加速康复外科理念下全膝关节置换患者术后早期下床活动现状调查  

The clinical study of early ambulation in patients with Total Knee Arthroplasty under the guidance of fast track surgery

作　　者：向娜[1] 马玉芬 高娜[3] 佟冰渡[3] 刘翱搏 陈妍君 王阳阳 李杨[1] XIANG Na;MA Yufen;GAO Na;TONG Bingdu;LIU Aobo;CHEN Yanjun;WANG Yangyang;LI Yang(School of Nursing,Peking Union Medical College,Beijing,100144,China)

机构地区：[1]北京协和医学院护理学院,100144 [2]中国医学科学院北京协和医院护理部 [3]中国医学科学院北京协和医院骨科

出　　处：《中国护理管理》2018年第11期1544-1549,共6页Chinese Nursing Management

摘　　要：目的 :调查全膝关节置换患者术后早期下床活动的现状。方法 :便利抽取符合入选标准的北京市某三级甲等医院骨科病房190名行全膝关节置换手术的患者,采用自行设计问卷调查患者一般情况、疾病情况与手术情况,以及患者早期下床活动情况。结果 :190例患者中,术后24小时内下床活动者占8.4%,术后24～48小时下床活动者占54.2%,术后48～72小时下床活动者占32.1%,首次下床最早时间为术后7.5小时,单侧和双侧全膝关节置换患者首次下床时间均主要在术后第2～3天;首次下床活动时间范围为3～5分钟;首次下床活动距离为0～250 m;首次下床活动范围主要在床边;首次下床活动的辅助者主要为医生。早期下床组患者与未早期下床组患者相比,早期下床组患者术后导尿管和伤口引流管拔除时间更早(P=0.017,P=0.037)、术后24小时内停止心电监护人数更多(P=0.049)、术后首次直腿抬高时间更早(P=0.01)、术后24小时白蛋白ALB数值更高(P=0.009),另外,早期下床组患者比未早期下床组患者康复自我效能水平高(P<0.01)、下床意愿更强烈(P=0.021),差异均有统计学意义。结论 :全膝关节置换患者术后首次下床时间主要集中在术后第2～3天,首次下床活动形式单一,多为床边站立及平地行走。Objective： To investigate the early ambulation of patients with Total Knee Arthroplasty （TKA）. Method： A convenienced sample of 190 patients with TKA from a Beijing three-level hospital were investigated with a self-designed early ambulation questionnaire. Results： Totally 8.4% of the 190 patients ambulated within 24 hours after surgery, 54.2% within 24 to 48 hours, and 32.1% within 48 to 72 hours after surgery. The earliest time of ambulation was 7.5 hours after surgery. Most patients ambulated within 2 to 3 days after surgery. The lasted time of first ambulation was 3 to 5 minutes, the distance was 0~250 meters, the range was mainly the bedside, and the doctors were the most important assistants. The early ambulation group were with earlier catheter and wound drain removal, a higher percentage of ECG Monitoring removal within 24 hours （P=0.017, P=0.037, P=0.049）, earlier first straight leg raising （P=0.01）, higher level of albumin index after surgery （P=-0.009, P〈0.01）, better rehabilitation self-efficacy and the desire to ambulate （P=-0.021）. Conclusion： Most patients with TKA ambulated in 2 to 3 days after surgery, the most popular activities were standing by the bed or walking on the ground.

关 键 词：全膝关节置换 早期下床活动 问卷调查 

分 类 号：R47[医药卫生—护理学]