可视脊柱内镜下髓核摘除椎管神经根减压椎间孔纤维环成形术围术期基于PDCA循环法的结构化护理

Structured care based on the PDCA cycle method in the perioperative period of visual spinal endoscopic nucleus pulposus nerve root decompression for foraminal fibrous annuloplasty

目的探讨基于戴明环(PDCA)循环法的结构化护理对可视脊柱内镜下髓核摘除椎管神经根减压椎间孔纤维环成形术围术期患者的影响。方法选择2019年12月至2021年8月行可视脊柱内镜下髓核摘除椎管神经根减压椎间孔纤维环成形术围术期护理的110例患者为研究对象。按照随机数字表法,将110例患者分成对照组(55例)和研究组(55例)。在实施护理90 d后,对比分析护理前后两组患者患处疼痛的视觉模拟评分(VAS评分)、Oswestry功能障碍指数(ODI评分)、并发症发生率,并评估护理效果。结果护理前,两组患者患处疼痛的VAS评分相比,差异无统计学意义(P>0.05);护理14 d后及护理3个月后,两组患者患处疼痛的VAS评分均较护理前降低,且两组患者护理3个月后VAS评分均明显低于护理14 d后VAS评分,差异有统计学意义(P<0.05);护理14 d后,研究组患者患处疼痛的VAS评分明显低于对照组,差异有统计学意义(P<0.05);护理3个月后,研究组患者患处疼痛的VAS评分明显低于对照组,差异有统计学意义(P<0.05);护理前,两组ODI评分中生活自理能力、站立、坐位、步行、提物、睡眠情况、社会生活、旅游的评分相比,差异无统计学意义(P>0.05);护理3个月后,两组的ODI评分中生活自理能力、站立、坐位、步行、提物、睡眠情况、社会生活、旅游的评分均较护理前降低,且研究组明显低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率(7.27%)明显低于对照组(21.82%),差异有统计学意义(P<0.05);研究组护理总有效率(96.36%)明显高于对照组(76.36%),差异有统计学意义(P<0.05)。结论基于PDCA循环法的结构化护理应用于可视脊柱内镜下髓核摘除椎管神经根减压椎间孔纤维环成形术患者的围术期,能有效改善患者认知功能、衰弱症状及营养状况,值得临床推广及应用。

Objective To explore the effect of structured nursing care based on the Daiming ring(PDCA)annuloplasty on perioperative patients who underwent visual spinal endoscopic nucleus pulposus enucleation with spinal canal nerve root decompression and transforaminal fibroannuloplasty.Methods From December 2019 to August 2021,110 patients who underwent perioperative nursing of nucleus pulposus enucleation,spinal canal nerve root decompression,intervertebral foramen annulus fibroplasty under visual spinal endoscopy in this hospital were selected for study.According to the random number table method,110 patients were divided into control group(55 cases)and study group(55 cases).After 90 days of nursing,the visual analog score(VAS score),oswestry dysfunction index(ODI score)and the incidence of complications of patients in the two groups before and after nursing were compared and analyzed,and the nursing effect of patients was evaluated.Results Before nursing,there was no significant difference in the VAS scores of suffering from pain between the two groups(P>0.05);after 14 days and after 3 months of nursing care,the VAS scores of patients with suffering pain in both groups were reduced compared with those before nursing care,and the VAS scores of patients after 3 months of nursing care in both groups were significantly lower than those after 14 days of nursing care,with a significant difference(P<0.05);after 14 days of care,the VAS score of patients with suffering pain in the study group,which was significantly lower than that in the control group,was significantly different(P<0.05);after 3 months of care,the VAS score of patients with suffering from pain in the study group,which was significantly lower than that in the control group,was significantly different(P<0.05);before nursing care,there was no significant difference between the two groups in the scores of ODI of living self-care ability,standing,sitting,walking,extracts,sleeping situation,social life,travel(P>0.05);after 3 months of nursing care,the scores of living self-care ability,standing,sitting,walking,lifting,sleeping situation,social life,travel in the ODI scale of both groups were reduced compared with those before nursing care,and the study group was significantly lower than the control group,with statistically significant differences(P<0.05);the complication rate of 7.27%in the study group was significantly lower than that of 21.82%in the control group,and the difference was statistically significant(P<0.05);the total effective rate of nursing care in the study group was 96.36%,which was significantly higher than the 76.36%rate in the control group,and the difference was statistically significant(P<0.05).Conclusions The structured nursing care based on PDCA circle method was applied to the perioperative period of patients undergoing spinal endoscopic enucleation of spinal canal nerve root decompression with foraminal fibroannuloplasty,which can effectively improve the cognitive function,debilitating symptoms and nutritional status of patients,and it is worth clinical promotion and application.