快速康复围术期护理模式在老年髋部骨折患者中的应用

目的:探讨快速康复围术期护理模式在老年髋部骨折患者中的应用方法及效果。方法:将2018年2月1日~12月31日53例老年髋部骨折患者设为对照组,实施常规护理模式;将2019年1月1日~10月31日53例老年髋部骨折患者设为加速康复外科(ERAS)组,实施快速康复围术期护理模式。比较两组护理效果。结果:ERAS组术前等待时间、住院时间短于对照组(P<0.05),术后1、3、5 d疼痛评分低于对照组(P<0.05),术后1个月髋关节功能评分高于对照组(P<0.05),并发症发生率低于对照组(P<0.05)。结论:快速康复围术期护理模式可缩短老年髋部骨折患者的术前等待时间、住院时间,减轻疼痛,改善术后髋关节功能,降低并发症发生率。     

The impact of post-operative pain on outcomes following hip fracture

Untreated pain is a major health care issue and very little is known about the treatment of pain and the effect of pain on post-operative outcomes in older adults. This study was performed to identify the impact of pain on outcomes following hip fracture in older adults. Four hundred and eleven consecutive cognitively intact patients admitted with hip fracture to four New York hospitals were enrolled in a prospective cohort study. Patients were interviewed daily using standardized pain assessments. We used multiple logistic regression and ordinary least squares linear regression to examine the association of post-operative pain on immediate post-operative outcomes (duration of stay, physical therapy sessions missed or shortened, ambulation following surgery, and post-operative complications) and outcomes 6 months following fracture (locomotion, mortality, return to the community, residual pain). Patients with higher pain scores at rest had significantly longer hospital lengths of stay (P=0.03), were significantly more likely to have physical therapy sessions missed or shortened (P=0.002), were significantly less likely to be ambulating by post-operative day 3 (P<0.001), took significantly longer to ambulate past a bedside chair (P=0.01), and had significantly lower locomotion scores at 6 months (P=0.02). Pain at rest was not significantly associated with post-operative complications, nursing home placement, survival at 6 months, or residual pain at 6 months. Post-operative pain is associated with increased hospital length of stay, delayed ambulation, and long-term functional impairment. Whereas appropriate caution is warranted in administering opioid analgesics to older adults, these data suggest that improved pain control may decrease length of stay, enhance functional recovery, and improve long-term functional outcomes.     

Cognitive function and health-related quality of life after delirium in connection with hip surgery. A six-month follow-up

NEED: Delirium is a serious psychiatric disorder, and elderly patients who undergo hip surgery are at higher risk for delirium development. PURPOSE: The purpose was to compare change in cognitive function and health-related quality of life 6 months after hip surgery in patients who experienced postoperative delirium with those who did not. SAMPLE: A total of 115 patients 75 years or older were included. MEASURES: Screening for delirium was done using the Diagnostic and Statistical Manual, 4th ed criteria. Cognitive function was measured with the Mini Mental State Examination and health-related quality of life with the SF-36. RESULTS: Of the 115 patients, 32 became delirious during hospital stay (D group), whereas the remaining patients did not (NonD group). Both D and NonD groups scored lower on the Mini Mental State Examination at follow-up than during hospital stay, but the deterioration was significantly greater in the D group. At follow-up, health-related quality of life was improved in patients who were destined for hip replacement surgery but unchanged or impaired for those with hip fracture. Delirium onset in connection with hip fracture lowered the health-related quality of life even more. At follow-up, low cognitive function correlated with lower scoring in physical function. Greater knowledge about delirious patients' vulnerable positions related to lower cognition and life quality can improve rehabilitation and support for these patients.     

Out-of-hospital Auricular Acupressure in Elder Patients with Hip Fracture: A Randomized Double-Blinded Trial

