基于加速康复外科理念的护理模式结合耳穴埋豆在老年髋部骨折围手术期中的应用

杨嫦; 骆国钢; 周敏捷

doi:10.16766/j.cnki.issn.1674-4152.003314

基于加速康复外科理念的护理模式结合耳穴埋豆在老年髋部骨折围手术期中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003314

温州市中西医结合医院创伤骨科二，浙江温州 325000

基金项目:

浙江省温州市卫生健康委项目 Y20220526

浙江省中医药科技计划项目 2021ZB275

详细信息

通讯作者:
骆国钢，E-mail：fa62pufei@163.com

中图分类号: R473.6 R683.3
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- 文章访问数: 96
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- 被引次数: 0
出版历程
- 收稿日期: 2023-07-28
- 网络出版日期: 2024-01-29

Application of nursing model based on enhanced recovery after surgery concept combined with ear point embedding in the perioperative period of elderly hip fractures

Orthopaedic Trauma Ⅱ Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨基于加速康复外科(ERAS)理念的护理模式结合耳穴埋豆对老年髋部骨折患者术后疼痛、负性情绪和睡眠质量的影响。方法选取2022年11月—2023年5月温州市中西医结合医院收治的200例老年髋部骨折手术患者，采用随机数字表法将其随机分为对照组(100例)和观察组(100例)。对照组实施基于ERAS理念的围手术期常规护理，观察组在此基础上给予耳穴埋豆干预。比较2组疼痛程度[视觉模拟评分法(VAS)]、疼痛介质[前列腺素E2(PGE2)、β-内啡肽(β-EP)]、焦虑情况[焦虑自评量表(SAS)]以及睡眠质量[匹兹堡睡眠质量指数(PSQI)]。结果观察组术后24 h、48 h和72 h VAS疼痛评分低于对照组(均P＜0.05)；观察组术后24 h、48 h和72 h PGE2和β-EP水平低于对照组(均P＜0.05)；观察组干预后SAS评分为(33.45±4.78)分，低于对照组的(38.90±6.09)分(t=7.040, P＜0.05)；观察组干预后PSQI评分为(9.10±1.23)分，低于对照组的(12.45±3.02)分(t=10.273, P＜0.05)。结论基于ERAS理念的护理模式结合耳穴埋豆可有效缓解老年髋部骨折患者术后疼痛，消除焦虑情绪，提高睡眠质量，对患者早日康复有积极的意义。
- 髋部骨折 /
- 中医适宜技术 /
- 耳穴埋豆 /
- 疼痛 /
- 加速康复外科 /
- 焦虑
Abstract: Objective To investigate the effects of a medical care model based on the concept of enhanced recovery after surgery (ERAS) combined with ear point embedding on postoperative pain, negative emotions and sleep quality in elderly hip fracture patients. Methods Selected 200 elderly hip fracture patients who admitted to Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from November 2022 to May 2023, and divided into control group (100 cases) and observation group (100 cases) by digital table method, the control group received perioperative routine care based on ERAS concept, and the observation group received ear point embedding intervention on this basis. Pain severity [visual analogue scale (VAS)], pain mediators [prostaglandin E2 (PGE2), beta-endorphin (β-EP)], anxiety status [self-rating anxiety scale (SAS)] and sleep quality [Pittsburgh sleep quality index (PSQI)] were compared between the two groups. Results The VAS scores of the observation group at 24 h, 48 h and 72 h were lower than those of the control group (P < 0.05); the levels of PGE2 and β-EP at 24 h, 48 h and 72 h after surgery were lower than those in the control group (P < 0.05). The SAS score after surgery was (33.45±4.78)points, which was lower than that in the control group[(38.90±6.09) points, t=7.040, P < 0.05]. The PSQI score after the intervention was (9.10±1.23) points, which was lower than that in the control group[(12.45±3.02) points, t=10.273, P < 0.05]. Conclusion The care model based on the ERAS concept, combined with ear point embedding, can effectively reduce postoperative pain in elderly hip fracture patients, eliminate anxiety, improve sleep quality and have a positive impact on early patient recovery.
- Hip fracture /
- Appropriate technology of TCM /
- Ear point buried beans /
- Pain /
- Enhanced recovery after surgery /
- Anxiety

