基于加速康复外科理念的术前护理干预模式在老年腰椎管狭窄症手术患者中的应用研究

  目的  研究基于加速康复外科理念的术前护理干预对老年腰椎管狭窄症患者睡眠质量、焦虑情绪及术后并发症的影响。  方法  选取蚌埠医学院第一附属医院2017年7月—2019年6月因腰椎管狭窄症行腰椎手术的102例65岁以上患者，按随机数字表法分为对照组(51例)与观察组(51例)。对照组实施医院骨科常规护理，观察组实施基于加速康复外科理念的术前护理干预措施。比较2组患者护理干预前后睡眠质量、焦虑情绪、术后并发症及护理满意度的差异。  结果  干预前2组患者一般资料、焦虑情绪及睡眠质量比较差异无统计学意义(均P>0.05)。干预后，观察组匹兹堡睡眠质量指数量表得分为(6.20±1.60)分，对照组得分为(13.35±2.27)分，组间差异有统计学意义(t=18.402，P < 0.001)；观察组焦虑自评量表得分为(38.42±8.99)分，对照组得分为(44.63±8.92)分，组间差异有统计学意义(t=3.505，P=0.001)；观察组术后并发症发生率(5.88%)低于对照组(19.61%，χ2=4.320，P=0.038)；观察组护理总满意率为96.08%，对照组为80.39%，组间差异有统计学意义(χ2=15.389，P < 0.001)。  结论  基于加速康复外科理念的术前护理干预模式应用于老年腰椎管狭窄症疾病中，能有效提高患者睡眠质量，改善患者焦虑情绪，降低术后并发症发生率，同时能提升患者对医疗服务及质量的满意度。 

Application of preoperative nursing intervention mode based on the concept of enhanced recovery after surgery in elderly patients with lumbar spinal stenosis

  Objective  To study the effects of preoperative nursing intervention based on the concept of enhanced recovery after surgery on sleep quality, anxiety and postoperative complications in elderly patients with lumbar spinal stenosis.  Methods  The clinical data of 102 patients (age>65 years) who underwent lumbar spinal surgery due to lumbar spinal stenosis from July 2017 to June 2019 in the First Affiliated Hospital of Bengbu Medical College were randomly divided into the control group (n=51) and experimental group (n=51). The control group received routine orthopaedic care in the hospital, whilst the experimental group received preoperative nursing interventions based on the concept of accelerated rehabilitation surgery. The differences in sleep quality, anxiety, postoperative complications and nursing satisfaction between the two groups before and after nursing intervention were compared.  Results  No significant differences were found in the general information, anxiety and sleep quality between the two groups before intervention (all P>0.05). After intervention, the Pittsburgh Sleep Quality Index scores in the experimental group and the control group were (6.20±1.60) points and (13.35±2.27) points, respectively, and the difference between groups was statistically significant (t=18.402, P < 0.001). The scores of the self-rating anxiety scale were (38.42±8.99) points in the experimental group and (44.63±8.92) points in the control group, with statistically significant difference between groups (t=3.505, P=0.001). The incidence of postoperative complications in the experimental group (5.88%) was significantly lower than that in the control group (19.61%), and the difference between groups was significant (χ2=4.320, P=0.038). The nursing satisfaction was 96.08% in the experimental group and 80.39% in the control group, and the difference between groups was statistically significant (χ2=15.389, P < 0.001).  Conclusion  The preoperative nursing intervention mode based on the concept of enhanced recovery after surgery can effectively improve the sleep quality of elderly patients with lumbar spinal stenosis, improve the anxiety of patients, reduce the incidence of postoperative complications and improve the satisfaction of patients with medical services and quality.