Objectives: Auricular acupressure is known to decrease the level of anxiety in patients during ambulance transport. The purpose of this randomized, double‐blind, sham control study was to determine whether auricular acupressure can decrease not only the level of anxiety but also the level of pain in a group of elder patients with acute hip fracture. Methods: With the assistance of the Vienna Red Cross, 38 patients with acute hip fracture were enrolled into this study. Patients were randomized into two study groups: the true intervention group and the sham control group. Subjects in the true intervention group (n= 18) received bilateral auricular acupressure at three auricular acupressure points for hip pain. Patients in the sham group (n= 20) received bilateral auricular acupressure at sham points. Baseline demographic information, anxiety level, pain level, blood pressure, and heart rate were obtained before the administration of the appropriate acupressure intervention. The level of anxiety, level of pain, hemodynamic profiles, and level of satisfaction were reassessed once the patients arrived at the hospital. Results: Patients in the true intervention groups had less pain (F = 28, p = 0.0001) and anxiety (F = 4.3, p = 0.018) and lower heart rate (F = 18, p = 0.0001) on arrival at the hospital than did patients in the sham control group. As a result, the patients in the true intervention group reported higher satisfaction in the care they received during the ride to the hospital. Conclusions: The authors encourage physicians, health care providers, and emergency rescuers to learn this easy, noninvasive, and inexpensive technique for its effects in decreasing anxiety and pain during emergency transportation.     

不同时期体位管理在预防老年髋部骨折患者肺部感染中的应用效果

目的 探讨不同时期体位管理对老年髋部骨折患者肺部感染发生的预防效果.方法 选取我院2013年9月至2015年3月收治的髋部骨折行手术治疗的老年患者60例为对照组,采用骨科常规护理措施;选取我院2015年4月至2016年9月收治的髋部骨折行手术治疗的老年患者60例为干预组,在对照组基础上于不同时期采取相应的体位管理措施.对比分析两组患者围术期发生肺部感染情况.结果 干预组在CPIS评分、肺部感染率、满意度评分、康复知识测评均明显优于对照组,差异具有统计学意义(P<0.05);干预组在住院时间、术后发热天数、感染恢复时间均明显短于对照组,差异具有统计学意义(P<0.05).结论 对老年髋部骨折患者采取有效的体位管理,可减少患者围术期肺部感染的发生,缩短住院天数,减轻患者痛苦,降低因肺部感染导致的院内病死率,有效提高骨科整体护理水平,值得临床推广应用.     

Treatment of pain for older hip fracture patients across settings

PURPOSE: To examine the treatment of pain following hip fracture across settings (hospital to nursing home or rehabilitation facility). DESIGN: This was a secondary data analysis of two survey design studies that collected data on hip fracture patients in the hospital and for posthospital days at an institutional setting. SAMPLE: 115 subjects, 65 years or older, who had undergone surgical treatment of a hip fracture. METHODS: Medical records were reviewed to compare the amount of pain medication administered to postoperative hip fracture elders during the last 24 hours in the hospital with that of the first 24 hours in the nursing home (NH). FINDINGS: The mean length of stay following surgery was 4.8 days. Subjects received significantly less medication during the first 24 hours in the NH as compared with the last 24 hours of hospitalization. Over one third (37.4%) of the subjects received no opioid analgesic and 18.3% (n = 21) received no analgesic of any kind during the first 24 hours of NH stay. IMPLICATIONS: Rather than simply listing medications orders, hospital nursing staff should communicate type, amount, frequency and efficacy of pain medication in transfer notes to nursing home staff. Nursing home staff would benefit from postoperative pain management education.     

Transcutaneous electrical nerve stimulation for postlaparotomy pain

This study was designed to evaluate the transcutaneous electrical nerve stimulation (TENS) postoperative program administered by a physical therapy department. A surgeon, a physical therapist, a recovery room nurse, and unit nurses participated in the program which included preoperative evaluation and patient education, application of sterile electrodes parallel to the incision in the operating room, TENS activation in the recovery room, follow-up visits, and data collection. Seventy-five patients who underwent laparotomy and received TENS at the most comfortable machine settings were compared by chart review to 75 patients who had undergone similar surgical procedures performed by the same surgeon before TENS postoperative pain management had been instituted. The TENS was applied for an average of five days; machine settings of intensity, frequency, and pulse width tended to be midrange. The TENS group took significantly less pain medication, but the length of hospital stay was not significantly different. Patients with TENS rated their pain on 10-point scales as more intense than uncomfortable. This study demonstrated that a well-structured interdisciplinary program of postoperative TENS management can reduce the amount of pain medication taken by patients after laparotomy.     

