基于多学科协作的创伤性老年髋部骨折诊疗与护理模式的实施和效果评价

熊飞; 邵小平; 芮碧宇

doi:10.16766/j.cnki.issn.1674-4152.003312

基于多学科协作的创伤性老年髋部骨折诊疗与护理模式的实施和效果评价

doi: 10.16766/j.cnki.issn.1674-4152.003312

上海交通大学医学院附属第六人民医院急诊医学科，上海 200233

基金项目:

上海市卫生健康委员会科研项目 202240142

详细信息

通讯作者:
邵小平，E-mail：shaoxiaoping1972@126.com

中图分类号: R473.6 R683.3
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- 文章访问数: 234
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- 被引次数: 0
出版历程
- 收稿日期: 2023-06-25
- 网络出版日期: 2024-01-29

Implementation and evaluation of a multidisciplinary team-based model for managing and caring for elderly patients with traumatic hip fractures

Department of Emergency Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China

摘要

摘要: 目的探讨基于多学科协作的创伤性老年髋部骨折诊疗与护理模式的应用效果，分析其对患者住院期间手术相关指标、术后并发症发生率及护理满意度的影响。方法回顾性分析2022年9月—2023年4月在上海交通大学医学院附属第六人民医院接受髋关节手术的228例患者。根据救治和护理流程分为观察组(105例)和对照组(123例)。对照组采用常规流程，观察组在急诊科设置创伤性老年髋部骨折一站式病房，通过开通绿色通道和多学科综合会诊，优化诊疗和护理流程。比较2组患者手术相关指标、术后并发症发生率及患者满意度。结果与对照组比较，观察组术前等待时间[(1.62±0.35) vs.(2.70±0.52)d]、术后下床时间[(1.68±0.36) vs.(2.37±0.52)d]、住院时间[(5.62±1.76) vs.(8.27±2.52)d]明显缩短，术后入住ICU比例(2.86% vs. 9.76%)及30 d再入院率(2.86% vs.9.76%)明显降低(均P < 0.05)。与对照组比较，观察组术后肺部感染(2.86% vs. 9.76%)、切口感染(4.76% vs.13.01%)、下肢深静脉血栓发生率(8.57% vs.17.89%)均显著降低(均P < 0.05)。观察组总护理满意度为99.05%，明显高于对照组的91.87%(P < 0.05)。结论基于多学科协作的创伤性老年髋骨折诊疗与护理模式可使患者尽早实施手术治疗，缩短住院时间，减少围手术期并发症，改善患者护理满意度。
- 创伤性髋部骨折 /
- 老年 /
- 多学科协作 /
- 护理流程 /
- 绿色通道 /
- 效果评价
Abstract: Objective To investigate the impact of a multi-disciplinary team-based model on managing and caring for elderly patients with traumatic hip fractures, and analyze of surgical-related indicators, postoperative complications rate, and nursing satisfaction during the patient's hospitalization. Methods A retrospective analysis was conducted on 228 patients who underwent hip joint surgery at the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2022 to April 2023. The patients were divided into two groups: an observation group (105 cases) and a control group (123 cases), based on their treatment and care processes. The control group followed the routine procedure, while the observation group received acre in a dedicated one-stop ward designed specifically for elderly patients with traumatic hip fractures in the emergency department. The treatment and nursing process in the observation group were optimized through the implementation of a streamlined pathway and multidisciplinary comprehensive consultation. The study compared operation-related indicators, postoperative complication rates, and nursing satisfaction between the two groups. Results Compared with the control group, the observation group demonstrated significant improvements in various aspects. The preoperative waiting time [(1.62±0.35) d vs. (2.70±0.52) d], postoperative mobilization time [(1.68±0.36) d vs. (2.37±0.52) d], and length of hospital stay [(5.62±1.76) d vs. (8.27±2.52) d] were significantly shortened in the observation group (all P < 0.05). Additionally, the observation group exhibited a significant decrease in the proportion of postoperative ICU admission (2.86% vs.9.76%) and 30-day readmission rate (2.86% vs.9.76%), all P < 0.05. Moreover, compared with the control group, the incidence of postoperative pulmonary infection (2.86% vs.9.76%), incision infection (4.76% vs.13.01%), and lower extremity deep vein thrombosis (8.57% vs.17.89%) in the observation group were significantly reduced (all P < 0.05). The overall nursing satisfaction rate in the observation group was 99.05%, which was significantly higher than in the control group (91.87%, P < 0.05). Conclusion The implementation of a multidisciplinary team-based model for managing and caring for elderly patients with traumatic hip fractures has demonstrated several positive outcomes. This model facilitates early surgical treatment, leading to shorter hospital stays, decreased perioperative complications, and improved nursing satisfaction.
- Traumatic hip fracture /
- Elderly /
- Multidisciplinary team /
- Nursing process /
- Green channel /
- Effect evaluation

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表 1 2组行髋关节手术的患者一般资料比较

Table 1. Comparison of general data among patients undergoing hip joint surgery in two groups

项目	观察组(n=105)	对照组(n=123)	统计量	P值
年龄(x±s，岁)	70.7±4.5	71.6±5.0	1.424^a	0.158
性别(例)			2.263^b	0.132
男性	60	58
女性	45	65
骨折类型(例)			0.519^b	0.771
股骨颈骨折	74	91
股骨转子间骨折	26	28
股骨转子下骨折	5	4
手术类型(例)			0.027^b	0.987
髋关节置换术	48	55
髓内钉内固定	29	35
人工股骨头置换术	28	33
合并症(例)
高血压	22	21	0.557^b	0.455
糖尿病	13	11	0.711^b	0.399
冠心病	7	9	0.037^b	0.848
脑梗死	5	5	0.066^b	0.798
注：^a为t值，^b为χ²值。

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表 2 2组行髋关节手术患者住院期间手术相关指标比较

Table 2. Comparative assessment of surgical-related indicators during hospitalization for patientsundergoing hip joint surgery between two groups

组别	例数	术前等待时间(x±s，d)	术后入住ICU[例(%)]	术后下床时间(x±s，d)	住院时间(x±s，d)	30 d再入院[例(%)]
观察组	105	1.62±0.35	3(2.86)	1.68±0.36	5.62±1.76	3(2.86)
对照组	123	2.70±0.52	12(9.76)	2.37±0.52	8.27±2.52	12(9.76)
统计量		18.073^a	4.387^b	11.448^a	9.047^a	4.387^b
P值		< 0.001	0.036	< 0.001	< 0.001	0.036
注：^a为t值，^b为χ²值。

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表 3 2组行髋关节手术患者术后并发症发生情况比较[例(%)]

Table 3. Comparison of postoperative complications in patients undergoing hip joint surgery between two groups [cases (%)]

组别	例数	肺部感染	切口感染	下肢深静脉血栓	术后谵妄
观察组	105	3(2.86)	5(4.76)	9(8.57)	3(2.86)
对照组	123	12(9.76)	16(13.01)	22(17.89)	6(4.88)
χ²值		4.387	4.606	4.184	0.194
P值		0.036	0.032	0.041	0.660

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表 4 2组行髋关节手术患者护理满意度比较[例(%)]

Table 4. Comparison of nursing satisfaction in patients undergoing hip joint surgery between two groups (%)]

组别	例数	非常满意	满意	不满意	满意度
观察组	105	70(66.67)	34(32.38)	1(0.95)	104(99.05)
对照组	123	49(39.84)	64(52.03)	10(8.13)	113(91.87)
注：2组满意度比较，χ²=6.355，P=0.012。

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