强化术后恢复在胸腰椎骨折合并神经损伤患者护理中的应用

中华创伤杂志 Pub Date : 2019-07-15 DOI:10.3760/CMA.J.ISSN.1001-8050.2019.07.013

L. Deng, Yong-hong Ding, Xu Zhang, Xiaohua Chen

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引用次数: 0

摘要

目的探讨ERAS在胸腰椎骨折伴神经损伤的护理中的应用。方法对2013年11月至2017年11月重庆总医院收治的64例双侧胸腰椎骨折合并神经损伤患者的临床资料进行回顾性病例对照研究。男性52例，女性12例，年龄26 ~ 62岁，平均年龄43岁。28例损伤节段位于T11-T12, 15例位于T12-L1, 10例位于L1-L2, 11例位于L2-L3。根据Frankel神经功能分级，A级14例，B级18例，C级24例，d级8例。所有患者均行直视下普通椎弓根螺钉置入联合小切口穹窿减压。其中32例患者接受ERAS康复护理(ERAS组)，32例患者接受常规康复护理(常规组)。比较两组术后3个月并发症发生率、住院时间、住院费用、患者对护理工作的满意度、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及Frankel神经功能分级。结果随访8 ~ 12个月[(10.2±1.3)个月]。ERAS组1例出现肺部感染;常规组创面感染1例，褥疮1例，下肢静脉血栓形成1例(P<0.01)。ERAS组住院时间明显短于常规组[(9.3±1.2)d∶(15.6±1.8)d]，差异有统计学意义(P<0.01)。ERAS组住院费用显著低于常规组[(52±13)万元(RMB) vs(63±17)万元(RMB)]，差异有统计学意义(P<0.05)。ERAS组满意度为84%(27/32)，常规组满意度为56%(18/32)，差异有统计学意义(P<0.05)。术后3个月，ERAS组VAS(2.6±1.2)分比(3.8±1.5)分、ODI(11.4±2.1)分比(15.8±2.5)分显著低于常规组(P<0.05或0.01)。术后3个月，根据Frankel分级，ERAS组A级1例，B级5例，C级9例，D级5例，E级12例;A级3例，B级7例，C级7例，D级9例，e级6例。ERAS组Frankel 1级及(或)以上康复率显著高于常规组[97%(31/32)比91%(29/32)，P<0.05]。结论ERAS康复护理措施可减少围手术期并发症，减少住院时间和住院费用，减轻疼痛，促进功能恢复，获得患者满意的反馈。关键词:康复护理;脊柱骨折;脊髓损伤;增强术后恢复

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Application of enhanced recovery after surgery in nursing of patients with thoracolumbar fracture with nerve injury

Objective To investigate the application of enhanced recovery after surgery (ERAS) in the nursing of thoracolumbar fracture with nerve injury. Methods A retrospective case-control study was conducted to analyze the clinical data of 64 patients with bilateral thoracolumbar fractures with nerve injury admitted to the Chongqing General Hospital from November 2013 to November 2017. There were 52 males and 12 females, aged 26-62 years, with an average age of 43 years. The injured segments were located at T11-T12 in 28 patients, T12-L1 in 15 patients, L1-L2 in 10 patients, and L2-L3 in 11 patients. According to the Frankel classification of neurological function, there were 14 patients at grade A, 18 at grade B, 24 at grade C and eight at grade D. All patients were treated with common pedicle screw placement under direct vision combined with dome shaped decompression through small incision. Among the patients, 32 received ERAS rehabilitation nursing (ERAS group) and 32 received routine rehabilitation nursing (routine group). The incidence of complications, hospitalization time, hospitalization expense, patients' satisfaction with nursing work, visual analogue scale (VAS), Oswestry dysfunction index (ODI) and Frankel classification of neurological function at 3 months after operation were compared between the two groups. Results The patients were followed up for 8-12 months [(10.2±1.3)months]. In the ERAS group, one patient had pulmonary infection; in the routine group one patient had wound infection, one had bedsore, and one had venous thrombosis in lower limb (P<0.01). The hospitalization time of ERAS group was significantly shorter than that of routine group [(9.3±1.2)days ∶ (15.6±1.8)days] (P<0.01). The hospitalization expense of ERAS group was significantly lower than that of routine group [(52±13)thousand yuan (RMB) vs. (63±17)thousand yuan (RMB)] (P<0.05). The satisfaction rates of ERAS group and routine group were 84% (27/32) and 56%(18/32), respectively (P<0.05). At 3 months after operation, the ERAS group had significantly lower VAS [(2.6±1.2)points vs. (3.8±1.5)points] and ODI (11.4±2.1)points vs. (15.8±2.5)points] than the routine group (P<0.05 or 0.01). At 3 months after operation, according to the Frankel grading, there was one patient at grade A, five at grade B, nine at grade C, five at grade D, and 12 at grade E in the ERAS group; while there were three patients at grade A, seven at grade B, seven at grade C, nine at grade D, and six at grade E. The recovery rate of Frankel grade 1 and/or above in ERAS group was significantly higher than that in routine group [97%(31/32) vs. 91%(29/32), P<0.05]. Conclusion Rehabilitation nursing measures of ERAS can help reduce perioperative complications, hospitalization time and hospitalization expenses, relieve pain, promote functional recovery, and gain satisfactory feedbacks from the patients. Key words: Rehabilitation nursing; Spinal fractures; Spinal cord injuries; Enhanced recovery after surgery

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中华创伤杂志

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期刊介绍： Chinese Journal of Trauma (International Standard Serial Publication Number: ISSN 1001-8050, Domestic Uniform Serial Publication Number: CN 50-1098/R) was founded in September 1985, which is the only high-level medical professional academic journal that can comprehensively and systematically reflect the achievements and development trends of China's traumatology medicine, and has a wide academic influence in China's traumatology medicine community. It has a wide range of academic influence in China's trauma medicine. Chinese Journal of Trauma is a source journal of China Science and Technology Paper Statistics, a source journal of China Science Citation Database (CSCD), a core journal of China Comprehensive Medicine and Health Care, a source journal of China Academic Journals Comprehensive Evaluation Database (CAJCED), a full-text journal of China Journal Full-text Database (CJFD), a core academic journal of China Center for Scientific Evaluation (RCCSE), a core academic journal of China Traumatology and Traumatology Center (CTC), a core academic journal of China Traumatology Center (RCCSE). RCCSE) core academic journals; Chinese Biomedical Journal Database (CMCC), Chinese Biomedical Journal Citation Database (CBJCED), China Journal Network (CJN), China Academic Journals (CD-ROM), Chinese Academic Journals Abstracts (Chinese Edition), Chemical Abstracts of the United States (CA), Index Copernicus of Poland (IC), and Japan Institute of Science and Technology Database (JICST), World Health Organization Western Pacific Region Medical Search (WPRIM) and Russian Journal of Abstracts (ΡЖ) included journals.