老年股骨近端骨折围手术期处理流程的研究

Study on the Perioperative Management Process of Elderly Proximal Femoral Fractures

目的研究老年股骨近端骨折围手术期处理流程,比较新旧流程体系的合理性以及治疗结果的有效性,不断改进,制定规范、合理的临床围手术期处置流程。方法本研究选取2016年1月—2019年7月包头医学院第三附属医院骨科使用旧有流程的老年髋部骨折患者102例,纳入旧流程组;2019年8月—2022年7月包头医学院第三附属医院骨科使用新流程患者118例,纳入新流程组。同时整理并收集新旧流程实施过程中的患者年龄、性别比例、入院诊断、平均手术等待时间、术中出血量、围手术期输血量,术后髋关节功能评定结果、手术并发症发生例数、平均医疗费用、平均住院时间、并发症加重情况等,通过收集数据进行组间比较,明确新旧流程实施结果。结果新流程组围手术期平均输血量为(257.63±77.24)mL,24 h内完成手术27例,平均住院医疗费用为(41602.6±11878.49)元,优于旧流程组的(333.33±135.22)mL、5例(、51790.49±15744.51)元,差异有统计学意义(P<0.05)。结论新流程的实施可以有效缩短手术等待时间,缩短该类患者的平均住院日,有效降低围手术期用血量,降低住院期间医疗支出,提高24 h内手术完成率,是行之有效的围手术期处置流程。

Objective To study the perioperative management process of elderly proximal femoral fractures,compare the rationality of the old and new process systems and the effectiveness of treatment results,and constantly improve them,so as to develop standardized and reasonable clinical perioperative treatment procedures.Methods A total of 102 elderly patients with hip fracture who used the old process in the department of orthopedics,the Third Affiliated Hospital of Baotou Medical College from January 2016 to July 2019 were selected and included in the old process group in this study.From August 2019 to July 2022,118 patients in the department of orthopedics,the Third Affiliated Hospital of Baotou Medical College used the new processe and were included in the new process group.At the same time,the age,gender ratio,admission diagnosis,average waiting time for operation,intraoperative blood loss,and perioperative blood transfusion volume of patients during the implementation of the new and old processes were sorted out and collected.The results of hip joint function evaluation,the number of cases of surgical complications,the average medical cost,the average length of hospital stay,and the aggravation of complications were compared between the two groups.By collecting data and comparing between groups,the implementation results of the old and new processes were clarified.Results In the new process group,the average perioperative blood transfusion volume was(257.63±77.24)mL,the operation was completed in 27 cases within 24 h,and the average hospitalization cost was(41602.6±11878.49)yuan.Compared with the old process group(333.33±135.22)mL,5 cases,(51790.49±15744.51)yuan,the difference was statistically significant(P<0.05).Conclusion The implementation of the new process can effectively shorten the waiting time for surgery,shorten the average length of stay,effectively reduce perioperative blood consumption,reduce hospitalization expenses,and improve the completion rate of surgery within 24 hours.It is an effective perioperative management process.