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表 1 2组髋部骨折患者一般资料比较

Table 1. Comparison of the general data between two groups in patients with hip fracture

组别	例数	性别[例(%)]		年龄(x±s，岁)	BMI (x±s)	合并疾病[例(%)]			手术方式[例(%)]
组别	例数	男性	女性	年龄(x±s，岁)	BMI (x±s)	糖尿病	高血压	高血脂	内固定	髋关节置换术
对照组	100	53(53.0)	47(47.0)	66.23±5.10	21.09±2.78	30(30.0)	46(46.0)	12(12.0)	44(44.0)	56(56.0)
观察组	100	59(59.0)	41(41.0)	66.10±5.04	21.16±3.45	25(25.0)	49(49.0)	10(10.0)	39(39.0)	61(61.0)
统计量		0.731^a		0.181^b	0.158^b	0.627^a	0.181^a	0.204^a	0.515^a
P值		0.393		0.856	0.875	0.428	0.671	0.651	0.473
注：^a为χ²值，^b为t值。

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表 2 2组髋部骨折患者不同时间点疼痛情况比较(x ±s，分)

Table 2. Comparison of pain at different time points between 2 groups in patients with hip fracture (x ±s, points)

组别	例数	干预前	术后24 h	术后48 h	术后72 h	F值	P值
对照组	100	7.57±1.34	6.01±1.24^a	5.78±1.10^a	4.90±1.11^a	9.023	＜0.001
观察组	100	7.43±1.45	5.27±1.23^a	4.43±1.34^a	3.89±0.56^a	13.568	＜0.001
t值		0.709	4.237	7.787	8.124
P值		0.479	＜0.001	＜0.001	＜0.001
注：与同组干预前比较，^aP＜0.05。

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表 3 2组髋部骨折患者不同时间点疼痛介质水平比较(x ±s, pg/mL)

Table 3. Comparison of pain media levels at different time points between two groups in patients with hip fracture (x ±s, pg/mL)

组别	例数	PGE2				F值	P值
组别	例数	干预前	术后24 h	术后48 h	术后72 h	F值	P值
对照组	100	13.03±2.45	20.56±2.34^a	18.77±2.77^a	16.90±3.11^a	10.235	＜0.001
观察组	100	13.14±2.09	17.53±2.29^a	15.70±3.09^a	13.09±2.17	15.356	＜0.001
t值		0.342	9.254	7.398	10.047
P值		0.733	＜0.001	＜0.001	＜0.001

组别	例数	β-EP				F值	P值
组别	例数	干预前	术后24 h	术后48 h	术后72 h	F值	P值
对照组	100	89.09±10.23	140.98±15.67^a	125.23±16.78^a	100.22±19.34^a	7.123	＜0.001
观察组	100	88.79±7.89	131.45±16.78^a	119.23±14.56^a	94.19±9.23^a	10.456	＜0.001
t值		0.232	4.151	2.701	2.814
P值		0.817	＜0.001	0.008	0.005
注：与同组干预前比较，^aP＜0.05。

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表 4 2组髋部骨折患者不同时间点焦虑情况比较(x ±s，分)

Table 4. Comparison of anxiety at different time points between two groups in patients with hip fracture (x ±s, points)

组别	例数	干预前	手术前一晚	干预后	F值	P值
对照组	100	36.45±4.56	52.45±5.10^a	38.90±6.09^b	8.456	＜0.001
观察组	100	36.11±5.18	46.12±6.77^a	33.45±4.78^b	12.459	＜0.001
t值		0.493	7.468	7.040
P值		0.623	＜0.001	＜0.001
注：与同组干预前比较，^aP＜0.05；与同组手术前一晚比较，^bP＜0.05。

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表 5 2组髋部骨折患者睡眠质量比较(x ±s，分)

Table 5. Comparison of sleep quality between two groups in patients with hip fracture (x ±s, points)

组别	例数	干预前	干预后	t值	P值
对照组	100	16.56±2.09	12.45±3.02	11.191	＜0.001
观察组	100	16.34±3.10	9.10±1.23	21.708	＜0.001
t值		0.588	10.273
P值		0.557	＜0.001

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