腰椎后路融合内固定患者术后首次下床活动影响因素分析  

Analysis of influencing factors of initial ambulation after posterior lumbar fusion and internal fixation

作　　者：杨一琴 胡三莲 钱会娟 周玲[3] 崔伶伶 YANG Yiqin;HU Sanlian;QIAN Huijuan;ZHOU Ling;CUI Lingling(School of Nursing,Shanghai Jiao Tong University,Shanghai200025,China;Department of Nursing,Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai200233,China;Department of Orthopedics,Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai200233,China)

机构地区：[1]上海交通大学护理学院,上海200025 [2]上海交通大学医学院附属第六人民医院护理部,上海200233 [3]上海交通大学医学院附属第六人民医院骨科,上海200233

出　　处：《中国医药导报》2023年第6期72-75,89,共5页China Medical Herald

摘　　要：目的调查腰椎后路融合内固定患者术后首次下床活动现状及影响因素。方法采用便利抽样法,选取于2021年4月至9月在上海交通大学附属第六人民医院脊柱外科住院的328例腰椎后路融合内固定术后患者为研究对象。早期下床组为术后3日内首次下床能够完成床椅转移或离床坐位或床边站立或平地行走的患者;不然为非早期下床组。采用一般资料调查表、广泛性焦虑自评量表(GAD-7)、医疗社会支持量表进行调查,运用多因素logistic回归分析影响腰椎后路融合内固定患者术后首次下床活动的因素。结果单因素分析结果显示,两组年龄、术后血红蛋白、骨质疏松、疼痛评分、留置尿管、手术方式、社会支持评分、焦虑情况比较,差异有统计学意义(P<0.05)。logistic回归结果显示,年龄(≥60岁)、术后血红蛋白(偏高)、骨质疏松(是)、疼痛评分(≥5分)、留置尿管(是)、手术方式(开刀)、焦虑情况(中重度)为影响患者下床时间的危险因素(OR>1,P<0.05);社会支持(良好)影响患者下床时间的保护因素(OR<1,P<0.05)。结论较高的术后血红蛋白和良好的医疗社会支持水平有利于提高腰椎后路融合内固定患者术后早期下床活动水平,促进其康复有重要意义。而年龄大、骨质疏松、中重度焦虑、留置导尿管等因素是危险因素。Objective To investigate the status quo and influencing factors of first ambulation after posterior lumbar fusion and internal fixation.Methods A total of 328 patients admitted to the Department of Spinal Surgery,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from April to September 2021 after posterior lumbar fusion and internal fixation were selected as subjects by convenience sampling method.Patients who got out of bed for the first time within three days after surgery were in the early stage of getting out of bed and being able to complete bed chair transfer or sitting or standing or walking on the ground beside the bed;otherwise,it was the non-early exfoliation group.The general data questionnaire,the generalized anxiety scale(GAD-7),and the medical-social support scale were used to investigate,while the factors affecting the first postoperative movement of patients with posterior lumbar fusion and internal fixation were analyzed by multiple logistic regression.Results Univariate analysis showed that there were statistically significant differences in age,postoperative hemoglobin,osteoporosis,pain score,indignant urinary catheter,surgical method,social support score,and anxiety between the two groups(P<0.05).Logistic regression results showed that age(≥60 years old),postoperative hemoglobin(high),osteoporosis(yes),pain score(≥5 points),indent catheter(yes),operation method(operation),anxiety(moderate to severe)were the risk factors affecting the time of getting out of bed(OR>1,P<0.05);social support(good)was a protective factor affecting the time of patients getting out of bed(OR<1,P<0.05).Conclusion Higher postoperative hemoglobin and good level of medical and social support can improve the early postoperative activity level of patients with posterior lumbar fusion and internal fixation,which has important significance to promote their rehabilitation.Older age,osteoporosis,moderate to severe anxiety,indwelling catheter and other risk factors.

关 键 词：腰椎后路融合内固定术 加速康复外科 早期下床活动 社会支持 

分 类 号：R681.5[医药卫生—骨科学]