互動達標理論的延續性照護在加速康復外科人工髖關節置換術后患者中的應用效果

努爾古麗·買提哈提　史凌云　王新玲

[摘要] 目的 探討應用互動達標理論在加速康復外科（ERAS）人工髖關節置換術（THA）患者實施延續性照護的效果及評價。 方法 選取2017年12月～2018年7月新疆醫科大學第一附屬醫院關節外科的THA患者102例，采用隨機數字表法將患者分為實驗組和對照組，每組各51例，對照組采取傳統出院與隨訪護理模式，實驗組在此基礎上采用互動達標理論進行延續性照護。比較兩組患者出院后的髖關節功能（Harris）評分、日常生活能力（ADL）評分、疼痛評分、并發癥發生率及滿意度。 結果 實驗組患者術后隨訪期間Harris評分、ADL評分及患者滿意度均高于對照組，而疼痛評分和并發癥發生率低于對照組，差異有統計學意義或高度統計學意義（P < 0.05或P < 0.01）。結論 在ERAS模式下的THA患者中應用互動達標理論實施延續性照護取得良好效果，有助于進一步促進患者的院外早期康復，豐富和完善ERAS與優質護理服務的內涵，值得在臨床實踐中推廣。

[關鍵詞] 互動達標理論;加速康復外科;人工髖關節置換術;延續性照護

[中圖分類號] R473.6? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）06（b）-0140-04

Application effect of continuous care of interactive standard theory in patients after artificial hip replacement in accelerated rehabilitation surgery

NVRGUL·Mithat1? ?SHI Lingyun2? ?WANG Xinling3

1.School of Nursing of Xinjiang Medical University， Xinjiang Uygur Autonomous Region， Urumqi? ?830011， China; 2.Department of Joint Surgery， the First Affiliated Hospital， Xinjiang Uygur Autonomous Region， Urumqi? ?830011， China; 3.Nursing Department， the Fifth Affiliated Hospital of Xinjiang Medical University， Xinjiang Uygur Autonomous Region， Urumqi? ?830011， China

[Abstract] Objective To investigate the effect and evaluation of continuous care in patients undergoing artificial hip replacement （THA） by using Interactive standard theory in enhanced recovery after surgery （ERAS）. Methods From December 2017 to July 2018， 102 patients with THA in Joint Surgery Department of the First Affiliated Hospital of Xinjiang Medical University were selected， patients were divided into experimental group and control group by random number table method. The control group adopted traditional discharge and follow-up nursing mode， and the experimental group adopted interactive standard theory for continuous care on this basis. The scores of hip joint function （Harris）， daily living ability （ADL）， pain， complication rate and satisfaction after discharge were compared between the two groups. Results During postoperative follow-up， Harris score， ADL score and patient satisfaction of the experimental group were higher than those of the control group， while pain score and complication rate were lower than those of the control group. The difference was statistically significant （P < 0.05 or P < 0.01）. Conclusion In the case of THA patients in ERAS mode， the application of interactive compliance theory to implement continuity care achieved good results， which is conducive to further promoting the early out-of-hospital rehabilitation of patients and enriching and improving the connotation of ERAS and high-quality nursing service， which is worth promoting in clinical practice.

規范隨訪內容：隨訪組護士根據每個患者的康復目標，從健康教育、飲食情況、胃腸道情況、按時用藥、疼痛程度、切口情況、不適主訴、功能鍛煉情況、門診復查8個方面進行隨訪并指導，將患者的回訪結果逐項記錄在出院患者記錄本上，并囑患者記錄在隨訪手冊上，以便日后查看[11]。

隨訪達標評價與質量控制：組長與組員共同評價每位患者出院后3個月內康復目標的達標情況及隨訪干預的效果。如果目標達到，結束互動達標隨訪護理;如果目標未達到，則需進一步分析，與患者及其家屬共同尋找原因后，修改原有護理措施和計劃，并再次實施隨訪干預措施，直至達標。……