【摘要】：目的探討損害控制在90歲以上超高齡患者髖部骨折圍術(shù)期護(hù)理中的可行性與效果。方法對2010年1月至2014年12月該科收治的53例90歲以上髖部骨折患者實(shí)施手術(shù)損害控制(DCS)。采用改良生理學(xué)和手術(shù)嚴(yán)重性評分系統(tǒng)及大坪醫(yī)院骨科老年患者手術(shù)風(fēng)險(xiǎn)評分系統(tǒng)術(shù)前對患者進(jìn)行風(fēng)險(xiǎn)評估,患者均接受了1~4次風(fēng)險(xiǎn)評估。評估后35例患者72h內(nèi)手術(shù),為早期手術(shù)組;18例患者5~10d手術(shù),為延遲手術(shù)組。對兩組患者進(jìn)行分組護(hù)理,早期手術(shù)組采用第一時間的疼痛控制,醫(yī)護(hù)一體化的期望值管理,快速康復(fù)理念的功能鍛煉;延遲手術(shù)組采用多學(xué)科模式營養(yǎng)支持,積極的心肺功能鍛煉,力所能及的功能鍛煉。比較兩組患者術(shù)后住院時間、ICU住院時間、住院期間并發(fā)癥發(fā)生率,觀察分組護(hù)理的效果。結(jié)果兩組術(shù)后住院時間、術(shù)后ICU住院時間、住院期間并發(fā)癥發(fā)生率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。53例患者均達(dá)到了手術(shù)目的,出院前能借助助行器下床行走。結(jié)論對90歲以上髖部骨折患者在圍術(shù)期護(hù)理中實(shí)施手術(shù)損害控制是有效的。
[Abstract]:Objective to explore the feasibility and effect of damage control in perioperative nursing of hip fracture in patients over 90 years old. Methods from January 2010 to December 2014, 53 patients with hip fracture over 90 years old were treated with surgical damage control (DCS). The patients were evaluated before operation by using the modified physiological and surgical severity scoring system and the surgical risk scoring system of the elderly patients in the orthopedic department of Daping Hospital. All the patients received 1 or 4 risk assessments. After evaluation, 35 patients were operated within 72 hours, 18 patients in the early operation group and 18 patients in the early operation group were treated with delayed operation for 5 to 10 days. Two groups of patients were divided into two groups: the early operation group was treated with first-time pain control, the expectant value management of medical and nursing integration, the functional exercise of the concept of rapid rehabilitation, and the delayed operation group was supported by multi-disciplinary nutrition model. Active cardiopulmonary exercise, as far as possible. The length of stay in ICU and the incidence of complications during hospitalization were compared between the two groups, and the effect of group nursing was observed. Results there was no significant difference between the two groups in postoperative hospitalization time, postoperative ICU hospitalization time and the incidence of complications during hospitalization (P0.05). 53 patients achieved the purpose of operation, and could walk out of bed with a walking aid before discharge. Conclusion the perioperative nursing of hip fracture patients over 90 years old is effective.
【作者單位】： 第三軍醫(yī)大學(xué)大坪醫(yī)院野戰(zhàn)外科研究所關(guān)節(jié)四肢外科;
【分類號】：R473.6

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