医护一体手术室综合管理预防脊柱骨折伴脊髓损伤患者术中压力性损伤的效果分析

Effect of an integrated medical and nursing care management in operating room on preventing intraoperative stress injury in patients with spinal fractures and spinal cord injury

目的分析医护一体手术室综合管理预防脊柱骨折伴脊髓损伤患者术中压力性损伤的效果。方法选择2019年12月至2022年7月接受手术的脊柱骨折伴脊髓损伤患者116例,按随机数表法分为对照组(58例,接受围术期常规管理)和研究组(58例,开展围术期常规管理+医护一体手术室综合管理)。统计2组术后压力性损伤发生率、发生程度、发生部位与损伤面积,观察患者管理前、管理后心理弹性、创伤后成长、功能独立性、脊髓功能、感觉与运动水平的变化,记录2组围术期并发症。结果研究组压力性损伤发生率为3.45%低于对照组的15.52%(P<0.05);研究组压力性损伤发生程度轻于对照组(P<0.05);2组压力性损伤发生部位、并发症发生率差异无统计学意义(P>0.05);研究组术后当天、术后3 d的压力性损伤面积低于对照组(P<0.05);研究组管理后心理弹性量表(CD-RISC)、创伤后成长自评量表(PTGI)、功能独立性评定量表(FIM)评分均高于对照组(P<0.05);研究组脊髓独立性评定量表中文版(SCIMⅢ)、国际脊髓损伤神经评分标准(ASIA)中的ASIA感觉功能评分(SS)、ASIA运动功能评分(MS)评分均高于对照组(P<0.05)。结论脊柱骨折伴脊髓损伤患者接受医护一体手术室综合管理可有效预防或减少术中压力性损伤发生,提高心理弹性与创伤后成长水平,改善功能独立性、脊髓功能。

Objective To analyze the effect of an integrated medical and nursing care management in operating room on preventing intraoperative stress injury in patients with spinal fractures and spinal cord injury.Methods A total of 116 patients with spinal fractures and spinal cord injury who underwent surgery in our hospital from December 2019 to July 2022 were enrolled.They were randomly assigned into the control group(n=58,receiving perioperative routine management)and the study group(n=58,receiving perioperative routine management+integrated medical and nursing management in operating room)according to random number table method.The incidence,degree,location and area of postoperative stress injury were analyzed between groups.Changes in psychological resilience,post-traumatic growth,functional independence,spinal cord function,level of sensory and motor before and after management were assessed.The perioperative complications of the two groups were recorded.Results The incidence of pressure injury in the study group was significantly lower than that of the control group(3.45%vs 15.52%,P<0.05).The degree of pressure injury in the study group was significantly milder than that of the control group(P<0.05).There were no significant differences in the site of pressure injury and complication rate between groups(P>0.05).The area of postoperative stress injury on the 1 day and 3 days postoperatively was significantly smaller in the study group than that of the control group(P<0.05).The post-management scores of the Connor-Davidson Resilience Scale(CD-RISC),Posttraumatic Growth Inventory(PTGI)and Functional Independence Measure(FIM)Scale in the study group were significantly higher than those of the control group(P<0.05).The scores of the Chinese version of the Spinal Cord Independence Measure-Ⅲ(SCIM-Ⅲ),and the American Spinal Injury Association(ASIA)Sensory Function score(SS)and Motor Function score(MS)were significantly higher in the study group than those of the control group(P<0.05).Conclusion An integrated medical and nursing care management in operating room can effectively prevent or reduce the occurrence of intraoperative stress injury,and improve mental resilience,post-traumatic growth,improve functional independence and spinal cord function in patients with spinal fractures accompanied by spinal cord injury.