引导想象训练对老年全髋关节置换病人围手术期精神认知状态的影响

Effect of Guided Imagery Training on Perioperative Mental Cognitive Status of Elderly Total Hip Arthroplasty Patients

目的评估引导想象训练对老年全髋关节置换病人围手术期精神状态、疼痛和睡眠情况的影响。方法选取2021年6月至2021年10月我院接受全髋关节置换术的老年病人90例,采用随机数字表法分为对照组(46例)和观察组(44例)。对照组给予基于加速康复外科(ERAS)的围手术期护理,观察组在对照组的基础上进行运动引导想象训练。术前、术后当天、术后第1天、术后第3天和术后第7天,采用数字分级法(NRS)、理查兹-坎贝尔睡眠量表(RCSQ)和简易智能精神状态评价量表(MMSE)测评病人的疼痛、睡眠及精神状况;使用护理谵妄评分表(Nu⁃DESC)筛查病人住院期间谵妄发生情况。结果共有87例病人完成研究,总完成率为96.67%。重复测量方差分析结果显示两组病人疼痛、睡眠及精神变化存在时间效应、组间效应及交互效应,差异均有统计学意义(P<0.05)。术后,观察组发生谵妄12例(29.3%,12/41例),对照组发生谵妄24例(52.2%,24/46例),两组比较,差异有统计学意义(χ^(2)=4.689,P=0.030)。结论运动引导想象训练有助于改善老年全髋关节置换病人围手术期疼痛程度、睡眠情况和精神状态。

Objective To evaluate the effect of guided imagery training on perioperative pain,sleep and mental state of elderly patients with total hip replacement.Methods A total of 90 elderly patients admitted to our hospital from June 2021 to October 2021 were randomly divided into the control group and the observation group using the random number table method.The control group received ERAS,while the observation group received guided imagery training therapy on the basis of control group.Before operation,the day after operation,the first day after operation,the third day after operation,and the 7th day after operation,the patients􀆳pain,sleep,and mental status were evaluated with the Numerical Rating Scale(NRS),the Richards⁃Campbell Sleep Questionnaire(RCSQ),and the mini⁃mental state examination(MMSE).The Nursing⁃Delirium Screening Scale(Nu⁃DESC)was used to screen the occurrence of delirium during hospitalization.Results A total of 87 subjects completed the whole study,with a 96.67%completion rate.The results of repeated measurement ANOVA showed that there were time effect,inter group effect and interaction effect in pain,sleep and mental changes of the two groups,and the difference was statistically significant(P<0.05).After operation,12 cases of delirium occurred in the observation group(29.3%,12/41 cases)and 24 cases of delirium occurred in the control group(52.2%,24/46 cases).The difference between the two groups was statistically significant(χ^(2)=4.689,P=0.030).Conclusion Guided imagery training therapy may effectively relieve the pain degree and improve the sleep and mental state for elderly total hip arthroplasty patients during the perioperative period.