预见性循证护理在高龄腰椎手术患者术中获得性压力性损伤预防中的应用效果

吴敏; 谢婧怡; 励雯雯; 李兰兰; 董洲; 程惠敏

doi:10.16766/j.cnki.issn.1674-4152.004151

预见性循证护理在高龄腰椎手术患者术中获得性压力性损伤预防中的应用效果

doi: 10.16766/j.cnki.issn.1674-4152.004151

合肥市第一人民医院手术室，安徽合肥 230061

基金项目:

安徽省教育厅高等学校科研计划项目 2022AH050768

详细信息

通讯作者:
程惠敏，E-mail：13856046866@163.com

中图分类号: R473.6
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- 文章访问数: 14
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- 被引次数: 0
出版历程
- 收稿日期: 2024-11-15
- 网络出版日期: 2025-10-31

The application of a predictive nursing model based on evidence theory in preventing intraoperative acquired pressure injury in elderly patients with transforaminal lumbar interbody fusion

Department of Operating Rooms, the First People' s Hospital of Hefei, Hefei, Anhui 230061, China

摘要

摘要: 目的研究预见性循证护理模式在高龄腰椎手术(TLIF)患者术中获得性压力性损伤(IAPI)预防中的应用效果。方法研究对象为2021年2月—2024年2月在合肥市第一人民医院行TLIF治疗的高龄患者80例，以随机数字表法分为对照组(40例，采用常规护理干预)及观察组(40例，采用预见性循证护理模式干预)，比较2组患者的IAPI及并发症发生情况、IAPI严重程度、疼痛程度[视觉模拟评分法(VAS)]及腰背部功能[Oswestry功能量表(ODI)]。结果 (1) 术后72 h，2组患者IAPI发生部位比较差异无统计学意义(P＞0.05)，观察组患者IAPI发生率、损伤个数、损伤面积及并发症发生率均较对照组显著降低(P＜0.05)；(2)术后72 h，观察组患者IAPI为Ⅲ~Ⅳ级的占比较对照组显著降低(P＜0.05)；(3)术后30 min、3 d及1周时，2组患者VAS评分均降低，且观察组较对照组显著降低(P＜0.05)；(4)干预后，2组患者ODI评分均降低，且观察组较对照组显著降低[疼痛，(3.31±0.59)分vs. (3.67±0.52)分；个人综合功能，(8.14±2.26)分vs. (10.05±2.03)分；单项功能，(9.28±1.84)分vs. (10.53±1.72)分，均P < 0.05]。结论预见性循证护理模式用于TLIF高龄患者的护理中可有效预防IAPI的发生，缩小IAPI损伤面积，减轻IAPI严重程度及疼痛程度，改善腰背部功能。
- 循证护理 /
- 预见性护理模式 /
- 腰椎手术 /
- 获得性压力性损伤
Abstract: Objective To study the application effectiveness of a predictive nursing model based on evidence theory in preventing intraoperative acquired pressure injury (IAPI) in elderly patients with transforaminal lumbar interbody fusion (TLIF). Methods A total of 80 elderly patients who underwent TLIF treatment at the First People' s Hospital of Hefei from February 2021 to February 2024 were enrolled and randomly assigned to a control group (n=40, routine nursing intervention) and an observation group (n=40, predictive nursing model based on evidence theory on the basis of the control group) by random number table method. IAPI, complication rates, pain degree (visual analogue scale, VAS), and low back function (Oswestry disability indexes, ODI) were compared between the two groups. Results (1) At 72 h after operation, no significant difference in IAPI location was observed between the two groups (P>0.05), however, the incidence rate of IAPI, injury number, injury area, and complication rate in the observation group were lower than those in the control group (P < 0.05), respectively. (2) The proportion of IAPI classified as grade Ⅲ-Ⅳ in the observation group was lower than that in the other group (P < 0.05). (3) VAS scores decreased in both groups at 30 min, 3 d, and 1 week after surgery, with the observation group showing lower scores (P < 0.05). (4) ODI scores decreased in both groups after the intervention, with significantly lower scores observed in the observation group [pain, (3.31±0.59) points vs. (3.67±0.52) points; personal comprehensive function, (8.14±2.26) points vs. (10.05±2.03) points; single function, (9.28±1.84) points vs. (10.53±1.72) points, all P < 0.05]. Conclusion The application of predictive nursing model based on evidence theory in elderly patients with TLIF can effectively prevent the occurrence, area, and severity of IAPI, and improve lower back function.
- Evidence-based nursing /
- Predictive nursing model /
- Transforaminal lumbar interbody fusion /
- Intraoperative acquired pressure injury

