曾颖 何平 吴胜秋 李萍

[關键词] 无痛病房;无栓病房;加速康复外科理念;老年骨折

[中图分类号] R473.2          [文献标识码] B          [文章编号] 1673-9701（2021）29-0162-05

The value of the Good Pain Management and No-Thrombus Management ward in the rehabilitation management of elderly patients with fracture

ZENG Ying   HE Ping   WU Shengqiu   LI Ping

Department of Orthopedics， the People′s Hospital of Jianyang City in Sichuan Province， Jianyang   641400， China

[Abstract] Objective To explore the value of the Good Pain Management （GPM） and No-Thrombus Management ward in the rehabilitation management of elderly patients with fracture. Methods A total of 300 elderly patients with fracture in the department of orthopedics of our hospital from December 2019 to December 2020，who were divided into the study group and the control group. The control group adopted routine postoperative rehabilitation management. For the study group， a GMP and No-Thrombus Management ward was constructed under the guidance of the concept of enhanced recovery after surgery. The related indicators during the intervention， the visual analogue pain （VAS） scores， Caprini scores and Generic Quality of Life Inventory-74 （GQOL-74） before and after the intervention，and patient′s satisfaction were compared between the two groups. Results The time to get out of bed， length of hospital stay and the incidence of deep venous thrombosis （DVT） in the study group were significantly lower than those in the control group， with statistically significant differences（P<0.05）.The VAS scores and Caprini scores in the study group were significantly lower than those in the control group at 3 days and 7 days after operation， with statistically significant differences（P<0.05）. The scores of physical function，mental state， social function， and material life in the study group after the intervention were significantly higher than those before the intervention in this group and those in the control group， with statistically significant differences（P<0.05）.The intervention satisfaction rate in the study group was 82.67%，which was significantly higher than that in the control group （72.00%），with statistically significant difference（P<0.05）. Conclusion The application of a GMP and No-Thrombus Management ward for rehabilitation management of elderly patients with fracture can significantly speed up patients′ postoperative recovery，reduce their postoperative pain and DVT risk， and improve their quality of life.It has higher clinical value.

[Key words] Good pain management ward; No-thrombus management ward; Concept of enhanced recovery after surgery; Fractures in the elderly

老年骨折患者包括创伤、退变、骨病等病种，其中有不少患者因疼痛而拒绝翻身、活动、功能锻炼等，从而增加压疮、下肢静脉血栓（Lower extremity venous thrombosis，DVT）等发生风险，因而需要给予老年骨折患者术后康复管理以改善其预后[1-2]。既往常规术后康复干预主要通过对症处理方式来实现，缺少一定针对性，而加速康复外科理念早期的倡导者及实践者是丹麦外科医生Kehlet，旨在通过多学科、多模式综合治疗保证患者围手术期安全、降低并发症发生率、促进患者术后早期功能恢复等[3-4]。目前，加速康复外科理念下无痛、无栓病房的建立是促进老年骨折患者术后康复的当务之急，但目前较少有研究对其构建方式进行深入探讨[5]。因此本研究收集相关病例进行对照试验，现报道如下。

1 资料与方法

1.1 一般资料

选择2019年12月至2020年12月在我院接受治疗的300例骨科老年骨折患者作为研究对象，按照抽签方式将其随机分为研究组和对照组，每组各150例，其中观察组男85例，女65例;年龄60～77岁，平均（68.23±4.67）岁;受伤原因包括交通事故42例，坠落伤41例，殴打伤38例，其他29例;骨折至手术时间4～30 d，平均（12.58±3.11）d;对照组男82例，女68例;年龄61～78岁，平均（69.86±3.79）岁;受伤原因包括交通事故48例，坠落伤40例，殴打伤35例，其他27例;骨折至手术时间4～30 d，平均（12.37±3.23）d。两组患者一般资料比较，差异无统计学意义（P>0.05），具有可比性。本研究经我院医学伦理委员会审核并批准实行。……