三联预康复策略在退行性脊柱侧弯患者围术期的应用效果-中华老年骨科与康复电子杂志

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Title:: Application and effectiveness evaluation of the triple pre-rehabilitation strategy in the perioperative period of patients with degenerative scoliosis

作者:: 李美娜; 宋艳丽; 杨姗姗; 李聚彩; 罗慧利; 吕杰; 050011 石家庄，河北医科大学第三医院脊柱外科

Author(s):: Li Meina; Song Yanli; Yang Shanshan; Li Jucai; Luo Huili; Lyu Jie; Department of Spinal surgery, Hebei medical university third hospital, Shijiazhuang 050011, ChinaCommunication author: Lyu Jie, Email:ssylvjie@163.com

关键词:: 三联预康复策略; 退行性脊柱侧弯; 效果评价

Keywords:: Triple pre-rehabilitation strategy; Degenerative scoliosis; Effect evaluation

DOI:: 10.3877/cma.j.issn.2096-0263.2023.06.005

文献标志码:: A

摘要:: 目的研究并分析三联预康复策略对退行性脊柱侧弯患者围术期的运动功能、营养状况和心理状况康复的影响。方法纳入2019年1月至2022年12月于我院脊柱外科就诊的107例退行性脊柱侧弯患者为研究对象，试验组患者采用三联预康复策略，对照组患者采用常规护理策略。所有患者均于入院、手术前1 d、出院当天记录视觉模拟评分法视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、焦虑自评量表（SAS）、自我心理状态评分（SDS），于入院及出院当天记录患者健康调查简表（SF-36）评分，同时记录术前、术后1 d及出院当天血红蛋白、白蛋白及总蛋白数值。结果试验组和对照组入院、术前及出院时VAS评分及ODI指数进行重复测量设计的方差分析，结果显示VAS评分与ODI评分不同组别间差异无统计学意义，不同时间点间差别有统计学意义（P＜0.05），组别与时间点间存在交互作用,进一步分析单独效应，入院和术前两组差别无统计学意义，出院时两组差异有统计学意义（P＜0.05），对照组及试验组各时间点间差异均有统计学意义（P＜0.05）；两组患者满意度比较，试验组患者表现出更高的满意度（P＜0.05）；两组SF-36评分进行重复测量设计的方差分析显示不同组别间差异无统计学意义，不同时间点间除生理职能外差异有统计学意义（P＜0.05），组别与时间点间躯体疼痛、一般健康状况有交互作用，其余维度无交互作用。对照组在生理机能、躯体疼痛、精力、社会功能、情感职能、精神健康维度各时间点间差异均有统计学意义（P＜0.05），试验组在生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康和健康变化维度各时间点间差异均有统计学意义（P＜0.05）。两组患者接受不同的处理策略的主效应有差别，不同组别的护理策略主效应有差别。患者入院时、术后即刻、出院时血红蛋白、总蛋白及白蛋白含量重复测量设计的方差分析显示不同组别间差异无统计学意义，不同时间点间差别均有统计学意义（P＜0.05），除血红蛋白外组别与时间点间有交互作用，对照组及试验组各时间点间差异均有统计学意义（P＜0.05）。患者入院及出院SAS及SDS评分经重复测量设计的方差分析显示不同组别间差异无统计学意义，不同时间点间差异有统计学意义（P＜0.05），SDS评分组别与时间点间有交互作用。对照组及试验组各时间点间差异均有统计学意义（P＜0.05），两组患者接受不同处理策略的主效应有差别，不同组别的护理策略主效应有差别。结论三联预康复策略综合护理对退行性脊柱侧弯患者术后运动功能、营养状况和心理健康的康复中具有积极意义，可在临床护理工作中进行推广应用。

Abstract:: Objective To explore and analyze the effect of triple prehabilitation strategy on perioperative motor function, nutritional status and psychological status in patients with degenerative spine scoliosis (DSS). Methods A total of 107 patients with degenerative scoliosis who were treated in the Department of Spinal Surgery of our hospital from January 2019 to December 2022 were included as the research objects. The patients in the experimental group were given triple pre-rehabilitation strategy, and the patients in the control group were given routine nursing strategy. Visual Analogue Scale (VAS), Oswestry disability index (ODI) and self-rating anxiety Scale (SAS) were recorded at admission, 1 day before surgery and on the day of discharge SF-36 scores were recorded on the day of admission and discharge. Hemoglobin, albumin, and total protein values were recorded before operation, 1 day after operation and on the day of discharge. Results The VAS score and ODI score showed no statistically significant difference between different groups and there was statistically significant difference between different time points (P<0.05). There was interaction between groups and time points. Further analysis of individual effects showed no statistically significant difference between the two groups at admission and before surgery. There were statistically significant differences between the two groups at discharge (P<0.05), and there were statistically significant differences between the control group and the experimental group at each time point (P<0.05). Patient satisfaction also differed significantly between the two groups, with higher satisfaction reported by patients in the experimental group (P<0.05). The repeated measurement design analysis of variance between the experimental group and the control group in the SF-36 score showed no statistical significance between different groups (P>0.05), and there were statistically significant differences between different time points except for physiological functions (P<0.05). There were interactions between groups and time points in physical pain and general health status, but no interactions in other dimensions. In the control group, there were statistically significant differences in physiological function, physical pain, energy, social function, emotional function, and mental health at each time point (P<0.05). There were statistically significant differences in physiological function, physiological function, physical pain, general health status, energy, social function, emotional function, mental health, and health change among the experimental groups at each time point (P<0.05). The main effect of the two groups receiving different treatment strategies was different, and the main effect of nursing strategies was different in different groups. The repeated measurement of hemoglobin, total protein, and albumin contents at admission, immediately after surgery, and at discharge showed no statistical significance between different groups, and statistically significant differences at different time points (P<0.05), except for hemoglobin, there was interaction between groups and time points. There was statistical significance between control group and experimental group at each time point (P<0.05). SAS and SDS scores at admission and discharge showed no significant difference among different groups, but significant difference among different time points (P<0.05). SDS scores interacted with time points. There were statistically significant differences between control group and experimental group at each time point (P<0.05). Conclusion The comprehensive nursing of triple prehabilitation strategy has a positive significance in the rehabilitation of postoperative motor function, nutritional status and mental health of patients with degenerative scoliosis, which can be promoted and applied in clinical nursing work.

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

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