【摘要】：目的制定斷指再植患者延續(xù)性康復(fù)護(hù)理指導(dǎo)標(biāo)準(zhǔn),為斷指再植患者的出院指導(dǎo)和手功能康復(fù)訓(xùn)練提供科學(xué)的規(guī)范和流程;建立衛(wèi)星式斷指再植患者出院后復(fù)診聯(lián)絡(luò)點(diǎn),為患者提供就近復(fù)診醫(yī)院,保證出院后康復(fù)訓(xùn)練科學(xué)有效;探討延續(xù)性康復(fù)護(hù)理在斷指再植患者中的應(yīng)用效果,促進(jìn)斷指再植患者手功能康復(fù)。方法1.斷指再植患者出院指導(dǎo)及分階段康復(fù)訓(xùn)練標(biāo)準(zhǔn)的制定與改進(jìn):通過文獻(xiàn)篩選和半結(jié)構(gòu)化訪談初步擬定斷指再植患者出院指導(dǎo)標(biāo)準(zhǔn)和分階段康復(fù)訓(xùn)練標(biāo)準(zhǔn)的備選方案,邀請(qǐng)15名手外科專家運(yùn)用德爾菲法經(jīng)過兩輪專家函詢最終確定斷指再植患者出院指導(dǎo)及分階段康復(fù)訓(xùn)練標(biāo)準(zhǔn);利用以往在我院手外科進(jìn)修學(xué)習(xí)的醫(yī)生和護(hù)士及其所在醫(yī)療單位建立全國(guó)衛(wèi)星式斷指再植出院患者復(fù)診聯(lián)絡(luò)點(diǎn),便于出院后居住地距離本院較遠(yuǎn)的患者就近復(fù)診;建立斷指再植患者出院隨訪及復(fù)診數(shù)據(jù)庫。2.臨床應(yīng)用研究:成立延續(xù)性康復(fù)護(hù)理研究小組,將2016年1~6月在我院手外科行斷指再植手術(shù)的380例患者根據(jù)住院號(hào)尾數(shù)的奇偶分為觀察組和對(duì)照組,奇數(shù)為觀察組181例,偶數(shù)為對(duì)照組199例。在兩組患者出院前3天填寫出院患者信息調(diào)查表,組織出院患者進(jìn)行出院前指導(dǎo),建立患者信息數(shù)據(jù)庫,對(duì)照組患者出院后自行進(jìn)行康復(fù)訓(xùn)練,定期返院復(fù)診,觀察組患者出院后進(jìn)行延續(xù)性康復(fù)護(hù)理隨訪干預(yù),電話隨訪與復(fù)診干預(yù)交叉進(jìn)行,患者出院后2周、2個(gè)月、5個(gè)月時(shí)電話隨訪,出院后1個(gè)月、3個(gè)月、6個(gè)月時(shí)到本院或就近衛(wèi)星醫(yī)院復(fù)診聯(lián)絡(luò)點(diǎn)進(jìn)行康復(fù)護(hù)理干預(yù)。對(duì)兩組患者出院后復(fù)診情況進(jìn)行比較,并對(duì)兩組患者出院時(shí)、出院后1個(gè)月和6個(gè)月患者康復(fù)依從性、日常生活能力及手功能康復(fù)情況進(jìn)行評(píng)定。結(jié)果在出院后三次復(fù)診中觀察組181例患者有6例出現(xiàn)缺診情況,復(fù)診率為96.69%,最終獲得175例完整數(shù)據(jù);對(duì)照組199例患者有49例出現(xiàn)缺診情況,復(fù)診率為75.38%,最終獲得150例完整數(shù)據(jù);觀察組患者復(fù)診率高于對(duì)照組(P0.01),差異具有統(tǒng)計(jì)學(xué)意義。出院時(shí)兩組患者康復(fù)依從性、日常生活能力評(píng)分及手功能評(píng)分無差異(P0.05),出院后1個(gè)月和6個(gè)月觀察組患者康復(fù)依從性、日常生活能力評(píng)分和手功能評(píng)分優(yōu)于對(duì)照組(P0.05),差異具有統(tǒng)計(jì)學(xué)意義,且隨著出院時(shí)間延長(zhǎng),兩組患者日常生活能力評(píng)分和手功能評(píng)分逐漸提高。結(jié)論1.延續(xù)性康復(fù)護(hù)理出院指導(dǎo)標(biāo)準(zhǔn)和分階段康復(fù)訓(xùn)練標(biāo)準(zhǔn)為康復(fù)指導(dǎo)者和患者提供了科學(xué)規(guī)范的操作流程,為出院后斷指再植患者康復(fù)訓(xùn)練提供了保證。2.衛(wèi)星式斷指再植患者復(fù)診聯(lián)絡(luò)點(diǎn)為出院患者提供就近復(fù)診醫(yī)院,對(duì)康復(fù)訓(xùn)練進(jìn)行及時(shí)的評(píng)估與指導(dǎo),提高了患者康復(fù)依從性和科學(xué)性,減輕患者經(jīng)濟(jì)負(fù)擔(dān)。3.延續(xù)性康復(fù)護(hù)理為出院后斷指再植患者提供規(guī)范的康復(fù)訓(xùn)練標(biāo)準(zhǔn),提高患者訓(xùn)練依從性,促進(jìn)手功能盡快恢復(fù),使患者早日回歸社會(huì),值得臨床推廣應(yīng)用。
[Abstract]:Objective to establish the guidance standard of continuous rehabilitation nursing for patients with replantation of severed finger, to provide scientific norms and procedures for discharge guidance and rehabilitation training of hand function for patients with replantation of severed finger, and to establish a focal point for rediagnosis after discharge of satellite replantation of severed finger, so as to provide patients with a nearby revisit hospital and ensure that rehabilitation training after discharge can be scientific and effective. To explore the application effect of continuous rehabilitation nursing in patients with replantation of severed fingers and to promote the rehabilitation of hand function in patients with replantation of severed fingers. Method 1. The formulation and improvement of discharge guidance and phased rehabilitation training criteria for patients with severed finger replantation: through literature screening and semi-structured interview, the criteria for discharge guidance and phased rehabilitation training for patients with severed finger replantation were preliminarily worked out, and 15 hand surgical experts were invited to determine the discharge guidance and phased rehabilitation training criteria for patients with replantation of severed fingers through two rounds of expert correspondence. Using the doctors and nurses who studied in hand surgery in our hospital in the past and their medical units, a national focal point for the rediagnosis of patients discharged from satellite replantation of severed fingers was established, which was convenient for the patients whose residence was far from our hospital to revisit the hospital after discharge, and to establish a database of follow-up and rediagnosis of patients with replicating severed fingers. 