基于快速康复的系统模式在胸腰椎结核术后伴睡眠质量障碍患者治疗中的效果评价

doi:10.3969/j.issn.1000-6621.2021.05.008

摘要/Abstract

摘要：

目的评价基于快速康复的系统模式在胸腰椎结核术后伴睡眠质量障碍患者治疗中的效果评价。方法回顾性分析解放军总医院第八医学中心脊柱微创外科2016年2月至2019年8月收治的216例胸腰椎结核手术患者。其中,对2016年2月至2017年8月就诊的104例胸腰椎结核手术患者术后进行常规护理;对2017年9月至2019年8月就诊的112例胸腰椎结核患者术后进行快速康复的系统模式。采用系统随机抽签法从常规护理模式和快速康复系统模式中各抽取40例作为对照组和观察组。比较两组患者术后第3天和术后第1周的疼痛程度[采用视觉模拟评分量表(visual analogue scales,VAS)进行评估]、术后第2周睡眠质量程度(采用匹兹堡睡眠质量指数量表进行评估)和躯体活动能力(采用Braden评分量表进行评估),以及术后住院时间。结果观察组术后第3天、术后第1周VAS疼痛评分为(4.22±0.81)分和(2.22±0.82)分,均明显低于对照组[分别为(4.98±1.12)分和(2.98±1.12)分],差异均有统计学意义(t值分别为3.477、3.463,P值均<0.001)。观察组术后第2周匹兹堡睡眠质量指数评分为(5.65±2.40)分,明显低于对照组[(6.98±1.12)分],差异有统计学意义(t=3.176,P=0.001)。观察组术后第2周经常步行的患者有28例(70.0%),明显高于对照组的17例(42.5%),差异有统计学意义(χ²=6.146,P=0.013)。观察组术后住院时间为(14.76±0.86)d,明显短于对照组[(15.22±0.54)d],差异有统计学意义(t=2.865,P=0.002)。结论基于快速康复的系统模式在胸腰椎结核术后伴睡眠质量障碍患者的术后治疗中具有明显的效果,可减轻患者疼痛,提高睡眠质量,促使其恢复活动能力。

关键词: 结核,脊柱, 睡眠障碍, 康复护理, 评价研究

Abstract:

Objective Effect evaluation of rapid rehabilitation based system model in patients with sleep disorder after spinal thoracolumbar tuberculosis surgery. Methods This is a retrospective study, 216 patients with thoracolumbar tuberculosis were involved from February 2016 to August 2019 treated in the 8th Medical Center, PLA General Hospital. Among them, 104 patients were treated with routine nursing care after surgery from February 2016 to August 2017, 112 patients were treated with rapid rehabilitation based systematic nursing model after surgery from September 2017 to August 2019. Forty cases were randomly selected from the two models respectively. The differences between the two groups were compared in the pain degree (by visual analogue scales, VAS) on the 3rd day and 1st week after surgery, the sleep quality (by pittsburgh sleep quality index scale) and the physical activity ability (by Braden rating scale) on the 2nd week after surgery, and the postoperative hospital stay. Results The degree of pain in the observation group after postoperative were (4.22±0.81) and (2.22±0.82) on the 3rd day and 1st week respectively, which were lower than the control group (4.98±1.12) and (2.98±1.12), the differences were statistically significant (t=3.477 and 3.463, P<0.001). The degree of Pittsburgh sleep quality index at the second week after operation in the observation group was (5.65±2.40), which was significantly lower than the control group (6.98±1.12), the differences were statistically significant (t=3.176, P=0.001). There were 28 patients (70.0%) who were able to walk frequently two weeks after surgery in the observation group, the proportion was higher than that in the control group (42.5%, 17/40), the difference was statistically significant (χ²=6.146,P=0.013).In the observation group, the postoperative hospitalization time was (14.76±0.86) days, which was less than the control group ((15.22±0.54) days), the difference was statistically significant (t=2.865, P=0.002). Conclusion The systematic nursing model based on rapid rehabilitation has a significant clinical effect in patients with sleep disorder after thoracolumbar tuberculosis surgery, which can reduce pain, improve sleep quality, and promote the recovery of activity.

Key words: Tuberculosis,spinal, Sleep disorders, Rehabilitation nursing, Evaluation studies

艾雅娟, 韩旭. 基于快速康复的系统模式在胸腰椎结核术后伴睡眠质量障碍患者治疗中的效果评价[J]. 中国防痨杂志, 2021, 43(5): 452-456. doi: 10.3969/j.issn.1000-6621.2021.05.008

AI Ya-juan, HAN Xu. Effect evaluation of rapid rehabilitation based systematic model in patients with sleep disorder after thoracolumbar tuberculosis surgery[J]. Chinese Journal of Antituberculosis, 2021, 43(5): 452-456. doi: 10.3969/j.issn.1000-6621.2021.05.008

