循证护理模式用于下颌骨骨折患者术后护理的临床观察

徐少君; 徐旭; 严钦; 范丽琴

doi:10.16766/j.cnki.issn.1674-4152.002616

循证护理模式用于下颌骨骨折患者术后护理的临床观察

doi: 10.16766/j.cnki.issn.1674-4152.002616

徐少君^1, ,,
徐旭¹,
严钦²,
范丽琴¹

1.
温州医科大学附属衢州医院(衢州市人民医院)口腔科，浙江衢州 324000
2.
浙江大学医学院附属第二医院口腔颌面外科，浙江杭州 310000

基金项目:

浙江省医药卫生科技计划项目 2018KY878

详细信息

通讯作者:
徐少君, E-mail: hhxsjhyt@163.com

中图分类号: R473.78 R782.05
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- 文章访问数: 292
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- 被引次数: 0
出版历程
- 收稿日期: 2021-11-29
- 网络出版日期: 2022-09-26

Observe on the clinical effect of evidence-based nursing model for postoperative nursing of patients with mandibular fracture

XU Shao-jun^{1
, ,},
XU Xu¹,
YAN Qin²,
FAN Li-qin¹

1.
Department of Somatology, Quzhou Hospital Affiliated to Wenzhou Medical University, Quzhou, Zhejiang 324000, China

摘要

摘要: 目的观察循证护理模式用于提高下颌骨骨折患者术后康复水平的临床效果。方法选择2018年1月—2021年6月温州医科大学附属衢州医院和浙江大学医学院附属第二医院收治的120例下颌骨骨折患者为研究对象，按照入院时间将患者分为对照组(60例)和研究组(60例)，2组患者均进行小型钛板颌骨内固定术治疗，对照组患者术后实施常规护理干预，研究组患者实施循证护理干预。记录患者手术时间、术中出血量、住院时间和骨折愈合时间等手术指标，于术后3个月和6个月测定或评估患者咀嚼能力、牙齿咬合力、生活质量和心理健康状况，评价患者口腔卫生健康状况，观察患者术后并发症发生情况。结果研究组住院时间[(11.59±1.27)d vs.(16.94±1.45)d]和骨折愈合时间[(41.28±4.09)d vs.(49.62±4.31)d]均显著短于对照组(t=21.543、10.579，均P＜0.001)；研究组术后3个月咀嚼功能、牙齿咬合力和SF-36评分均显著高于对照组水平(均P＜0.001)，而2组术后6个月上述指标差异均无统计学意义(均P＞0.05)；研究组术后6个月HAMA和HAMD评分、PI、DI、GI和SBI均显著低于对照组(均P＜0.001)；研究组术后并发症总体发生率(5.00%，3/60)显著低于对照组水平(18.33%，11/60，χ²=5.175，P=0.023)。结论循证护理模式可有效缩短下颌骨骨折患者术后康复周期，提高术后早期下颌运动功能水平和生活质量，减轻患者心理负担，改善口腔卫生健康状况，有助于减少术后并发症。
- 循证护理 /
- 下颌骨骨折 /
- 小型钛板颌骨内固定术 /
- 康复水平 /
- 术后并发症
Abstract: Objective To observe the clinical effect of evidence-based nursing mode on improving the postoperative rehabilitation level of patients with mandibular fracture. Methods Total 120 patients with mandibular fractures treated in Quzhou Hospital Affiliated to Wenzhou Medical University and the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2018 to June 2021 were collected as the research objects. The 120 patients with mandibular fracture were divided into control group (n=60) and study group (n=60) according to the admission time. Patients in two groups were treated with small titanium plate jaw internal fixation. The control group were given routine nursing intervention while the study group were given cluster nursing intervention. The operation time, intraoperative blood loss, hospitalization time and fracture healing time were recorded. The masticatory ability, bite force, quality of life, mental health, oral health status and postoperative complications were evaluated at 3 and 6 months after surgery. Results The duration of hospital stay and healing time of fracture in study group were significantly lower than those in control group [(11.59±1.27) d vs. (16.94±1.45) d, (41.28±4.09) d vs. (49.62±4.31) d, t=21.543, 10.579, all P < 0.001]. Compared with control group, the masticatory function, bite force and SF-36 score of patients were significantly increased in study group at 3 months after operation (all P < 0.001), while there was no statistical significance at 6 months after surgery (all P > 0.05). The scores of HAMA, HAMD, PI, DI, GI and SBI were significantly decreased at 6 months after surgery in study group (all P < 0.001). The overall incidence of postoperative complications in study group (5.00%, 3/60) was significantly lower than that in control group (18.33%, 11/60, χ²=5.175, P=0.023). Conclusion Evidence-based nursing model can effectively shorten the postoperative rehabilitation period of patients with mandibular fracture and improve the early postoperative mandibular motor function and quality of life, which contributes to reduce the psychological burden of patients, improve oral health and reduce the risk of postoperative complications.
- Evidence-based nursing /
- Mandibular fracture /
- Small titanium plate internal fixation of jaw /
- Rehabilitation level /
- Postoperative complications

