快速康复外科理念在老年全髋关节置换术患者围术期中的应用

目的探讨快速康复外科(fast track surgery,FTS)理念在老年全髋关节置换术(total hip arthroplasty,THA)患者围术期护理中的应用效果。方法按随机数字表法将2009年10月至2011年12月浙江省杭州市第一人民医院骨科收治的拟行THA的69例患者分为对照组36例和观察组33例,对照组采取常规围术期护理,观察组在对照组基础上将FST理念融入围术期护理,采用汉密尔顿焦虑量表(hamilton anxiety scale,HAMA)及疼痛视觉模拟评分法(visual analog scale,VAS)于术前1d及术后7d分别对患者进行测评,同时记录相关的生理指标。结果两组患者术前的HAMA评分、VAS评分、收缩压、舒张压和心率的差异均无统计学意义(均P>0.05);术后的HAMA评分、VAS评分、收缩压、舒张压和心率等均较术前有所下降(P<0.05或P<0.01);术后观察组的HAMA评分、VAS评分及心率较对照组下降更明显(P<0.05或P<0.01),但两组患者收缩压和舒张压的差异无统计学意义(P>0.05)。结论将FST理念应用于老年髋关节置换患者的围术期护理,有助于减轻患者围术期的焦虑程度,缓解其术后疼痛,同时能改善患者的血压和心率等生理指标,值得在临床推广应用。

Application of Fast Track Surgery Concept in Perioperative Nursing of Elderly Patients with Total Hip Arthroplasty

Objective To explore the effect of fast track surgery（FTS） concept on the perioperative nurs- ing of elderly patients with total hip arthroplasty（THA）. Methods From October 2009 to December 2011,69 THA patients in the hospital were divided into observational group（n=33）and control group （n=36）. The control group adopted the conventional perioperative nursing, while the observational group was implemented with FTS concept based on the conventional perioperative nursing. Afterwards,pain de- grees（visual analog scale, VAS）, anxious status （ Hamilton anxiety scale, HAMA）, and other physiological indicators of the two groups were compared at 1 d before operation and 7 d after operation. Results There was no significant difference in the HAMA and VAS scores, systolic blood pressure,diastolic blood pres- sure and heart rate between the two groups before operation（P〉0.05）. However,the scores of HAMA and VAS,systolic blood pressure, diastolic blood pressure and heart rate were significantly lessened after operation（P〈0.05 or P〈0.01）in the observational group. After operation, the VAS and HAMA scores and heart rate of the observational group were significantly lower than those of the control group（P〈0.01 or P〈0. 05） ,while no significant difference was observed in the systolic blood pressure and diastolic blood pressure between the two groups（P〉0.05）. Conclusion FST concept in the perioperative nursing of eld- erly THA patients helps to reduce the perioperative anxiety, relieve the postoperative pain and improve the patients＇ blood pressure and heart rate and other physiological indicators, which is worth further clinical application.