图/表 3

表1

各临床特征在观察组和对照组间的比较

临床资料	对照组(40例)	观察组(40例)	统计检验值	P值
年龄(岁, $x ˉ$ ±s)	42.35±3.48	42.72±3.11	t=0.501	0.308
性别[例,构成比(%)]			χ²=0.082	0.775
男	8(20.0)	7(17.5)
女	32(80.0)	33(82.5)
文化程度[例,构成比(%)]			χ²=0.764	0.858
小学	1(2.5)	2(5.0)
初中	10(25.0)	8(20.0)
高中	19(47.5)	18(45.0)
大学及以上	10(25.0)	12(30.0)
婚姻状况[例,构成比(%)]			χ²=0.251	0.617
已婚	28(70.0)	30(75.0)
未婚	12(30.0)	10(25.0)
病程(年, $x ˉ$ ±s)	2.38±0.48	2.42±0.52	t=0.357	0.363
患病部位[例,构成比(%)]			χ²=0.802	0.370
胸椎	21(52.5)	17(42.5)
腰椎	19(47.5)	23(57.5)
病灶节段[例,构成比(%)]^a			χ²=0.053	0.818
1个	24(60.0)	25(62.5)
2个	16(40.0)	15(37.5)
术中出血量(ml, $x ˉ$ ±s)	582.75±122.39	598.00±110.06	t=0.590	0.280
手术时间(min, $x ˉ$ ±s)	320.12±61.54	335.05±56.31	t=1.132	0.130
术前血红蛋白 (g/L, $x ˉ$ ±s)	115.29±5.61	116.11±5.14	t=0.682	0.248

表1

表2

表3

参考文献 16

[1]	宋敏, 谢智恩, 杨宏志, 等. 不同转归成年活动性脊柱结核患者术前多层螺旋CT扫描特征分析. 结核病与肺部健康杂志, 2019,8(4):272-279. doi: 10.3969/j.issn.2095-3755.2019.04.008.
[2]	藏珊珊, 崔敬华, 朱惠英, 等. 肺结核患者心理状况及影响因素分析. 解放军医药杂志, 2019,31(11):47-49. doi: 10.3969/j.issn.2095-140X.2019.11.011.
[3]	张琼, 叶健. 骨科患者术后睡眠质量及影响因素的调查分析. 河北医学, 2013,19(10):1590-1591. doi: 10.3969/j.issn.1006-6233.2013.10.060.
[4]	魏晨慧, 郭锦丽, 程宏, 等. 不同类别骨科手术病人围术期睡眠质量及影响因素分析. 护理研究, 2020,34(12):2120-2125. doi: 10.12102/j.issn.1009-6493.2020.12.012.
[5]	罗丽敏, 王慧, 王赵杰, 等. 聚焦解决模式对腰椎结核术后患者睡眠质量及焦虑、抑郁的影响. 国际精神病学杂志, 2020,47(2):404-407.
[6]	沈莉莉, 李传忠. 基于快速康复外科理念的多模式镇痛对腹腔镜手术患者术后康复的影响. 实用临床医药杂志, 2019,23(13):36-38. doi: 10.7619/jcmp.201913010.
[7]	饶裕泉, 张冰, 袁开明, 等. 不同保温方法对脊柱手术患者围术期核心体温和恢复情况的影响. 临床麻醉学杂志, 2019,35(3):266-269. doi: 10.12089/jca.2019.03.013.
[8]	内山真. 睡眠障碍诊疗指南. 谭新, 译. 西安, 第四军医大学出版社, 2006,68(9):2047-2060.
[9]	杨程显, 李戈. Braden量表评估压疮风险的研究进展及展望. 护理学报, 2014,21(7):25-27.
[10]	艾雅娟, 刘向东, 毕娜, 等. 脊柱结核患者术后行疼痛护理干预的效果观察. 中国防痨杂志, 2019,41(10):1113-1117. doi: 10.3969/j.issn.1000-6621.2019.10.009.
[11]	Ren C, Zhang X, Liu Z, et al. Effect of Intraoperative and Postoperative Infusion of Dexmedetomidine on the Quality of Postoperative Analgesia in Highly Nicotine-Dependent Patients After Thoracic Surgery: A CONSORT-Prospective, Randomi-zed, Controlled Trial. Medicine (Baltimore), 2015,94(32):e1329. doi: 10.1097/MD.0000000000001329.
[12]	尹芝华, 王舒琳, 高征, 等. 下肢创伤后骨感染患者围术期护理流程优化+快速康复的效果评价. 中华创伤杂志, 2019,35(2):156-161. doi: 10.3760/cma.j.issn.1001-8050.2019.02.010.
[13]	李五妹, 李志伟, 曹鲁梅, 等. 快速康复护理模式在侧路、后路椎间孔镜下治疗腰椎间盘突出症中的应用. 国际护理学杂志, 2020,39(6):1079-1082. doi: 10.3760/cma.j.cn221370-20181231-00330.
[14]	吴炜炜, 兰秀燕, 邝惠容, 等. 传统健身运动对老年人睡眠质量影响的Meta分析. 中华护理杂志, 2016,51(2):216-224. doi: 10.3761/j.issn.0254-1769.2016.02.016.
[15]	孟玮玮. 循证护理干预对腰椎术后患者早期下床活动的影响. 武警医学, 2012,23(12):1075-1077. doi: 10.3969/j.issn.1004-3594.2012.12.021.
[16]	刘世军, 江素芹, 李治国. 早期腰背肌功能训练对脊柱胸腰段骨折经后路椎弓根内固定术后疼痛及脊柱功能恢复的影响. 颈腰痛杂志, 2019,40(2):287-288. doi: 10.3969/j.issn.1005-7234.2019.02.050.

组别	例数	躯体活动能力
组别	例数	卧床	坐椅子	偶尔步行	经常步行
观察组	40	0(0.0)	1(2.5)	11(27.5)	28(70.0)
对照组	40	0(0.0)	3(7.5)	20(50.0)	17(42.5)
χ²值		-	1.053	4.266	6.146
P值		-	0.305	0.039	0.013