动力髋螺钉、股骨近端防旋髓内钉及人工髋关节置换修复老年股骨转子间骨折

背景：有研究认为对于不稳定型股骨转子间骨折并有严重疏松且不能耐受关节置换的患者,髓内固定为首选;对于高龄不稳定骨折,严重骨质疏松,术前可行走,能耐受一次较大手术者可首选人工股骨头置换;而对骨折稳定、骨质疏松不严重、身体状况较好者也可选用动力髋螺钉髓外固定.目的：对比分析动力髋螺钉、股骨近端防旋髓内钉及人工髋关节置换不同植入物修复老年股骨转子间骨折的临床效果.方法：将120例股骨转子间骨折老年患者随机分为动力髋螺钉组、股骨近端防旋髓内钉组和人工髋关节组,其中动力髋螺钉组45例,股骨近端防旋髓内钉组40例,人工髋关节组35例,对3组患者的术中出血量、手术时间、住院时间以及住院期间并发症和治疗优良率等指标进行对比观察.结果与结论：股骨近端防旋髓内钉组的手术时间、术中出血量以及治疗优良率均明显优于其他两组,差异有显著性意义（P＜0.05）.此外,股骨近端防旋髓内钉组住院期间并发症也明显少于其他两组,差异有显著性意义（P＜0.05）.提示股骨近端防旋髓内钉修复老年股骨转子间骨折的临床效果明显优于动力髋螺钉和人工髋关节置换,具有术中出血量少、手术时间短、治愈率高等优点,并能显著改善患者的生活质量.     

Pre-operative and post-operative effect of a pain management programme prior to total hip replacement: a randomized controlled trial

Patients may wait some time for total hip replacement with conservative management of pain and disability, but no attempts to rehabilitate them. This study randomised 40 patients accepted for and awaiting total hip replacement to a brief rehabilitative psychologically based pain management programme (PMP) or to a control group with no intervention. Patients were assessed before randomisation, 3 months after the PMP or equivalent waiting time, and again one year later after total hip replacement. Assessments included pain, impact of pain (Arthritis Impact Scale: AIMS), mobility (timed walk), sleep and analgesic consumption. The patients who had learned pain management reported lower pain intensity and pain distress and less sleep disturbance than waiting list controls, but no improvement in function or analgesic consumption. Six patients opted to delay, but this did not differ between groups. Post-hip replacement both groups improved in pain and some aspects of activity (AIMS) with greater improvement in the PMP group for physical activity and total AIMS scores, suggesting that some techniques had continued to be of use post-surgically. Rehabilitative pain management may be useful to patients pre-operatively in managing everyday pain, but not to the extent that they opt to delay surgery; it may also improve their function after hip replacement.     

基于FTS理念的预见性护理在老年股骨颈骨折患者中的应用效果

目的 探讨基于加速康复外科（FTS）理念的预见性护理在老年股骨颈骨折患者中的应用效果。方法 选取2017年1月至2018年4月我院收治的78例老年股骨颈骨折患者作为研究对象,按照随机数字表法将其分为对照组与观察组,各39例。对照组实施常规护理,观察组实施基于FTS理念的预见性护理。比较两组的疼痛程度、焦虑状态、髋关节功能、不良事件发生情况、护理满意度、临床指标。结果 术后72 h,观察组的VAS、SAS评分低于对照组（P<0.05）。术后6个月,观察组的Harris评分高于对照组（P<0.05）。观察组的不良事件总发生率低于对照组（P<0.05）。观察组的护理满意度高于对照组（P<0.05）。观察组的手术时间、骨折愈合时间、住院时间短于对照组（P<0.05）。结论 基于FTS理念的预见性护理可缓解老年股骨颈骨折患者的疼痛程度,改善焦虑状态及髋关节功能,减少不良事件的发生,提高护理满意度,改善临床指标。     

人工股骨头置换术与股骨近端抗旋髓内钉内固定术治疗高龄不稳定型股骨转子间骨折的疗效比较

[目的]比较人工股骨头置换术(AFHR)和股骨近端抗旋髓内钉(PFNA)内固定术治疗高龄不稳定型股骨转子间骨折的临床疗效.[方法]回顾性分析2008年5月至2012年1月本院62例AFHR(A组,n=32)和PFNA(B组,n=30)治疗的高龄不稳定性转子间骨折患者临床资料.比较两组手术时间、术中出血量、首次下地负重时间、住院时间、围手术期并发症的发生情况及随访术后100 d时的患肢髋关节功能Harris评分结果.[结果]A组手术时间和术中出血量均高于B组,而首次下地负重时间和住院时间短于B组,且差异有统计学意义(P＜0.05),组间并发症发生率差异无统计学意义(P＞0.05).A组的Harris评分明显优于B组(P＜0.05).[结论]人工股骨头置换术治疗高龄患者不稳定性股骨转子间骨折,住院时间短、患者首次负重锻炼早,可迅速明显改善患者的近期生活质量,是一种值得推广的有效治疗手段.     

