基于4R危机管理快速康复模式在老年脊柱结核术后并发认知障碍患者中的应用价值

选择解放军总医院第八医学中心骨科2019年2月至2021年12月收治的128例老年脊柱结核手术患者。其中,2019年2月至2020年5月就诊的68例患者术后实施的是常规护理;2020年6月至2021年12月就诊的60例患者术后实施的是基于4R危机管理快速康复模式。通过随机抽签法,从两组中各抽取40例患者作为对照组和观察组。观察组术后无突发事件和术后并发症,对照组术后4例(10.0%)发生不良事件,6例(15.0%)出现并发症,差异均有统计学意义(χ²=4.211,P=0.040;χ²=6.486,P=0.001)。观察组术后第3天、术后第1周、术后第2周的认知功能障碍评分为(26.90±0.58)分、(26.72±0.55)分和(26.57±0.54)分,均低于对照组[分别为(27.12±0.60)分、(27.02±0.57)分和(26.95±0.50)分],差异均有统计学意义(t=1.702,P=0.047;t=2.441,P=0.008;t=3.221,P<0.001)。术后第2周观察组躯体活动具有独立步行能力者29例(72.5%),多于对照组的19例(47.5%),差异有统计学意义(Z=-2.467,P=0.014)。术后观察组住院时间为(14.55±0.67)d,明显少于对照组的(15.02±0.82)d,差异有统计学意义(t=2.836,P=0.003)。研究认为,对于脊柱结核术后伴认知障碍的老年患者,实施4R危机管理快速康复模式可提高临床护理安全性,减少术后并发症发生,有利于患者术后的康复。

Application value of rapid rehabilitation model based on 4R crisis management in elderly patients with cognitive impairment after spinal tuberculosis surgery

A total of 128 patients undergoing spinal tuberculosis surgery admitted to the Department of Orthopedics, 8th Medical Center, PLA General Hospital, from February 2019 to December 2021 were selected. Routine nursing was performed in 68 cases of the above patients from February 2019 to May 2020, of the other 60 patients admitted from June 2020 to December 2021 were treated with rapid rehabilitation mode based on 4R crisis management after surgery. By random drawing, 40 patients were selected from the each of the two groups as control group and observation group. No emergencies or postoperative complications were found in observation group; while in the control group, 4 cases (10.0%) suffered adverse events and 6 cases (15.0%) had complications, the differences was statistically significant (χ²=4.211, P=0.040; χ²=6.486, P=0.001). The cognitive impairment scores on the third day, the first week and the second week after operation of the observation group were significantly lower than those of the control group (26.90±0.58 vs. 27.12±0.60, t=1.702, P=0.047; 26.72±0.55 vs. 27.02±0.57, t=2.441, P=0.008; 26.57±0.54 vs. 26.95±0.50, t=3.221, P<0.001, respectively). Twenty-nine patients (72.5%) had the independent walking physical activity of independent walking ability after surgery in the observation group, significantly more than that in the control group (19 patients, 47.5%)(Z=-2.467, P=0.014). In the observation group, the postoperative hospitalization time was (14.55±0.67) d, significantly shorter than that in the control group ((15.02±0.82) d, t=2.836, P=0.003). Therefore, for the elderly patients with cognitive impairment after spinal tuberculosis surgery, the implementation of 4R crisis management rapid rehabilitation mode could improve the safety of clinical nursing, reduce the occurrence of postoperative complications, and is helpful to the postoperative rehabilitation of patients.