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表 1 2组下颌骨骨折患者一般资料比较

Table 1. Comparison of general data of mandibular fracture patients between two groups

组别	例数	年龄(x±s，岁)	性别(例)		致伤原因(例)			骨折部位(例)
组别	例数	年龄(x±s，岁)	男性	女性	交通事故	高空坠落	撞击	颏孔部	下颌骨正中	下颌角	髁状突部
对照组	60	38.26±3.54	36	24	35	19	6	25	12	11	12
研究组	60	37.82±3.61	38	22	33	22	5	23	15	12	10
统计量		0.663^a	0.141^b		0.369^b			0.509^b
P值		0.509	0.707		0.831			0.917
注：^a为t值，^b为χ²值。

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表 2 2组下颌骨骨折患者手术治疗指标比较(x±s)

Table 2. Comparison of surgical treatment indexes of mandibular fractures between two groups(x±s)

组别	例数	手术时间(min)	术中出血量(mL)	住院时间(d)	骨折愈合时间(d)
对照组	60	86.27±7.62	41.59±4.52	16.94±1.45	49.62±4.31
研究组	60	85.94±7.53	40.83±4.47	11.59±1.27	41.28±4.09
t值		0.229	0.934	21.543	10.579
P值		0.819	0.352	＜0.001	＜0.001

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表 3 2组下颌骨骨折患者术后咀嚼功能、牙齿咬合力及生活质量比较(x±s)

Table 3. Comparison of postoperative masticatory function, bite force and quality of life between two groups of patients with mandibular fracture(x±s)

组别	例数	咀嚼功能(%)		牙齿咬合力(Ibs)		SF-36评分(分)
组别	例数	术后3个月	术后6个月	术后3个月	术后6个月	术后3个月	术后6个月
对照组	60	74.52±4.07	81.95±4.62	128.35±6.26	141.68±8.21	76.85±4.71	83.96±5.33
研究组	60	79.76±4.43	82.71±4.67	139.36±8.15	143.49±8.37	83.41±5.26	85.07±5.39
t值		6.756	0.894	8.318	1.194	7.221	1.125
P值		＜0.001	0.373	＜0.001	0.235	＜0.001	0.263

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表 4 2组下颌骨骨折患者护理前后心理状况比较(x±s，分)

Table 4. Comparison of psychological status of mandibular fracture patients before and after nursing(x±s, scores)

组别	例数	HAMA评分		HAMD评分
组别	例数	护理前	术后6个月	护理前	术后6个月
对照组	60	21.34±1.96	12.52±1.28^a	22.59±2.07	13.41±1.45^a
研究组	60	20.97±1.93	9.63±1.02^a	22.47±2.04	10.72±1.16^a
t值		1.076	13.615	0.311	11.108
P值		0.284	＜0.001	0.756	＜0.001
注：与同组护理前比较，^aP＜0.05。

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表 5 2组下颌骨骨折患者术后PI、DI、GI和SBI比较(x±s)

Table 5. Comparison of postoperative PI, DI, GI and SBI between the two groups of patients with mandibular fracture(x±s)

组别	例数	PI	DI	GI	SBI
对照组	60	1.79±0.18	1.68±0.17	1.12±0.14	1.86±0.19
研究组	60	1.58±0.16	1.47±0.15	0.79±0.06	0.92±0.10
t值		6.650	7.140	15.670	32.934
P值		＜0.001	＜0.001	＜0.001	＜0.001

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参考文献(20)

