黎燕　丁心逸　　舒曼　　夏臣杰

[關键词] “互联网+”延续护理;全膝关节置换术;关节功能;生活质量;服药依从性

[中图分类号] R473.5          [文献标识码] B          [文章编号] 1673-9701（2021）16-0180-04

Impacts of "internet plus" extended nursing on functional rehabilitation and oral anticoagulation compliance after total knee arthroplasty

LI Yan1， 2   DING Xinyi1   SHU Man2   XIA Chenjie1

1.Zhejiang Chinese Medical University， Hangzhou   310053， China; 2.Zhejiang Hospital， Hangzhou   310030， China

[Abstract] Objective To explore the impacts of "internet plus" extended nursing on functional rehabilitation and oral anticoagulation compliance after total knee arthroplasty. Methods A follow-up research was conducted on 60 patients undergoing total knee arthroplasty （TKA） admitted to our hospital from June 2018 to June 2019. According to the nursing mode adopted after discharge， 60 patients were divided into the control group（n=30） and the intervention group （n=28）. The control group was treated with conventional home nursing， while the intervention group was treated with "internet plus" extended nursing. The American hospital for special surgery（HSS） knee joint score and quality of life （QOL） score were adopted to compare knee joint function and QOL between the two groups of patients. According to whether oral anticoagulants were taken continuously or not， the medication compliance of two groups of patients was evaluated and compared. Results Within 1 and 3 months after discharge， the HSS scores of patients in the intervention group were （65.310±7.981） points and （86.342±9.101） points， which were significantly higher than （60.432±7.319） points and （71.138±7.733） points in the control group（P<0.05）. The QOL scores of the intervention group were （77.530±2.682） points and （94.408±3.912） points， which were significantly higher than （69.228±2.481） points and （86.611±2.141） points of the control group（P<0.05）. Within 1 month after discharge，the compliance of patients in the intervention group with oral anticoagulant drugs was higher than that in the control group（P=0.043）， and the incidence of deep vein thrombosis was 3.6%， which was significantly lower than 9.4% in the control group（P=0.704）. Conclusion "Internet plus" extended nursing can raise the compliance of oral anticoagulant drugs for patients returning home after TKA operation， improve knee joint function， and fundamentally increase the QOL of patients， which is worthy of clinical promotion.

[Key words] "Internet plus" extended nursing; Total knee arthroplasty; Joint function; Quality of life; Compliance with medication

全膝关节置换术（Total knee arthroplasty，TKA）是临床上治疗各类终末期膝关节病患的有效方式[1]。通过植入人工假体，修复磨损的关节表面，帮助患者解决疼痛畸形、改善关节功能、提高生活质量。然而，TKA术后患者需要长时间的康复护理及抗凝治疗，来预防膝关节粘连僵硬、深静脉血栓（Deep venous thrombosis，DVT）等严重并发症的发生。据统计，我国关节置换术后DVT发生率超过50%[2]，影响患者术后功能康复的同时，也是诱发肺栓塞导致患者围手术期死亡的主要原因[3]。

由于医疗资源紧张，病床周转率加快，使得TKA术后患者康复护理的大部分时间需要自行在家中进行。患者由于惧怕疼痛、缺乏专业的指导及服药依从性差等因素，往往会错失最佳干预时机，延缓关节功能康复进程，增加DVT发生风险。随着互联网在医疗领域的普及，基于“互联网+”延续护理模式逐渐成为指导与管理骨科术后归家患者的重要方法[4]。区别于依赖“患者及家属为主”的常规家庭护理模式，“互联网+”延续护理旨在通过各种现代信息手段，包括微信平台、QQ及自媒体视频等，来横向拓宽照护深度，纵向延伸地护理服务的时间[5]。本文回顾性研究2018年6月至2019年6月KTA术后接受“互联网+”延续护理和常规家庭护理患者共60例，比较前者在指导膝关节功能康复及增加抗凝药物服用依从性的优势，现报道如下。

1 资料与方法