血友病性骨关节病患者关节置换术围术期管理策略的应用效果研究
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摘要
目的:分析血友病性骨关节病患者围术期护理问题,通过安全管理及康复管理,有效保障患者安全,改善关节功能。方法:便利选取2013年1月至2016年12月因血友病性骨关节病住院行膝关节置换术患者152例为研究对象。2015年1月至2016年12月患者为实验组,2013年1月至2014年12月患者为对照组。实验组从安全管理(精准完成预试验、形成手术室人员接血友病患者流程、预防出血)及康复管理(三期功能锻炼)对患者进行管理;对照组参考常规膝关节置换术患者护理常规对患者进行护理。比较两组患者出血发生率、美国特种外科医院膝关节评分(HSS评分)及膝关节活动度。结果:实验组患者术后出血发生率(5.00%)明显低于对照组(15.07%),差异具有统计学意义(P<0.05);实验组患者HSS评分(88.84±9.89)分明显高于对照组的(82.17±8.58)分,差异具有统计学意义(P<0.05);实验组患者膝关节活动度(90.93±6.21)度明显高于对照组的(77.99±9.71)度,差异具有统计学意义(P<0.05)。结论:通过对血友病性骨关节病患者进行安全管理及康复管理,可保障患者安全,减少出血发生率,显著改善患者膝关节功能,值得在临床中推广。
Objective: To evaluate the effectiveness of safety management and rehabilitation management of patients with hemophiliac osteoarthrosis. Methods: Totally 152 patients with hemophilic osteoarthrosis for knee replacement were included. Patients enrolled from 2013 to 2014 were included in the control group, while patients enrolled from 2015 to 2016 were included in the experiment group. The patients in the experiment group received safety management and rehabilitation management. The control group received nursing care from patients with conventional knee arthroplasty.The bleeding incidence, HSS score and knee range were compared between the two groups. Results: The incidence of postoperative bleeding in the experimental group was significantly lower than that in the control group(P<0.05). The HSS score of the experimental group was significantly higher than that of the control group(P<0.05). The knee joint activity of the experimental group(90.93±6.21) was significantly higher than that of the control group(P<0.05). Conclusion: The safety management and rehabilitation management of hemophiliac osteoarthrosis patients can enhance the safety of patients, reduce the incidence of bleeding and improve the knee function of patients.
Objective: To evaluate the effectiveness of safety management and rehabilitation management of patients with hemophiliac osteoarthrosis. Methods: Totally 152 patients with hemophilic osteoarthrosis for knee replacement were included. Patients enrolled from 2013 to 2014 were included in the control group, while patients enrolled from 2015 to 2016 were included in the experiment group. The patients in the experiment group received safety management and rehabilitation management. The control group received nursing care from patients with conventional knee arthroplasty.The bleeding incidence, HSS score and knee range were compared between the two groups. Results: The incidence of postoperative bleeding in the experimental group was significantly lower than that in the control group(P<0.05). The HSS score of the experimental group was significantly higher than that of the control group(P<0.05). The knee joint activity of the experimental group(90.93±6.21) was significantly higher than that of the control group(P<0.05). Conclusion: The safety management and rehabilitation management of hemophiliac osteoarthrosis patients can enhance the safety of patients, reduce the incidence of bleeding and improve the knee function of patients.
引文
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[2]Mortazavi SM,Haghpanah B,Ebrahiminasab MM,et al.Functional outcome of total knee arthroplasty in patients with heamophilia.Heamophilia,2016,22(6):919-924.
[3]冯宾,翁习生,林进,等.血友病性骨关节病变的外科治疗策略.中华骨科杂志,2016,36(7):413-421.Feng B,Weng XS,Lin J,et al.Surgical treatment in heamophilic patients with musculoskeletal disorder.Chin J Orthop,2016,36(7):413-421.
[4]中国血友病协作组中华医学会血液学分会血栓与止血学组.血友病诊断与治疗中国专家共识(2017年版).中华血液学杂志,2017,38(5):364-370.Thrombosis and Hemostasis Group.Hematology Society of Chinese Medical Association.Hemophilia Treatment Center Collaborative Network of China.Consensus of Chinese expert on the diagnosis and treatment of hemophilia(version 2017).Chin J Hematol,2017,38(5):364-370.
[5]王学锋,冯建民,孙竞,等.中国血友病骨科手术围术期处理专家共识.中华骨与关节外科杂志,2016,9(5):361-370.Wang XF,Feng JM,Sun J,et al.Expert consensus in perioperative management in hemophilia patients undergoing orthopedic surgery in China.Chinese Journal of Bone and Joint Surgery,2016,9(5):361-370.
[6]Kubes R,Salaj P,Hromadka R,et al.Range of motion after total knee arthroplasty in hemophilic arthropathy.BMC Musculoskelet Disord,2018,19(1):162.
[7]周宗科,翁习生,曲铁兵,等.中国髋、膝关节置换术加速康复--围术期管理策略专家共识.中华骨与关节外科杂志,2016,9(1):1-9.Zhou ZK,Weng XS,Qu TB,et al.Expert consensus in enhanced recovery after total hip and knee arthroplasty in China:perioperative management.Chinese Journal of Bone and Joint Surgery,2016,9(1):1-9.
[8]Ranawat CS,Shine JJ.Duocondylar total knee arthroplasty.Clin Orthop Relat Res,1973(94):185-195.
[9]Srivastava A,Brewer AK,Mauser-Bunschoten EP,et al.Guidelines for the management of hemophilia.Haemophilia,2013,19(1):e1-e47.