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表 1 2组行TLIF治疗的高龄患者一般资料比较

Table 1. Comparison of general data between two groups of elderly patients who underwent TLIF treatment

组别	例数	性别(例)		年龄(x±s，岁)	损伤节段(例)		手术原因(例)
组别	例数	男性	女性	年龄(x±s，岁)	L_4~5段	L₅~S₁段	椎管狭窄	椎管滑脱	椎间盘突出
观察组	40	23	17	68.64±3.87	26	14	29	7	4
对照组	40	26	14	67.47±4.12	22	18	27	8	5
统计量		0.474^a		1.309^b	0.833^a		0.249^a
P值		0.491		0.194	0.361		0.883
注：^a为χ²值，^b为t值。

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表 2 2组行TLIF治疗的高龄患者IAPI及并发症发生情况比较

Table 2. Comparison of IAPI and the occurrence of complications between two groups of elderly patients treated with TLIF

组别	例数	颊部[例(%)]	肩部[例(%)]	膝部[例(%)]	脚趾[例(%)]	IAPI发生[例(%)]	损伤个数(x±s，个)	损伤面积(x±s，cm²)	并发症[例(%)]
组别	例数	颊部[例(%)]	肩部[例(%)]	膝部[例(%)]	脚趾[例(%)]	IAPI发生[例(%)]	损伤个数(x±s，个)	损伤面积(x±s，cm²)	感染	神经损伤	血肿	肢体麻木	总发生
观察组	40	1(2.50)	1(2.50)	1(2.50)	1(2.50)	4(10.00)	2.49±0.64	4.82±1.56	1(2.50)	0	0	0	1(2.50)
对照组	40	3(7.50)	3(7.50)	4(10.00)	2(5.00)	12(30.00)	2.91±0.58	6.05±1.63	3(7.50)	1(2.50)	3(7.50)	1(2.50)	8(20.00)
统计量		1.053^a	1.053^a	1.920^a	0.346^a	5.000^a	3.075^b	3.448^b	0.263^a		1.385^a		4.510^a
P值		0.305	0.305	0.166	0.556	0.025	0.003	0.001	0.608	0.999	0.239	0.999	0.034
注：^a为χ²值，^b为t值。

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表 3 2组行TLIF治疗的高龄患者IAPI严重程度比较[例(%)]

Table 3. Comparison of the severity of IAPI in two groups of elderly patients treated with TLIF[cases (%)]

组别	例数	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级
观察组	40	0	3(7.50)	1(2.50)	0
对照组	40	0	1(2.50)	7(17.50)	4(10.00)
注：2组IAPI严重程度比较，Z=2.310，P=0.021。

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表 4 2组行TLIF治疗的高龄患者疼痛程度比较(x±s，分)

Table 4. Comparison of pain degree between two groups of elderly patients who underwent TLIF treatment(x±s, points)

组别	例数	术前	术后30 min	术后3 d	术后1周	F值	P值
观察组	40	7.42±1.87	4.12±1.05^a	3.56±0.66^ab	2.76±0.68^abc	43.563	＜0.001
对照组	40	7.03±1.94	4.98±0.91^a	4.01±0.58^ab	3.28±0.59^abc	28.724	＜0.001
F值		0.915	4.129	3.564	3.927
P值		0.363	＜0.001	＜0.001	＜0.001
注：与同组术前比较，^aP＜0.05；与同组术后30 min比较，^bP＜0.05；与同组术后3 d比较，^cP＜0.05。

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表 5 2组行TLIF治疗的高龄患者腰背部功能比较(x±s，分)

Table 5. Comparison of lumbar and dorsal function between two groups of elderly patients treated with TLIF(x±s, points)

组别	例数	疼痛		个人综合功能		单项功能
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
观察组	40	7.56±1.03	3.31±0.59	14.76±2.02	8.14±2.26	15.52±1.76	9.28±1.84
对照组	40	7.19±1.12	3.67±0.52	14.24±2.17	10.05±2.03	15.29±1.83	10.53±1.72
统计量		1.538^a	2.895^b	1.109^a	3.976^b	0.573^a	3.139^b
P值		0.128	0.005	0.271	＜0.001	0.568	0.002
注：^a为t值，^b为F值。

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