[1]	李缘婷, 郭东群, 田莹, 等. 循证护理理论在临床实践中的应用进展[J]. 护理实践与研究, 2020, 17(3): 57-59. doi: 10.3969/j.issn.1672-9676.2020.03.019 LI Y T, GUO D Q, TIAN Y, et al. Application progress of evidence-based nursing theory in clinical practice[J]. Nursing Practice and Research, 2020, 17(3): 57-59. doi: 10.3969/j.issn.1672-9676.2020.03.019
[2]	董晓燕, 陶贵彦, 张莉, 等. 循证护理在老年髋部脆性骨折患者坠积性肺炎护理中的应用效果[J]. 中国临床护理, 2021, 13(1): 10-14. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHL202101004.htm DONG X Y, TAO G Y, ZHANG L, et al. Application of evidence-based nursing for prevention of hypostatic pneumonia among elderly patients with osteoporotic hip fracture[J]. Chinese Clinical Nursing, 2021, 13(1): 10-14. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHL202101004.htm
[3]	闫丽红. 循证护理在老年股骨颈骨折患者中的应用效果评价[J]. 中国伤残医学, 2020, 28(8): 72-73. https://www.cnki.com.cn/Article/CJFDTOTAL-TNBX201619003.htm YAN H L. Application effect evaluation of evidence-based nursing in elderly patients with femoral neck fracture[J]. Chinese Journal of Trauma and Disability Medicine, 2020, 28(8): 72-73. https://www.cnki.com.cn/Article/CJFDTOTAL-TNBX201619003.htm
[4]	吴清清, 杨红萍, 宁丽, 等. 老年骨折患者谵妄预防及管理循证护理审查指标的制定及障碍因素分析[J]. 护理管理杂志, 2021, 21(4): 229-233, 264. https://www.cnki.com.cn/Article/CJFDTOTAL-HLGL202104003.htm WU Q Q, YANG H P, NING L, et al. Formulation of evidence-based nursing review indexes for the prevention and management of delirium in elderly fracture patients and analysis its obstacle factors[J]. Journal of Nursing Administration, 2021, 21(4): 229-233, 264. https://www.cnki.com.cn/Article/CJFDTOTAL-HLGL202104003.htm
[5]	高仁玉, 余海云, 李海波. 基于思维导图的循证护理方法在回肠膀胱术中的应用效果[J]. 安徽医学, 2019, 40(04): 463-466. doi: 10.3969/j.issn.1000-0399.2019.04.032 GAO R Y, YU H Y, LI H B. Application effect of evidence-based nursing method based on mind map in ileal bladder operation[J]. Anhui Medical Journal, 2019, 40(04): 463-466. doi: 10.3969/j.issn.1000-0399.2019.04.032
[6]	JACOBS J L. Implementation of an evidence-based, nurse-driven sepsis protocol to reduce acute care transfer readmissions in the inpatient rehabilitation facility setting[J]. Rehabil Nurs, 2020, 45(2): 57-70. doi: 10.1097/rnj.0000000000000205
[7]	HANCOCK L M. Implementation and evaluation of a cloud-based, evidence-based nurse mentor training program[J]. J Nurses Prof Dev, 2022, 38(2): 82-87. doi: 10.1097/NND.0000000000000723
[8]	周华, 金松. 颌间固位钉和牙弓夹板在颌骨骨折治疗中的临床应用[J]. 中华全科医学, 2014, 12(9): 1408-1410. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201409018.htm ZHOU H, JIN S. A clinical utilization of intermaxillary fixation screws and arch bars in treatment of mandibular fracture[J]. Chinese Journal of General Practice, 2014, 12(9): 1408-1410. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201409018.htm
[9]	BATBAYAR E O, MALWAND S, DIJKSTRA P U, et al. Accuracy and outcome of mandibular fracture reduction without and with an aid of a repositioning forceps[J]. Oral Maxillofac Surg, 2019, 23(2): 201-208. doi: 10.1007/s10006-019-00759-0
[10]	OSTRANDER B T, WANG H D, CUSANO A, et al. Contemporary management of mandibular fracture nonunion: A retrospective review and treatment algorithm[J]. J Oral Maxillofac Surg, 2018, 76(7): 1479-1493. doi: 10.1016/j.joms.2018.01.027
