基于加速康复理念的膝关节置换患者术后康复锻炼最佳证据应用研究

目的将膝关节置换患者术后康复锻炼的最佳证据应用于临床实践,为膝关节置换术后患者实施膝关节康复锻炼提供科学依据,促进术后加速康复。方法选取南通市第一人民医院2016年1月—2017年3月收治的人工全膝关节置换术患者45例作为证据应用前的对照组,选取2017年4月—2018年7月行人工全膝关节置换术患者49例作为证据应用后的观察组。遵循JBI循证护理中心的临床证据实践应用系统(JBI-PACES)的标准程序,比较证据应用前后护士对膝关节置换术后患者标准康复指导的执行情况、患者康复锻炼期间的疼痛度(VAS)、依从性、满意度、膝关节功能评分(AKSS评分)、平均住院日、并发症的发生率。结果应用基于加速康复理念的最佳证据后,护理人员对膝关节置换术后标准康复指导的执行率提高,患者术后康复锻炼期间的疼痛度降低(P<0.01),依从性和满意度提高(P<0.01),术后1周、1个月和3个月的膝关节AKSS评分提高(P<0.01),平均住院日缩短(P<0.01);观察组患者膝关节僵硬的发生率较对照组低,差异有统计学意义(P<0.05)。结论对膝关节置换患者术后康复锻炼实施基于加速康复理念的最佳证据应用,可规范护理人员的行为,促进膝关节置换患者的膝关节功能恢复,有效降低膝关节僵硬的发生。

Application of best practice of postoperative rehabilitation exercise in knee replacement arthroplasty patients based on enhanced recovery conception

Objective To apply the best practice of postoperative rehabilitation exercise in knee replacement arthroplasty patients so as to provide a scientific basis for postoperative rehabilitation exercise and promoting enhanced recovery after surgery(ERAS).Methods From January 2016 to March 2017,this study selected 45 patients with total knee arthroplasty(TKA)of Nantong First People's Hospital in control group before evidence application.From April 2017 to June 2018,this study also selected 49 TKA patients in observation group after evidence application.The practical application of clinical evidence system of Joanna Briggs Institute Practical Application of Clinical Evidence System(JBI-PACES)was used to compare the implementation of standardized rehabilitation direction for patients after TKA by nurses,score of Visual Analogue Scale(VAS)of patients during rehabilitation exercise,compliance,satisfaction,score of American Knee Society Score(AKSS),average length of stay,incidence of complication before and after evidence application.Results After evidence application based on ERAS,the implementation rate of standardized rehabilitation direction after TKA by nurses was increased and the scores of VAS of patients during rehabilitation exercise after surgery reduced;the compliance and satisfaction improved;the scores of AKSS one week,one and three months after surgery increased and the average length of stay was shortened;the differences were all statistical(P<0.01).Besides,the incidences of knee stiffness of observation group patients was lower than those in control group with statistical difference(P<0.05).Conclusions The application of best practice of postoperative rehabilitation exercise in knee replacement arthroplasty patients based on ERAS can standardize nurses'behavior,promote knee function recovery of TKA patients and effectively reduce the incidences of knee stiffness.