骨水泥型与生物型假体髋关节置换术治疗老年股骨颈骨折疗效研究

目的探讨骨水泥型与生物型假体髋关节置换术治疗不稳定型老年股骨颈骨折的疗效。方法于2013年1月至2015年1月在选择初次接受全髋关节置换手术的不稳定型老年股骨颈骨折患者60例,随机分为骨水泥型组和生物型假体组,各30例,分别行相应假体髋关节置换术,术后随访6个月。比较两组患者手术时间、术中出血量、住院天数、术后并发症发生情况、术后髋关节脱位发生情况和髋关节Harris评分。结果骨水泥型组和生物型组手术时间、术中出血量比较差异无统计学意义(P0.05),骨水泥型组住院时间短于生物型组(P0.05)。骨水泥型组术后并发症总发生率高于生物型组(P0.05)。术后1个月和6个月时,两组患者均出现髋关节脱位的情况。术后1个月和6个月时,骨水泥型组Harris评分高于生物型组(P0.05)。结论与生物型假体髋关节置换术相比,骨水泥型假体髋关节置换术不增加手术时间和术中出血量,患者住院时间更短,在改善患者术后早期髋关节功能方面有重要作用,但更易发生并发症。     

A randomized controlled trial of oxygen for reducing nausea and vomiting during emergency transport of patients older than 60 years with minor trauma.

OBJECTIVE: To test the hypothesis that oxygen administration reduces nausea and vomiting in patients with minor trauma during ambulance transport. PATIENTS AND METHODS: This study, conducted from January to April 2000, consisted of 100 patients older than 60 years with minor trauma, who were randomly assigned to breathe air or 100% oxygen at 10 L/min through a facemask during ambulance transport. A paramedic, blinded to treatment, recorded vomiting episodes during transport. Patients, also blinded to treatment, rated their levels of pain, nausea, vomiting, anxiety, and overall satisfaction with their care on 100-mm visual analog scales, with greater values indicating more intense sensation. Results from the 2 groups were compared with chi2 or unpaired 2-tailed t tests and presented as means +/- SDs. RESULTS: Before randomization, patients subsequently assigned to receive oxygen had significantly greater pain and nausea. On arrival at the hospital, oxygen saturation was higher in the 50 patients given oxygen (99% +/- 1 % vs 96% +/- 2%; P<.001) than in the 50 patients who breathed air. Reported pain remained greater in the oxygen group. However, those given oxygen had less nausea (22 +/- 29 vs 54 +/- 38 mm; P<.001) and vomiting (4 vs 19 episodes; P<.001), lower heart rates (86 +/- 12 vs 94 +/- 13 beats/min; P<.001), and higher overall satisfaction scores (54 +/- 33 vs 33 +/- 23 mm; P<.001). CONCLUSION: Our results indicate that supplemental oxygen during ambulance transport reduced nausea scores by 50% and decreased vomiting 4-fold. Consequently, patients reported greater satisfaction with their care. Thus, we recommend that patients be given supplemental oxygen during ambulance transport.     

Gender differences in post-operative pain and patient controlled analgesia use among adolescent surgical patients

The aim of this study was to explore gender differences in anticipatory emotional distress, coping strategies, post-operative pain perception, and patient-controlled analgesia (PCA) use among adolescent surgical patients. One hundred and two 12-18-year-old adolescents undergoing surgeries with overnight hospital stay were recruited. Participants completed pre-operative measures of anxiety and anticipated pain. Post-operatively, they reported on coping skills, post-operative anxiety, and pain. Data on PCA use were recorded from medical records. Girls reported higher levels of pre-operative state anxiety and anticipated more pain. After surgery, girls and boys differed on their lowest daily pain ratings and average daily pain ratings, with girls reporting more pain in both cases. Reports of highest daily pain were similar across genders. Gender was found to moderate the relationship between anticipatory distress and post-operative pain, such that higher anticipatory distress before surgery predicted more post-operative pain for girls, but not for boys. Patterns of PCA use did not vary by gender on post-operative days 0 or 1. Findings suggest that adolescent boys' and girls' pain experiences are different in several important respects, although somewhat less divergent than has been reported in samples of adult males and females. Results have implications for the development of targeted intervention strategies to help adolescents cope effectively with acute post-operative pain.     

