基于加速康复外科理念的护理干预对踝关节骨折择期手术患者术前患肢消肿的应用效果

Effect of nursing intervention based on enhanced recovery after surgery concept on preoperative swelling reduction of affected limbs of patients with ankle fracture undergoing elective surgery

目的:探讨基于加速康复外科(ERAS)理念的护理干预对行择期手术的踝关节骨折患者术前患肢消肿的效果。方法:选取2020年10月至2021年10月收治的行择期手术的踝关节骨折患者72例,2020年10月至2021年4月收治的35例患者接受常规护理干预,纳入常规护理组;2021年5月至2021年10月的37例患者接受基于ERAS理念的护理干预,纳入护理干预组。比较两组患者的主要观察指标,即肿胀比和肿胀度;次要观察指标,即疼痛视觉模拟评分(VAS)、印象变化量表(PGIC)、术前等待时间、并发症、护理质量满意度、服务态度满意度和住院环境满意度。结果:入院时,两组患者的肿胀比、肿胀度、VAS评分、PGIC差异无统计学意义(P>0.05);护理3 d,两组的肿胀比与肿胀度均有不同程度地降低(P<0.05),与常规护理组比较,护理干预组的肿胀比和肿胀度均显著降低(P<0.05);护理3 d、出院时,两组的VAS评分与PGIC均有不同程度地降低(P<0.05),与常规护理组比较,护理干预组的VAS与PGIC均显著降低(P<0.05)。与常规护理组比较,护理干预组的术前等待时间、总并发症发生率显著降低(P<0.05),护理质量满意度、服务态度满意度均显著增高(P<0.05)。结论:基于ERAS理念的护理干预可用于行择期手术的踝关节骨折患者患肢消肿,有效减轻创伤性水肿、疼痛、减少并发症、改善就医印象及满意度,建议临床推广应用。

Objective:To investigate the clinical effect of nursing intervention based on the concept of enhanced recovery after surgery(ERAS)on preoperative swelling reduction of the affected limbs of patients with ankle fracture undergoing elective surgery.Methods:Totally 72 patients with ankle fracture who underwent elective surgery in our hospital from October 2020 to October 2021were selected into our study,of which 35 patients hospitalized from October 2020 to April 2021 were included in the routine nursing group,who received routine nursing intervention,and 37 patients hospitalized from May 2021 to October 2021 were included in the ERAS nursing group,who received nursing intervention based on ERAS concept.The main observation indicators(swelling ratio and swelling degree)and secondary observation indicators(visual analog scale[VAS],patients’global impression of change[PGIC],preoperative waiting time,complications,satisfaction with nursing quality,satisfaction with service attitude and satisfaction with hospital environment)were compared between the two groups.Results:At admission,there was no significant differences in swelling ratio,swelling degree,VAS and PGIC between the two groups(P>0.05).After three days of nursing,the swelling ratio and swelling degree of the two groups were reduced in varying degrees(P<0.05).Compared with the routine nursing group,the swelling ratio and swelling degree of the ERAS nursing group were significantly reduced(P<0.05).The VAS and PGIC of the two groups decreased in varying degrees after 3 days of nursing and at discharge(P<0.05).Compared with the routine nursing group,the VAS and PGIC of the ERAS nursing group significantly decreased(P<0.05).Compared with the routine nursing group,the preoperative waiting time and the occurrence of complications in the ERAS nursing group decreased significantly(P<0.05),and the satisfaction of nursing quality and service attitude increased significantly(P<0.05).Conclusions:The nursing intervention based on ERAS concept can be used in patients with ankle fracture undergoing elective surgery for reducing the swelling of the affected limbs by effectively reducing traumatic edema,pain and postoperative complications and improving the impression of medical treatment and satisfaction,which is recommended to promote in clinical practice.