清醒俯卧位联合标准护理与标准护理防治老年髋部骨折患者早期术后肺部并发症的效果比较  

Comparative efficacy of awake prone positioning combined with standardized nursing care and standardized nursing care in the prevention of early postoperative pulmonary complications in elderly patients with hip fracture

作　　者：石柳[1,2,3,4] 高宇澄[2,3,4,5] 王昊 高旺 张程[1,2,3,4] 谢添 刘敏[1,2,3,4] 张曦文[4,7] 李荥娟[4,8] 田楚伟 邓春花[1,2,3,4] 陈辉[1,2,3,4] 芮云峰[1,2,3,4] Shi Liu;Gao Yucheng;Wang Hao;Gao Wang;Zhang Cheng;Xie Tian;Liu Min;Zhang Xiwen;Li Yingjuan;Tian Chuwei;Deng Chunhua;Chen Hui;Rui Yunfeng(Trauma Center,Key Base for Standardized Training for Emergency Department Physicians,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;Department of Orthopedics,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;Institute of Traumatic Orthopedics,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;Multidisciplinary Team for Comprehensive Management of Geriatric Hip Fracture,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;School of Medicine,Southeast University,Nanjing 210009,China;Department of Orthopedics,Third People′s Hospital of Hefei,Hefei 230022,China;Department of Critical Care Medicine,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China;Department of Geriatrics,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院创伤中心,东南大学附属中大医院急诊住培重点专业基地,南京210009 [2]东南大学附属中大医院骨科,南京210009 [3]东南大学创伤骨科研究所,南京210009 [4]东南大学附属中大医院老年髋部骨折多学科综合诊疗协作组,南京210009 [5]东南大学医学院,南京210009 [6]合肥市第三人民医院骨科,合肥230022 [7]东南大学附属中大医院重症医学科,南京210009 [8]东南大学附属中大医院老年科,南京210009

出　　处：《中华创伤杂志》2023年第11期1014-1021,共8页Chinese Journal of Trauma

基　　金：瑞华慈善基金会资助项目(YL20220525);合肥市卫生健康委员会应用医学研究项目(Hwk2021zd010)。

摘　　要：目的比较清醒俯卧位(APP)联合标准护理与标准护理防治老年髋部骨折患者早期术后肺部并发症(PPCs)的效果。方法采用回顾性队列研究分析2021年2月至2021年8月东南大学附属中大医院收治的84例老年髋部骨折患者的临床资料,其中男31例,女53例;年龄67~96岁[(82.3±6.3)岁]。骨折类型:股骨颈骨折45例,股骨转子间骨折39例。手术方式:闭合复位内固定术39例,人工股骨头置换术35例,全髋关节置换术10例。42例术后仅接受标准化护理(标准护理组),42例术后接受标准化护理和APP干预(APP联合标准护理组)。比较两组术后30 d内PPCs(包括肺炎、呼吸衰竭、胸腔积液、肺不张和肺水肿)发生率、术后第4天动脉血氧分压(PaO_(2))和动脉血二氧化碳分压(PaCO_(2))及动脉血氧饱和度(SaO_(2))、术后第4天与急诊就诊时PaO_(2)的差值、术后第4天临床肺部感染评分(CPIS)、APP相关不良事件数目。结果患者均获随访30~90 d[(86.1±16.5)d]。APP联合标准护理组术后30 d内PPCs发生率为16.7%(7/42),Ⅰ型呼吸衰竭发生率为4.8%(2/42);标准护理组分别为35.7%(15/42)、21.4%(9/42)(P均<0.05)。APP联合标准护理组术后第4天PaO_(2)为(82.0±8.8)mmHg,SaO_(2)为0.96±0.01,术后第4天与急诊就诊时PaO_(2)的差值为3.2(-1.9,8.0)mmHg;标准护理组分别为(74.3±12.1)mmHg、0.94±0.03、-7.6(-17.2,1.1)mmHg(P均<0.01)。APP联合标准护理组术后第4天CPIS为2.0(1.0,3.0)分,标准护理组为4.0(1.0,7.0)分(P<0.05)。两组术后30 d内肺炎、Ⅱ型呼吸衰竭、胸腔积液、肺不张和肺水肿发生率及术后第4天PaCO_(2)差异无统计学意义(P均>0.05)。两组均未发生APP相关不良事件。结论与标准护理比较,APP联合标准护理可显著降低老年髋部骨折患者早期PPCs,尤其是Ⅰ型呼吸衰竭的发生率,提高术后氧合。Objective To compare the effectiveness of awake prone positioning(APP)care combined with standardized nursing and standardized nursing care in the prevention of early postoperative pulmonary complications(PPCs)in elderly patients with hip fracture.Methods A retrospective cohort study was conducted to analyze the clinical data of 84 elderly patients with hip fracture Admitted to Zhongda Hospital Affiliated to Southeast University from February 2021 to August 2021.There were 31 males and 53 females,aged 67⁃96 years[(82.3±6.3)years].Fracture types were femoral neck fracture(n=45)and intertrochanteric fracture(n=39).Surgical procedures included closed reduction internal fixation(n=39),hip hemiarthroplasty(n=35),and total hip arthroplasty(n=10).Among them,42 patients received standardized nursing care and APP intervention(APP combined with standardized nursing care group),while the remaining 42 patients received standardized nursing care only(standardized nursing care group).The incidence rate of PPCs(including pneumonia,respiratory failure,pleural effusion,atelectasis and pulmonary edema)within 30 postoperative days,arterial oxygen pressure(PaO_(2)),arterial carbon dioxide pressure(PaCO_(2)),arterial oxygen saturation(SaO_(2))on the 4th postoperative day,difference in PaO_(2)between the 4th postoperative day and emergency visit,clinical pulmonary infection score(CPIS)on the 4th postoperative day,and number of adverse events related to APP were compared between the two groups.Results All the patients were followed up for 30⁃90 days[(86.1±16.5)days].The incidence rates of PPCs and type 1 postoperative respiratory failure in the APP combined with standardized nursing care group were 16.7%(7/42)and 4.8%(2/42),and were 35.7%(15/42)and 21.4%(9/42)in the standardized nursing care group(all P<0.05).The PaO_(2)and SaO_(2)on the 4th postoperative day,and difference in PaO_(2)between the 4th postoperative day and emergency visit were(82.0±8.8)mmHg,0.96±0.01,and 3.2(-1.9,8.0)mmHg in the APP combined with standardized nur

关 键 词：髋骨折 肺 老年人 手术后并发症 手术后医护 清醒俯卧位 

分 类 号：R473.6[医药卫生—护理学]