三联预康复策略在强直性脊柱炎胸腰椎后凸畸形患者围术期的应用及效果评价

Perioperative effect of trimodal prehabilitation strategy in patients with thoracolumbar kyphosis caused ankylosing spondylitis

目的分析运动、营养和心理三联预康复策略对强直性脊柱炎(ankylosing spondylitis,AS)胸腰椎后凸畸形患者围术期的运动功能、营养状况和心理状况的影响。方法采用便利抽样的方法,选取2019年1月至2021年6月在本院脊柱外科住院治疗的64例AS胸腰椎后凸畸形患者。根据入院时间先后顺序,选取2019年1月至10月在本院脊柱外科住院治疗的32例AS胸腰椎后凸畸形患者设为对照组,实施AS围术期常规护理;选取2019年11月至2021年6月在本院脊柱外科住院治疗的32例AS胸腰椎后凸畸形患者设为试验组,实施运动、营养和心理三联预康复策略。干预前、术前1d和术后1w比较两组运动功能包括Bath强直性脊柱炎功能指数(Bath ankylosing spondylitis functional index,BASFI)、Bath强直性脊柱炎测量指数(Bath ankylosing spondylitis metrology index,BASMI)、6分钟步行实验(six minutes walk test,6MWT);营养状况包括白蛋白、总蛋白值和心理状况包括焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)评分的差异。比较两组患者住院时间的差异。结果不同时间点两组间患者运动功能、营养和心理状况的组间效应、时间效应和交互效应比较,差异均有统计学意义(P<0.01)。术前1d和术后1w,试验组的BASFI、BASMI得分及SAS、SDS得分低于干预前且低于对照组(P<0.05,P<0.001);6MWT步行距离和白蛋白、总蛋白值优于干预前且优于对照组(P<0.05,P<0.001)。结论运动、营养和心理三联预康复策略可改善AS胸腰椎后凸畸形患者行截骨矫形术后的运动功能及营养状况、减轻焦虑和抑郁程度并缩短住院时间。

Objective To investigatethe perioperative effect of trimodal prehabilitation strategy with exercise,nutritional support and psychological interventionin patients with thoracolumbar kyphosis caused by ankylosing spondylitis(AS).Methods A total of 64 patients with AS thoracolumbar kyphosis treated in our hospital from January 2019 to June 2021 were selected.The 32 cases hospitalized in the Department of Spine Surgery of the hospital during January to October,2019 were assigned as control group,where routine perioperative nursing care was given,and the rest 32 cases hospitalized in the same department as trial group,where the prehabilitation strategies were implemented including exercises,nutritional support and psychological intervention on the basis of routine perioperative nursing care on admission till the day before pre-operation.The two groups were compared in terms of the scores by Bath ankylosing spondylitis function index(BASFI),Bath ankylosing spondylitis measurement index(BASMI),6-minute walking test score(6MWT),the levels of albumin and total protein,the scores by self-rating anxiety scale(SAS)and self-rating depression scale(SDS),the incidence of postoperativeserious complications and length of hospital stay before intervention,one day before operation and one week after operation.Results There were statistically significant differences in intergroup effect,time effect and interaction effect of BASFI,BASMI,6MWT,albumin,total protein,SAS,SDS and length of hospital stay at the respective time points(P<0.01).The BASFI,BASMI,SAS and SDS of the intervention group 1 day before operation and one week after operation were lower than those before intervention and those of the control group(P<0.05,P<0.01).The 6MWT,the levels of albumin and total protein group was significantly higher than those of the intervention and those of the control group(P<0.05,P<0.01).Conclusion The trimodal prehabilitation strategies with exercise,nutritional support and psychological intervention can improve motor function and nutritional status,relieve anxiety and depression,and shorten hospital stay in patients with AS and thoracolumbar kyphosis undergoing osteotomy and orthopedic surgery.