间和骨折愈合时间等手术指标,于术后3个月和6个月测定或评估患者咀嚼能力、牙齿咬合力、生活质量和心理健康状况,评价患者口腔卫生健康状况,观察患者术后并发症发生情况。结果研究组住院时间[(11.59±1.27)d vs.(16.94±1.45)d]和骨折愈合时间[(41.28±4.09)d vs.(49.62±4.31)d]均显著短于对照组(t=21.543、10.579,均P<0.001);研究组术后3个月咀嚼功能、牙齿咬合力和SF-36评分均显著高于对照组水平(均P<0.001),而2组术后6个月上述指标差异均无统计学意义(均P>0.05);研究组术后6个月HAMA和HAMD评分、PI、DI、GI和SBI均显著低于对照组(均P<0.001);研究组术后并发症总体发生率(5.00%,3/60)显著低于对照组水平(18.33%,11/60,χ^(2)=5.175,P=0.023)。结论循证护理模式可有效缩短下颌骨骨折患者术后康复周期,提高术后早期下颌运动功能水平和生活质量,减轻患者心理负担,改善口腔卫生健康状况,有助于减少术后并发症。

Objective To observe the clinical effect of evidence-based nursing mode on improving the postoperative rehabilitation level of patients with mandibular fracture.Methods Total 120 patients with mandibular fractures treated in Quzhou Hospital Affiliated to Wenzhou Medical University and the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2018 to June 2021 were collected as the research objects.The 120 patients with mandibular fracture were divided into control group(n=60)and study group(n=60)according to the admission time.Patients in two groups were treated with small titanium plate jaw internal fixation.The control group were given routine nursing intervention while the study group were given cluster nursing intervention.The operation time,intraoperative blood loss,hospitalization time and fracture healing time were recorded.The masticatory ability,bite force,quality of life,mental health,oral health status and postoperative complications were evaluated at 3 and 6 months after surgery.Results The duration of hospital stay and healing time of fracture in study group were significantly lower than those in control group[(11.59±1.27)d vs.(16.94±1.45)d,(41.28±4.09)d vs.(49.62±4.31)d,t=21.543,10.579,all P<0.001].Compared with control group,the masticatory function,bite force and SF-36 score of patients were significantly increased in study group at 3 months after operation(all P<0.001),while there was no statistical significance at 6 months after surgery(all P>0.05).The scores of HAMA,HAMD,PI,DI,GI and SBI were significantly decreased at 6 months after surgery in study group(all P<0.001).The overall incidence of postoperative complications in study group(5.00%,3/60)was significantly lower than that in control group(18.33%,11/60,χ^(2)=5.175,P=0.023).Conclusion Evidence-based nursing model can effectively shorten the postoperative rehabilitation period of patients with mandibular fracture and improve the early postoperative mandibular motor function and quality of life,which contributes to reduce the psychological burden of patients,improve oral health and reduce the risk of postoperative complications.