[11]	陈鹏鹏. 小型钛板坚固内固定术与金属丝骨间内固定术治疗下颌骨骨折的效果比较[J]. 河南医学研究, 2020, 29(17): 3134-3135. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYX202017020.htm CHEN P P. Comparison of small titanium plate solid internal fixation and wire interosseous internal fixation in the treatment of mandibular fractures[J]. Henan Medical Research, 2020, 29(17): 3134-3135. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYX202017020.htm
[12]	马瑞芸, 李文早. 微型夹板联合环颌结扎治疗儿童下颌骨骨折的疗效观察[J]. 医学临床研究, 2017, 34(1): 42-45. MA R Y, LI W Z. Clinical observation of minlplate combined with ring jaw ligation in children with man-dibular fracture[J]. Journal of Clinical Research, 2017, 34(1): 42-45.
[13]	姜小云, 王莉, 周子远. 对比小型钛板颌骨内固定术与颌间结扎牵引疗法治疗下颌骨骨折的疗效[J]. 全科口腔医学电子杂志, 2019, 6(16): 75-76. https://www.cnki.com.cn/Article/CJFDTOTAL-QKKQ201916052.htm JIANG X Y, WANG L, ZHOU Z Y. To compare the effect of titanium plate internal fixation and intermaxillary ligation and traction in the treatment of mandibular fractures[J]. Electronic Journal of General Stomatology, 2019, 6(16): 75-76. https://www.cnki.com.cn/Article/CJFDTOTAL-QKKQ201916052.htm
[14]	叶银龙. 下颌骨骨折患者应用小型钛板坚固内固定手术治疗的效果及对患者QOL评分的影响[J]. 中国保健营养, 2018, 28(32): 71. YE Y L. Effect of solid internal fixation with small titanium plate in the treatment of mandibular fracture and its influence on QOL score[J]. China Health Care & Nutrition, 2018, 28(32): 71.
[15]	谭晓华, 李芳, 朱淑静. 循证护理在经掌侧入路斜T型钢板内固定治疗桡骨远端骨折患者中的应用[J]. 国际护理学杂志, 2020, 39(10): 1868-1870. TAN X H, LI F, ZHU S J. Application of evidence-based nursing in patients with distal radius fracture treated with oblique T-plate internal fixation via volar approach[J]. International Journal of Nursing, 2020, 39(10): 1868-1870.
[16]	郝婧, 阳柳柳, 韩优, 等. 循证护理在消化性溃疡护理中的效果观察[J]. 中华胃肠内镜电子杂志, 2020, 7(4): 202-204. https://www.cnki.com.cn/Article/CJFDTOTAL-WCNJ202004008.htm HAO J, YANG L L, HAN Y, et al. Effect of evidence-based nursing on peptic ulcer[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2020, 7(4): 202-204. https://www.cnki.com.cn/Article/CJFDTOTAL-WCNJ202004008.htm
[17]	张周娟. 循证护理在无痛胃镜检查中的应用[J]. 中华全科医学, 2016, 14(3): 498-500. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.053 ZHANG Z J. Evidence-based nursing for patients with painless gastroscopy[J]. Chinese Journal of General Practice, 2016, 14(3): 498-500. doi: 10.16766/j.cnki.issn.1674-4152.2016.03.053
[18]	牛玉婷, 王薇, 李朝煜, 等. Stetler研究应用模式在循证护理实践中的应用进展[J]. 中华现代护理杂志, 2018, 24(24): 2959-2961. NIU Y T, WANG W, LI C Y, et al. Recent application of Stetler's model of research utilization in evidence-based nursing practice[J]. Chinese Journal of Modern Nursing, 2018, 24(24): 2959-2961.
[19]	刘晓丽. 口腔颌面部创伤性骨折患者牵引复位固定术后循证护理的应用[J]. 中国伤残医学, 2020, 28(20): 83-85. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201816032.htm LIU X L. Application of evidence-based nursing after traction reduction and fixation in patients with oral and maxillofacial traumatic fractures[J]. Chinese Journal of Trauma and Disability Medicine, 2020, 28(20): 83-85. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201816032.htm
[20]	张静, 李全, 杨悦. 口腔癌围手术期患者营养管理的证据总结[J]. 中华现代护理杂志, 2021, 27(13): 1681-1688. https://cpfd.cnki.com.cn/Article/CPFDTOTAL-HZKQ202011001085.htm ZHANG J, LI Q, YANG Y. Evidence summary of nutrition management in patients with oral cancer during the perioperative period[J]. Chinese Journal of Modern Nursing, 2021, 27(13): 1681-1688. https://cpfd.cnki.com.cn/Article/CPFDTOTAL-HZKQ202011001085.htm