股骨近端锁定钢板与PFNA治疗股骨近端骨折的临床效果比较

目的 比较股骨近端锁定钢板与股骨近端防旋髓内钉(PFNA)治疗股骨近端骨折的临床效果.方法 选取2017年1月至2021年1月收治的78例股骨近端骨折患者作为研究对象,遵循随机原则将其分为对照组(n=39)与研究组(n=39).对照组开展股骨近端锁定钢板治疗,研究组开展PFNA治疗.比较两组的临床疗效、手术情况、术后康...     

全髋关节置换与人工股骨头置换修复老年股骨颈骨折：18个月随访比较

背景：老年股骨颈骨折患者行人工髋关节置换治疗,关于选择全髋关节置换还是人工股骨头置换目前仍存在争议。目的：比较人工股骨头置换与全髋关节置换修复老年人股骨颈骨折后18个月的随访结果。方法：纳入行人工髋关节置换的股骨颈骨折患者70例,男17例,女53例,年龄60-83岁,均为GardenⅢ型,Ⅳ型患者。根据置换方式分为两组,股骨头置换组39例,全髋关节置换组31例,两组患者性别、年龄、骨折分型及合并疾病构成上差异无显著性意义,具有可比性。X射线观察两组患者关节置换效果,综合比较两组患者术中输血量、术中失血量、术后引流量、手术时间、住院时间及置换后髋关节功能。结果与结论：经18个月随访,两组患者X射线显示股骨颈骨折均复位固定良好,假体位置良好。两组患者住院时间和术后引流量比较差异无显著性意义（P〉0.05）;两组患者术中输血量、失血量及手术时间比较,股骨头置换组优于全髋关节置换组（P〈0.05）;全髋关节置换组的髋关节功能恢复优良率显著高于股骨头置换组（P〈0.05）。提示老年股骨颈骨折行全髋关节置换后关节功能恢复较好,远期并发症较低,是老年人股骨颈骨折的首选治疗方法;人工股骨头置换具有手术时间短、出血少及输血量少等优点,适合身体状况差、活动量小及受伤前患肢已有功能障碍的高龄患者。     

骨折联络服务理念在老年骨质疏松性髋部骨折术后患者中的应用效果

目的观察骨折联络服务(FLS)理念在老年骨质疏松性髋部骨折术后患者中的应用效果。方法选取2018年1月至2020年1月我院收治的108例老年骨质疏松性髋部骨折患者作为研究对象,按照入院日单双号分为对照组(单号入院,65例)及观察组(双号入院,43例)。对照组采用传统的术后康复管理,观察组采用FLS理念术后康复管理。比较两组患者随访失约次数、服药依从性、疼痛评分、骨质疏松相关知识知晓情况、患髋关节功能、二次骨折发生率及随访满意度。结果观察组随访失约次数少于对照组(P<0.05);观察组服药依从性高于对照组(P<0.05)。观察组出院时、出院1、3个月疼痛评分均低于对照组(P<0.05)。观察组骨质疏松相关知识知晓情况、出院半年患髋关节功能优于对照组(P<0.05)。随访期间,两组患者均未发生二次骨折。观察组随访满意度高于对照组(P<0.05)。结论FLS术后康复管理应用于老年骨质疏松性髋部骨折术后患者中,可减少随访失约次数,提高患者服药依从性,减轻术后疼痛,改善患者对骨质疏松相关知识知晓情况及患髋关节功能,避免二次骨折的发生,提高患者满意度。     

人工髋关节置换术在高龄股骨颈骨折治疗中的应用效果

目的观察分析实施人工髋关节置换术治疗高龄股骨颈骨折的临床效果。方法从该院2008年4月至2011年6月收治入院的股骨颈骨折高龄患者中抽取86例,随机分为A组与B组,A组患者实施人工股骨头置换术,B组患者实施人工全髋置换术,对比观察两组患者手术情况及临床疗效。结果A组患者手术时间、术中出血量、术后下床时间明显少于B组,术后Harris评分优良率低于B组,差异均有统计学意义（P〈0．05）。结论对高龄股骨颈骨折患者实施各种人工髋关节置换术,均具有理想的临床疗效,可根据患者情况综合考虑选择适宜术式,机体调节功能较差、手术耐受性较低的患者尤为适用人工股骨头置换术进行治疗。