基于出院准备服务的康复指导在膝关节置换中的应用

目的观察基于出院准备服务的康复指导在全膝关节置换术患者中的应用效果，探讨最佳护理措施。 方法采用前瞻性分析的研究方法，选择2019年4月至2020年9月在南方医科大学南方医院首次行全膝关节置换术患者共210例，按照随机数字表法分组。105例设为对照组，实施常规护理与康复干预；105例设为观察组，在常规护理基础上实施基于出院准备服务的康复指导的延续性护理模式。入院时、出院前、出院后1个月及3个月采用膝关节功能评分量表、Bathel指数评价患者的关节功能、日常生活能力；采用出院准备度量表对比两组患者出院准备度情况。根据不同数据类型，采用独立样本t检验、秩和检验、卡方检验和重复测量方差分析进行统计分析。 结果通过对全膝关节置换术患者实施出院准备服务的康复指导，患者从入院至出院后3个月时间里，在膝关节功能及日常生活能力方面逐步得到改善，出院前观察组患者出院准备度评分显著高于对照组(t＝36.020，P<0.01)。入院时和出院前两组患者的膝关节功能评分差异无统计学意义(F＝1.127、0.936，均为P>0.05)；出院后1个月及3个月观察组患者的膝关节功能评分高于对照组(F＝21.069、10.476，均为P<0.01)。两组患者入院时和出院前的日常生活能力评分差异无统计学意义(F＝0.979、1.158，均为P>0.05)，在出院后1个月及3个月观察组患者的日常生活能力评分显著高于对照组(F＝19.463、33.458，均为P<0.01)。 结论对全膝关节置换术患者实施基于出院准备服务的康复指导，可有效改善患者膝关节功能，提高其日常生活能力，促进患者早日康复。

Application of rehabilitation guidance based on discharge preparation service in knee arthroplasty

ObjectiveTo explore the effect of rehabilitation guidance based on discharge planning, for patients after total knee arthroplasty (TKA). MethodsFrom April 2019 to September 2020, a total of 210 patients who underwent primary total knee arthroplasty in Nanfang Hospital of Southern Medical University were prospectively selected. All the cases were divided into two groups according to random number table. The control group (n=105) received routine nursing and rehabilitation interventions, and the observation group (n =105) received continuous nursing mode of rehabilitation guidance based on discharge preparation service. Knee function scale and Bathel index were used to evaluate the joint function and activities of daily living of patients at admission, before discharge, and at one month and three months after discharge. The discharge readiness scale was used to compare the discharge readiness of the two groups. According to the data types, independent sample t test, rank sum test, chi square test and repeated measure ANOVA were used for statistical analysis. ResultsThrough the rehabilitation guidance of discharge preparation service for patients undergoing total knee arthroplasty, the patients gradually improved their knee function and activities of daily living from admission to three months after the discharge. The experimental group performed better than the control group in discharge readiness score (t=36.020, P<0.01). No statistically significant difference was found in knee joint function before surgery or discharging(F=1.127, 0.936, both P>0.05). The experimental group showed better knee fucntion one month and three months after the surgery (F=21.069, 10.476, both P<0.01). The daily life activites of the two group showed no remarkable difference at admission or before the discharge(F=0.979, 1.158, both P>0.05), while the experimental group performed better than the control group later in one and three months after the discharge(F=19.463, 33.458, both P<0.01). ConclusionApplication of rehabilitation guidance based on discharge planning after TKA would effectively improve joint function, daily life activities, thus promoting the patients to return to society.