手术室剪刀体位摆放联合健肢保温护理在股骨粗隆间骨折术中的应用研究

Application study of scissors placement in the operating room combined with limb insulation nursing in the treatment of intertrochanteric fractures of the femur

目的探讨在股骨粗隆间骨折术中应用手术室剪刀体位摆放联合健肢保温护理的效果。方法选取2020年10月至2023年10月天门市第一人民医院收治的148例股骨粗隆间骨折患者作为研究对象,按照随机数字表法分为对照组(74例)和观察组(74例)。对照组采取健肢保温护理,观察组在健肢保温护理基础上采取手术室剪刀体位摆放,均持续护理至手术结束。比较两组患者的围手术期指标、体温变化情况、应激反应指标[促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)及血清皮质醇(CS)]、并发症发生情况、患者舒适度以及满意度。结果观察组的术中出血量、透视次数少于对照组,手术时间短于对照组,差异有统计学意义(P<0.05)。观察组麻醉注药时、手术30 min及术毕时的体温均高于对照组,差异有统计学意义(P<0.05)。观察组术后24 h的ACTH、NE、CS水平均低于对照组,差异有统计学意义(P<0.05)。术中30 min,观察组的舒适状况量表(GCQ)各项评分均高于对照组,差异有统计学意义(P<0.05)。观察组的并发症总发生率低于对照组,满意度各项评分均高于对照组,差异有统计学意义(P<0.05)。结论手术室剪刀体位摆放联合健肢保温护理可缩短股骨粗隆间骨折患者手术时间,有效减少术中出血量和术中透视次数,还可维持患者体温恒定,减轻患者应激反应,降低并发症率,进而提升患者舒适度和满意度。

Objective To explore the effect of using surgical room scissors placement combined with limb insulation care in the treatment of intertrochanteric fractures of the femur.Methods A total of 148 patients with intertrochanteric fracture of femur admitted to the First People's Hospital of Tianmen from October 2020 to October 2023 were selected as the study objects,and were divided into control group(74 cases)and observation group(74 cases)according to random number table method.The control group was treated with limb insulation nursing,while the observation group was treated with scissors placement in operating room on the basis of limb insulation nursing,and continued nursing until the end of the operation.The perioperative indexes,temperature changes,stress response indexes(adreno cortico tropic hormone[ACTH],noradrenaline[NE]and cortisol[CS]),complications,patient comfort and satisfaction were compared between the two groups.Results The intraoperative blood loss and fluoroscopy times in the observation group were less than those in the control group,and the operative time was shorter than that in the control group,the differences were statistically significant(P<0.05).The body temperature of the observation group were higher than those of the control group when anesthesia was injected,30 min after operation and after operation,the differences were statistically significant(P<0.05).The levels of ACTH,NE and CS in the observation group were lower than those in the control group 24 h after operation,the differences were statistically significant(P<0.05).After 30 min of operation,the scores of GCQ in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).The total complication rate of the observation group was lower than that of the control group,and satisfaction scores were higher than those of the control group,the differences were statistically significant(P<0.05).Conclusion Scissors placement in the operating room combined with limb insulation nursing can shorten the operation time of patients with intertrochanteric fracture of femur,effectively reduce the amount of intraoperative blood loss and intraoperative fluoroscopy times,maintain the constant body temperature of patients,reduce the stress reaction of patients,reduce the complication rate,and thus improve the comfort and satisfaction of patients.