基于加速康复外科的出院计划在骨质疏松性胸腰椎骨折患者中的应用

Application of discharge planning based on enhanced recovery after surgery in patients with osteoporotic thoracolumbar fracture

目的探讨基于加速康复外科(ERAS)的出院计划在骨质疏松性胸腰椎骨折(OTLF)患者中的应用效果。方法采用回顾性队列研究分析2020年1月至2020年12月西安交通大学附属红会医院收治的230例OTLF患者临床资料,其中男44例,女186例;年龄53~92岁[(72.0±9.9)岁]。将2020年1月至6月入院的115例纳为常规护理组,给予常规护理干预;将2020年7月至12月入院的115例纳为出院计划组,给予基于ERAS的出院计划干预。比较两组住院时间、出院前4 h出院准备度量表(RHDS)评分、入院时及出院前4 h照顾者准备度量表(CPS)评分、12∶00前出院率、入院时及术后6个月中国人骨质疏松症简明生存质量量表(COQOL)评分、再骨折发生率。结果两组患者均随访6个月,出院计划组3例失访,常规护理组4例失访。出院计划组住院时间为(2.8±0.6)d,常规护理组为(2.6±0.7)d(P>0.05)。出院前4 h出院计划组RHDS评分为(103.0±8.3)分,高于常规护理组的(95.3±9.5)分(P<0.01)。入院时两组CPS评分差异无统计学意义(P>0.05),出院前4 h出院计划组CPS评分为(28.9±3.5)分,高于常规护理组的(24.3±4.8)分(P<0.01)。出院计划组12∶00前出院率为27.7%(31/115),高于常规护理组的15.3%(17/115)(P<0.05)。入院时两组COQOL评分差异无统计学意义(P>0.05),术后6个月出院计划组COQOL评分为(21.6±6.2)分,低于常规护理组的(26.6±6.9)分(P<0.01)。术后6个月出院计划组再骨折发生率为4.5%(5/112),低于常规护理组的12.6%(14/111)(P<0.05)。结论相较于常规护理,基于ERAS的出院计划能够提高OTLF患者的出院准备度、照顾者准备度和生存质量,优化床位管理,降低再骨折发生率。

Objective To analyze the application effect of discharge planning based on enhanced recovery after surgery(ERAS)in patients with osteoporotic thoracolumbar fracture(OTLF).Methods A retrospective cohort analysis was made on clinical information of 230 OTLF patients treated in Honghui Hospital of Xi′an Jiaotong University from January to December 2020,including 44 males and 186 females,aged 53-92 years[(72.0±9.9)years].A total of 115 patients receiving conventional nursing intervention from January to June 2020 were enrolled in regular nursing group and 115 patients receiving discharge planning intervention based on ERAS from July to December 2020 were enrolled in discharge planning group.The length of hospital stay,readiness for hospital discharge scale(RHDS)at 4 hours before discharge,caregiver preparedness scale(CPS)on admission and at 4 hours before discharge,discharge rate before 12∶00,Chinese osteoporosis quality of life short questionnaire(COQOL)on admission and at 6 months after surgery,and re-fracture rate were compared in the two groups.Results The patients were followed up for 6 months,except for 3 patients lost to follow up in discharge planning group and 4 patients in regular nursing group.The length of hospital stay was(2.8±0.6)days in discharge planning group and(2.6±0.7)days in regular nursing group(P>0.05).The RHDS in discharge planning group was significantly greater at 4 hours before discharge when compared with regular nursing group[(103.0±8.3)points vs.(95.3±9.5)points](P<0.01).The two groups had no significant difference in CPS at admittance(P>0.05),but a significantly greater CPS was found in discharge planning group at 4 hours before discharge when compared with regular nursing group[(28.9±3.5)points vs.(24.3±4.8)points](P<0.01).The discharge rate before 12∶00 in discharge planning group was significantly higher when compared with regular nursing group[27.7%(31/115)vs.15.3%(17/115)](P<0.05).The COQOL was similar at admittance between the two groups(P>0.05),but a significantly lower score was found in discharge planning group than that in regular nursing group[(21.6±6.2)points vs.(26.6±6.9)points](P<0.01).A significantly lower re-fracture rate was found in discharge planning group at 6 months after surgery when compared with regular nursing group[4.5%(5/112)vs.12.6%(14/111)](P<0.05).Conclusion For OTLF patients,discharge planning based on ERAS is superior to regular nursing in improving the readiness for hospital discharge,caregiver preparedness,quality of life and management of beds,and lowering re-fracture rate.