Objective:To observe application effects of primary nursing in prevention of postoperative delirium in elderly patients with hip replacement.Methods:A prospective study was conducted on 300 patients after hip replacement admitted to this hospital from March 2020 to February 2022.They were divided into control group and observation group according to the random number table method,150 cases in each.The control group was given routine nursing,while the observation group was given the primary nursing mode on the basis of that of the control group.The hospitalization time,the duration of delirium and the incidence of delirium,the degree of delirium scores before and after the nursing[confusion assessment method(CAM),delirium observation screening scale(DOS)],the cognitive function[Montreal cognitive assessment(MoCA)]score,the postoperative recovery quality[40-tiem postoperative quality of recovery(QoR-40)]score,the pain degree[numerical rating scale(NRS)]score,and the nursing satisfaction were compared between the two groups.Results:The hospitalization time and the duration of delirium in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).The incidence of delirium in the observation group was 12.67%,which was lower than 34.00%in the control group,and the difference was statistically significant(P<0.05).After the nursing,the CAM and DOS scores of the two groups were lower than those before the nursing,those of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).The MoCA and the QoR-40 scores of the two groups were higher than those before the nursing,and those of the observation group were higher than those of the control group;the NRS scores of the two groups were lower than those before the nursing,and that of the observation group was lower than that of the control group;and the difference was statistically significant(P<0.05).Further,the nursing satisfaction of the observation group was 90.67%,which was higher than 82.00%of the control group,and the difference was statistically significant(P<0.05).Conclusions:The primary nursing for the elderly patients with hip replacement can shorten the duration of delirium and the hospitalization time,reduce the degree of delirium,reduce the incidence of delirium,improve the cognitive function,accelerate the postoperative recovery,and improve nursing the satisfaction.Moreover,it is superior to single routine nursing.

目的:观察协同理论下的全方位护理在全膝关节置换术(TKA)后患者中的应用效果.方法:选取 2020 年 4 月至 2022 年4 月于该院行TKA术的 96 例患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各 48 例.对照组予以常规护理,观察组在对照组基础上予以协同理论下的全方位护理.比较两组护理前后自护能力[自我护理能力量表(ESCA)]评分、疼痛程度[视觉模拟评分法(VAS)]评分、心境状态[心境状态评价量表(POMS)]评分,膝关节功能[膝关节功能评分(HSS)]评分、日常生活能力[日常生活活动量表(ADL)]评分及治疗依从率.结果:护理后,两组ESCA评分高于护理前,且观察组高于对照组,两组VAS评分均低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);两组积极心境评分高于护理前,且观察组高于对照组,两组消极心境评分均低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);两组HSS评分高于护理前,且观察组高于对照组,两组ADL评分均低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组治疗依从率为95.83%,高于对照组的81.25%,差异有统计学意义(P<0.05).结论:协同理论下的全方位护理应用于TKA术后患者,可提高自护能力和治疗依从性,减轻疼痛程度,改善心境,促进膝关节功能恢复,以及提高日常生活能力,其效果优于常规护理.

目的:探讨疼痛规范化管理应用于人工髋关节置换手术患者的效果.方法:将83例人工髋关节置换手术患者分为两组.对照组41例,给予常规疼痛管理干预,观察组42例给予疼痛规范化管理干预.观察两组PCSA药物用量、关节功能、生活质量以及疼痛情况.结果:干预后,观察组PCSA药物用量少于对照组;观察组髋关节活动度、运动以及功能性活动水平均高于对照组;观察组生理、心理、生活影响评分均低于对照组;观察组疼痛影响、疼痛程度评分均低于对照组;差异均有统计学意义(P＜0.05).结论:疼痛规范化管理应用于人工髋关节置换手术患者可改善关节功能,提高生活质量,减少PCSA药物用量而有效减轻疼痛.

目的:探讨活动性疼痛评估对全髋关节置换(THA)患者术后疼痛管理质量的影响.方法:将128例全髋关节置换术患者分为两组.对照组63例,给予常规疼痛干预,观察组65例给予常规疼痛联合活动性疼痛评估干预,观察两组关节功能、术后不同时间点视觉模拟评分法(VAS)分数以及睡眠质量.结果:干预后,观察组功能性活动、髋关节活动度、运动评分均高于对照组;观察组术后24h、48h、72h运动时VAS分数均低于照组;观察组睡眠障碍、入睡时间、睡眠效率以及睡眠时间评分均低于对照组,差异均有统计学意义(P<0.05).结论:活动性疼痛评估可减轻THA患者术后疼痛,改善睡眠质量,提高关节功能和疼痛管理质量.

目的:探讨基于四位一体的个体标准化功能锻炼模式对股骨骨折患者髋关节功能的影响.方法:将96例股骨骨折患者分为两组,各48例.对照组采用临床常规围术期护理模式干预,观察组在对照组基础上联合四位一体的个体化标准功能锻炼.观察两组髋关节功能及并发症情况.结果:观察组髋关节功能评分均高于对照组;观察组并发症发生率低于对照组;差异均有统计学意义(P<0.05).结论:基于四位一体的个体标准化功能锻炼模式可有效改善股骨骨折患者髋关节功能,同时降低并发症的发生.

股骨颈骨折是老年人的常见病,随着人类寿命的延长,老年股骨颈病人也越来越多,严重影响病人的生活质量.现将我科2014年1例股骨颈骨折合并肺心病的护理经验总结如下: 1 临床资料 患者,女,72岁,以"右髋部疼痛,功能障碍2小时"入科,自诉"慢性支气管炎"50年余,3月前因肺气肿、肺心病、于中心医院治疗.入科后查体双肺过清音,两肺听诊呼吸音清,有少量湿罗音,呼吸活动降低,吸气时伴有三凹征,入科后病人呼吸困难,给予鼻导管吸氧3升/分,血氧饱和度＜90％,后改为面罩吸氧4升/分,血氧饱和度升至93％.内科会诊示①右股骨颈骨折;②慢性喘息性气管炎(急性发作);③慢性阻塞性肺气肿;④慢性肺源性心脏病、呼吸功能不全(代偿期);⑤心功能不全(Ⅱ级).给予患肢皮牵引、吸氧、雾化吸入等.肺部感染控制后行右侧股骨头置换术.

“安全”是患者的基本需要，是治疗的首要前提，是医护人员的重大职责，也是衡量医疗质量的重要标志之一。随着我国人口老龄化的加剧，骨科住院患者老年患者所占比例逐年上升，而老年患者常常合并多种内科疾病，增加了住院风险。分析这类特殊人群存在的安全隐患，并提出减少消除安全隐患的对策，为患者提供更加安全舒适的就医环境，从而提高临床护理质量和骨科老年患者的生活质量，减少危险因素的发生。

目的:探讨膝关节表面置换术后肢体肿胀的护理体会。方法:结合50例膝关节表面置换术后的临床资料。结果:50例患者中,除2例转上级医院诊治外,其余均治愈。结论:科学严密,有效的护理措施和康复指导,提高护理质量,降低并发症的发生,保证患者护理安全,提高患者满意度。

<正>胫骨平台骨折患者由于知识缺乏,致使治疗骨折康复期间并发关节僵直。由于患者长期卧床,如不及时有效地进行健康教育,并发关节僵直后不但增加患者痛苦、延长住院时间,而且增加经济负担,甚至影响以后日常工作生活。2011年以来,采用健康教育路径,对胫骨平台骨折患者实施系统、规范、针对性的健康知识