基于ERAS理念的麻醉苏醒期护理对老年髋部骨折全麻手术患者术后谵妄的影响

朱红艳; 徐维昉

doi:10.16766/j.cnki.issn.1674-4152.002391

基于ERAS理念的麻醉苏醒期护理对老年髋部骨折全麻手术患者术后谵妄的影响

doi: 10.16766/j.cnki.issn.1674-4152.002391

朱红艳,
徐维昉^,

新疆医科大学第一附属医院麻醉科，新疆乌鲁木齐 830001

基金项目:

新疆维吾尔自治区自然科学基金计划基金项目 2017D01C287

详细信息

通讯作者:
徐维昉，E-mail：zhy13999937151@163.com

中图分类号: R473.6 R681.6
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- 文章访问数: 269
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- 被引次数: 0
出版历程
- 收稿日期: 2021-04-23
- 网络出版日期: 2022-08-13

Influence of anaesthesia recovery nursing based on enhanced recovery after surgery on post-operative delirium in elderly patients under general anaesthesia for hip fracture surgery

ZHU Hong-yan,
XU Wei-fang^,

Department of Anaesthesiology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830001, China

摘要

摘要: 目的探讨基于快速康复外科(enhanced recovery after surgery，ERAS)理念的麻醉苏醒期护理对老年髋部骨折全麻手术患者术后谵妄(postoperative delirium，POD)的影响。方法选取2017年1月—2019年12月在新疆医科大学第一附属医院择期行髋部骨折手术的老年患者100例，应用随机数字表将患者分为对照组(50例)和观察组(50例)，对照组予以常规护理，观察组实施基于ERAS理念的麻醉苏醒期护理；比较2组POD发生情况、POD相关不良事件发生情况、术后恢复情况及护理满意度。结果观察组与对照组POD发生率分别为12.00%和30.00%，POD持续时间分别为(3.42±1.09)h和(4.74±1.31)h，差异均有统计学意义(均P＜0.05)。观察组POD相关不良事件包括跌倒/坠床、非计划性拔管、压力性损伤发生率均低于对照组，差异均有统计学意义(均P＜0.05)。观察组与对照组术后恢复情况中，拔管时间、麻醉术后恢复室(PACU)停留时间、定向力恢复时间及术后住院时间均短于对照组，差异均有统计学意义(均P＜0.05)。观察组护理满意度高于对照组，差异有统计学意义(P＜0.05)。结论基于ERAS理念的麻醉苏醒期能够有效预防老年髋部骨折全麻手术患者POD的发生，促进患者术后恢复。
- 快速康复外科 /
- 骨科 /
- 髋部骨折 /
- 老年 /
- 术后谵妄
Abstract: Objective To investigate the influence of anaesthesia recovery nursing based on enhanced recovery after surgery (ERAS) on postoperative delirium (POD) in elderly patients undergoing general anaesthesia for hip fracture surgery. Methods A total of 100 elderly patients who underwent elective hip fracture surgery in our hospital from January 2017 to December 2019 were selected, and they were randomly divided into the control group (n=50) and the observation group (n=50). The patients in the control group received routine nursing, whereas those in the observation group received anaesthesia recovery nursing based on ERAS. The occurrence of POD and delirium-related adverse events, post-operative recovery and nursing satisfaction were compared between the two groups. Results The incidence rates of POD in the observation and control groups were 12.00% and 30.00%, respectively, and with delirium durations of (3.42±1.09) h and (4.74±1.31) h, respectively (all P < 0.05). The incidence of POD-related adverse events including fall/bed fall, unplanned extubation and stress injury were lower than the control group, which were statistically significant (all P < 0.05).In the postoperative recovery of the observation group, extubation time, residence time after anesthesia recovery room (PACU), directional force recovery time and postoperative hospitalization time were shorter than the control group, all statistically significant (all P < 0.05). The nursing satisfaction of the observation group was higher than that of the control group (P < 0.05). Conclusion Anaesthesia recovery nursing based on ERAS can effectively prevent the occurrence of POD and promote post-operative recovery in elderly patients undergoing general anaesthesia surgery for hip fracture.
- Enhanced recovery after surgery /
- Orthopaedics department /
- Hip fracture /
- Elderly /
- Post-operative delirium

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表 1 2组行髋骨骨折手术的老年患者一般资料比较

Table 1. Comparison of general clinical data of ultra-low birth weight infants between the two groups

组别	例数	性别(男/女，例)	年龄(x±s，岁)	体重指数(x±s)	ASA分级(Ⅰ/Ⅱ/Ⅲ，例)	骨折类型(股骨颈骨折/ 股骨粗隆间骨折，例)	手术时间(x±s，min)
观察组	50	21/29	75.56±10.47	24.31±4.14	2/34/14	22/28	71.26±12.25
对照组	50	23/27	76.21±11.24	23.87±3.78	3/36/11	26/24	68.43±11.78
统计量		0.162^a	0.299^b	0.555^b		0.641^a	1.177^b
P值		0.687	0.765	0.580	0.772^c	0.423	0.242
注：^a为χ²值，^b为t值，^c为采用Fisher精确检验。

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表 2 2组行髋骨骨折手术的老年患者术后12 h发生POD及持续时间比较

Table 2. Comparison of general data of mothers and families of ultra-low birth weight infants in the two groups

组别	例数	发生POD[例(%)]	POD持续时间(x±s，h)
观察组	50	6(12.00)	3.42±1.09
对照组	50	15(30.00)	4.74±1.31
统计量		4.882^a	2.176^b
P值		0.027	0.042
注：^a为χ²值，^b为t值。

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表 3 2组行髋骨骨折手术的老年患者POD相关不良事件发生情况比较[例(%)]

Table 3. Comparison of hospital stay time, cost, growth and exclusive breastfeeding of ultra-low birth weight infants in two groups [cases (%)]

组别	例数	跌倒/坠床	非计划性拔管	压力性损伤	合计
观察组	50	1(2.00)	1(2.00)	0	2(4.00)
对照组	50	3(6.00)	3(6.00)	2(4.00)	8(16.00)
χ²值					4.000
P值		0.617^a	0.617^a	0.495^a	0.046
注：^a为采用Fisher精确检验。

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表 4 2组行髋骨骨折手术的老年患者术后恢复情况比较(x±s)

Table 4. Comparison of complications in the two groups of ultra-low birth weight infants during hospitalization (x±s)

组别	例数	拔管时间(min)	PACU停留时间(min)	定向力恢复时间(min)	住院时间(d)
观察组	50	16.55±2.41	28.43±6.23	15.32±1.54	16.12±4.36
对照组	50	23.74±3.47	38.39±5.79	22.14±2.68	24.27±5.17
t值		12.034	8.281	15.602	8.521
P值		＜0.001	＜0.001	＜0.001	＜0.001

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表 5 2组行髋骨骨折手术的老年患者护理满意度比较[例(%)]

Table 5. Comparison of ultra-low birth weight infants ' mothers ' psychological emotions, nursing knowledge mastery scores and satisfaction of the two groups [cases (%)]

组别	例数	很满意	满意	一般	不满意
观察组	50	17(34.00)	24(48.00)	8(16.00)	1(2.00)
对照组	50	11(22.00)	18(36.00)	18(36.00)	3(6.00)
注：2组满意度比较，Z=2.372，P=0.018。

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