腰椎退行性疾病患者术后翻身角度对脊柱中立位维持时长的影响  

Impact of postoperative turnover angle on the duration of maintaining spinal neutral position in patients with lumbar degenerative disease

作　　者：韩冰[1] 黄洁[2] 刘名名[2] 王玉梅[2] 闫硕[2] 门鑫 王立芳 刘华平[4] Han Bing;Huang Jie;Liu Mingming;Wang Yumei;Yah Shuo;Men Xin;Wang Lifang;Liu Huaping(Nursing Department,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing 100035,Chin;Clinical Epidemiology Research Center,Beijing Jishuitan Hospital,Beijing 100035,China;School of Nursing,Peking Union Medical College,Beijing 100144,China)

机构地区：[1]北京积水潭医院护理部,100035 [2]北京积水潭医院脊柱外科,100035 [3]北京积水潭医院临床流行病学研究室,100035 [4]中国医学科学院北京协和医学院护理学院,100144

出　　处：《中华现代护理杂志》2018年第19期2271-2275,共5页Chinese Journal of Modern Nursing

摘　　要：目的探讨腰椎退行性疾病术后卧床期间不同翻身角度对患者脊柱中立位维持时长的影响。方法选取2016年12月-2017年6月某三甲医院脊柱外科收治的腰椎退行性疾病行传统开放式手术的患者共201例，采用现况调查的方法，观察并记录患者卧床期间不同翻身角度下的脊柱中立位维持情况，根据术后卧床24h内的翻身角度将患者分成A组（小角度，持续≤60°；n=61）、B组（大角度，持续〉60°但≤90°；n=80）、C组（无规律，既有≤60°，也有〉60°但均≤90°；n=60）3组。3组患者维持脊柱中立位维持时长呈偏态分布，采用中位数和四分位数[M（P25，P75）]表示，组间比较采用秩和检验。结果3组患者的一般资料及临床资料差异无统计学意义（P〉0．05）。在脊柱中立位维持时长方面，B组[90．0（82．5，98．7）min]〉c组[64．8（56．7，78．9）min]〉A组[52．5（45．0，60．0）min]，3组间差异有统计学意义（Z=133．274，P〈0．01）；两两比较结果也显示各组间的差异均有统计学意义（P〈0．01）。结论大于60°的侧卧位更有利于维持患者侧卧期间的脊柱中立位，但各角度维持脊柱中立位的侧卧位时长均未达到2h。在制定腰椎退行性疾病术后卧床患者翻身护理常规时，要适时缩短翻身间隔，以保证患者在侧卧位时脊柱中立位的维持。Objective To investigate the impact of different turnover angles on the duration of maintaining spinal neutral position after surgery in patients with lumbar degenerative disease. Methods From December 2016 to June 2017, a total of 201 patients undergoing traditional open surgery for lumbar degenerative diseases from the Department of Spine Surgery of a Class Grade Ⅲ A hospital in Beijing were selected as the research object. A cross-sectional study was conducted to observe and record the maintenance of the neutral position of the spine while the patients were at different turnover angles during bed rest. According to the turnover angle within 24 hours after the operation, the patients were divided into three groups, group A （turnover angle sustained ≤ 60° ; n=61）, group B （sustained 〉 60° and 90° ; n=80）, group C （turnover angle ≤ 60° or 〉 60° , but allways ≤ 90° ; n=60）. Maintaining duration of the neutral position of the spine showed skew distribution. Median and four quantile [ M （P25, P75） ] were used, and rank sum test was used for comparison among groups. Results There was no significant difference in general condition and clinical data between the three groups （P 〉 0.05）. In terms of neutral position maintenance, group B [ 90.0 （82.5, 98.7 min） ] was better than group C [ 64.8 （56.7, 78.9） min] which was superior to group A [ 52.5 （45.0, 60.0） min ]. There were significant differences among the three groups （Z=133.274, P 〈 0.01）. The results also showed statistically significant differences between each two groups （P 〈 0.01）. Conclusions The turnover angle of more than60° is more beneficial to maintain the neutral position of the spine during lateral recumbency. However, the length for maintaining the neutral position of the spine from all angles does not reach 2 hours. Therefore, when it comes to the postoperative nursing care of turning over for bedbound patients with lumbar degenerative disease, it is necessary to shorten the turning in

关 键 词：体位 手术后医护 腰椎退行性疾病 卧床 翻身角度 脊柱中立位 

分 类 号：R687.3[医药卫生—骨科学]