JOURNAL OF RARE AND UNCOMMON DISEASES, JUN. 2018,Vol.25, No.3, Total No.12865

作者简介:李九群,女,副主任护师,护理部副主任,骨科专科护理,主要研究方向:护理管理通讯作者:李九群 ·论着·

  关节置换术是上个世纪骨科学界的一次里程碑式

进展。众所周知,人工关节置换术需要一个可持续

的、高质量的护理模式,随着人口逐渐老龄化,这种

需要将会越来越迫切。文献报道,预计到2030年,美

国的人工髋关节置换术将增长174%,而人工膝关节

置换术更是增长达673%[1]。我国目前尚无这方面的数医康护一体化模式在全膝关节置换患者临床路径中的应用*北京大学深圳医院运动医学与康复科 (广东 深圳 518036)

李九群 王凤卿 肖银贵 胡会英 高心灵 张洪雷

【摘要】目的 探讨医康护一体化模式在全膝关节置换患者临床路径中的应用效果。方法 将150例患者按入院的先后顺序随

机分为实验组、对照Ⅰ组和对照Ⅱ组。实验组在医康护一体化模式下通过整合疗理计划实施临床路径,对照Ⅰ组实施常规护理,对照Ⅱ组实施单纯临床护理路径。比较三组患者病人满意度、住院费用(除人工关节材料)、住院时间、膝关节功能评分(HSS)、术后并发症发生率。结果 实验组术后并发症发生率明显低于对照Ⅰ组和对照Ⅱ组,而对照Ⅱ组明显低于对照Ⅰ组(P<0.05);术前膝关节功能评分无明显差异性(P>0.05),术后实验组膝关节功能评分明显高于其他两组,而对照Ⅱ组明显高于对照Ⅰ组(P<0.05);实验组与对照Ⅰ组、对照Ⅱ组比较, 对照Ⅱ组与对照Ⅰ组比较,病人住院时间缩短,费用大幅降低,病人满意度提高(均P<0.05)。结论 在全膝关节置换患者中应用医康护一体化模式,能缩短患者住院日、降低住院费用,有效预防术后并发症,促进患者的功能康复,提高患者满意度,是值得推广的一种工作模式。

【关键词】医康护一体化模式;全膝关节置换;临床路径

【中图分类号】R658.3;R49

【文献标识码】A 【基金项目】深圳市科技创新研发资金基础研究项目(JCYJ20140415162338793)

DOI:10.3969/j.issn.1009-3257.2018.03.026

The Application of Doctor-therapist-nurse Mode in the Clinical Pathway of Total Knee Arthroplasty*

LI Jiu-qun, WANG Feng-qing, XIAO Yin-gui, et al., Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhan 518036, Guangdong Province, China [Abstract] Objective The study was to discuss the effect of the application of doctor-therapist-nurse mode in the clinical pathway for total knee arthroplasty. Methods second control group. The test group was carried out clinical pathway by the integrated therapy process under doctor-therapist-nurse mode. While the first and the second control group was practised the routine nursing and the clinical pathway nursing respectively. Then, the incidence of postoperative complication, the hospital for special surgery knee score (HSS), the hospital stay, the hospital charge (except the artificial prosthesis), and the patient satisfaction were compared among the three groups. Results than the test group in the incidence of postoperative complication, the hospital stay and the hospital charge obviously (P<0.05). The HSS had no difference among the three groups preoperatively (P>0.05), however, it was evident that the second control group got a higher score than the first control group but lower than the test group postoperatively (P<0.05). The second control group was higher than the first control group but lower than the test group in the patient satisfaction obviously (P<0.05). Conclusion The doctor-therapist-nurse mode could shorten the hospital stay, reduce the hospital charge, prevent the incidence of postoperative complication, promote the functional recovery and improve the satisfaction in total knee arthroplasty, which is a worth spreading mode.[Key words] Doctor-therapist-nurse Mode; Total Knee Arthroplasty; Clinical Pathway

据,但即将迎来一次大规模增长却是不争的事实。研究表明,即使是简单的临床路径如早期活动、避免留置导尿管、多通道给药策略等,也能够减少全膝关节置换术(TKA)的并发症,降低30天内的再入院率,缩短住院时间(HLOS)[2-12]。但遗憾的是,我国原有的临床路径都是由单学科成员(如管理者、护士等)开