2. Clinical application study: a continuous rehabilitation nursing research group was set up. 380 patients undergoing replantation of severed fingers in our hospital from January to June 2016 were divided into observation group and control group according to the parity of the number of hospitalization numbers. 181 patients in the observation group and 199 patients in the control group were divided into observation group (181 cases) and even number 199 cases (control group). Three days before discharge, the patients in the two groups filled out the information questionnaire, organized the discharged patients to guide them before discharge, and established the patient information database. The patients in the control group were given rehabilitation training after discharge and returned to the hospital regularly for follow-up. The patients in the observation group were followed up by continuous rehabilitation nursing after discharge, and telephone follow-up and follow-up were carried out at 2 weeks, 2 months and 5 months after discharge. One month, three months and six months after discharge, they went to our hospital or the revisit contact point of the nearest satellite hospital to carry out rehabilitation nursing intervention. The revisit of the two groups after discharge was compared, and the rehabilitation compliance, daily living ability and hand function rehabilitation of the two groups were evaluated at 1 month and 6 months after discharge. Results among 181 patients in the observation group, 6 patients had missed diagnosis, the rediagnosis rate was 96.69%, and 175 complete data were finally obtained, while 49 patients in the control group had absence, the rediagnosis rate was 75.38%, and 150 patients in the observation group had complete data. The rediagnosis rate in the observation group was higher than that in the control group (P 0.01), and the difference was statistically significant. There was no significant difference in rehabilitation compliance, ability of daily living score and hand function score between the two groups at discharge (P 0.05). 1 month and 6 months after discharge, the rehabilitation compliance, daily living ability score and hand function score of the observation group were better than those of the control group (P 0.05). The difference was statistically significant. With the prolongation of discharge time, the daily living ability score and hand function score of the two groups increased gradually. Conclusion 1. The continuous rehabilitation nursing discharge guidance standard and the phased rehabilitation training standard provide the scientific and standardized operation flow for the rehabilitation instructor and the patient, and provide the guarantee for the rehabilitation training of the severed finger replicating patients after discharge. 2. Satellite replantation of severed finger can provide the nearest revisit hospital for discharged patients, evaluate and guide the rehabilitation training in time, improve the compliance and science of patients' rehabilitation, and reduce the economic burden of patients. 3. Continuous rehabilitation nursing provides a standard of rehabilitation training for patients with replantation of severed fingers after discharge, improves the compliance of patients' training, promotes the recovery of hand function as soon as possible, and makes patients return to society as soon as possible, which is worth popularizing and applying in clinic.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.6

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