目的 探讨新型膀胱管理方式在老年胸腰椎压缩性骨折术后尿潴留中的应用价值.方法 随机将90例老年胸腰椎压缩性骨折术后尿潴留患者分为实验组(45例)和对照组(45例),实验组采用新型膀胱管理方式,对照组采用传统膀胱管理.观察两组疗效、恢复自行排尿时间、排尿完全通畅时间、膀胱残余尿量、尿管重置率、尿白细胞阳性比例、血清C反应蛋白(CRP)水平、生活质量(SF-36)的差异.结果 实验组管理后有效率显著高于对照组(P<0.05),恢复自行排尿时间、排尿完全通畅时间显著低于对照组(P<0.05),管理后膀胱残余尿量显著低于对照组(P<0.05).观察组尿管重置率、尿白细胞阳性比例、血清CRP水平均显著低于对照组(P<0.05).观察组管理后SF-36各维度评分均显著高于对照组(P<0.05).结论 新型膀胱管理方式可提高尿潴留临床治疗效果,促进自助排尿功能恢复,减轻传统管理方法导致的感染,提高患者生活质量.

Objective:To investigate the effect of enhanced recovery after surgery (ERAS) in percutaneous pedicle screw internal fixation treating thoracolumbar fracture patients.Methods:A retrospective case-control study was conducted to analyze the clinical data of 62 patients with thoracolumbar fracture treated by percutaneous pedicle screw internal fixation at Second Hospital of Soochow University from October 2018 to April 2019. There were 42 males and 20 females, aged 27-59 years (mean, 43.9 years). Fracture site included T 11 in 4 patients, T 12 in 28, L 1 in 23 and L 2 in 7, and AO type contained type A1 in 40 patients, type A2 in 3, and type A3 in 19. Thirty-one patients were treated with ERAS nursing mode (ERAS group), and other 31 patients with routine nursing mode (control group). The postoperative recovery time of intestinal function, first time of expelling flatus and dejection time, hospitalization time, preoperative and postoperative pain visual analogue scale (VAS), Kolcaba comfort scale (GCQ), Oswestry disability index (ODI), incidence of abdominal distension, incidence of urinary tract infection, first wake up dizziness, urinary retention, and wound healing were compared between the two groups. Results:Period of follow-up for all patients was 3-6 months (mean, 4.5 months). Postoperative recovery time of intestinal function, first time of expelling flatus and dejection time in ERAS group were (7.2±2.0)hours, (10.7±3.7)hours and (26.7±6.4)hours, respectively, which were significantly decreased compared to control group [(19.2±5.6)hours, (22.5±5.1)hours, (72.5±12.4)hours] ( P<0.05). Hospitalization time was (4.7±1.3)days in ERAS group, shorter than that in control group [(5.9±1.5)days]. There was no significant difference in VAS preoperatively between the two groups ( P>0.05). VAS in ERAS group was (3.6±1.5)points, (2.8±0.8)points, (1.7±0.6)points at postoperative 1, 3 and 7 days, lower than that in control group [(4.6±1.3)points, (4.0±1.3)points, (2.7±0.9)points] ( P<0.05). GCQ score in ERAS group was (72.0±6.5)points, (75.0±11.1)points, (88.4±5.1)points and (89.3±4.5)points at 2 hours before operation and 2 hours, 1 days and 3 days after operation, which were higher than that in control groups [(54.0±7.2)points, (59.5±6.3)points, (62.7±5.9)points, (76.0±5.7)points] ( P<0.05). ODI in ERAS group was 37.3±5.8, 28.9±6.3 and 23.1±2.7 at 3 days, 1 month and 3 months after operation, which was markedly decreased compared to control group (44.9±7.9, 33.9±8.7, 30.3±5.3) ( P<0.05). Moreover, the incidence of abdominal distension, urinary tract infection and first wake up dizziness in ERAS group was 7%, 5%, 3%, respectively, reduced from that in control group (26%, 35%, 16%) ( P<0.05). No significant difference was observed in urinary retention wound healing of the two groups, but there was no difference in wound healing ( P>0.05). Conclusion:For thoracolumbar fracture patients treated with percutaneous pedicle screw internal fixation, ERAS has advantages over traditional nursing in attenuating pain, shortening hospitalization time, reducing postoperative abdominal distension and urinary tract infection, and accelerating functional recovery.

目的 探讨新的膀胱管理方式对胸腰椎骨折术后尿潴留患者的影响.方法 选取2017年6月-2018年12月在我院脊柱科行胸腰椎闭合复位经皮椎弓根钉内固定术后尿潴留患者90例,按随机数字表法分为A组(保留导尿)、B组(间歇导尿)和C组(中频电刺激+间歇导尿)各30例.观察3组患者膀胱功能恢复情况、泌尿系感染发生率及舒适度和焦虑程度.结果 干预后,C组患者膀胱功能恢复情况优于A组(P<0.05),C组残余尿量均低于其他两组(P<0.05);C组患者尿白细胞阳性比例低于A组(P<0.05),C组血清CRP水平均低于其他两组(P<0.05),表明C组可有效减少泌尿系感染的发生率;C组舒适度优于A组(P<0.05),但与B组比较差异无统计学意义(P>0.05);C组焦虑评分显著低于其他两组(P<0.05).结论 中频电刺激联合间歇导尿能尽早恢复患者膀胱功能,降低泌尿系感染,减轻患者焦虑情绪,是一种较为安全、科学且有效的膀胱管理方式.

腰痛发病率高,在全球范围内造成巨大的经济损失,主要原因被认为与脊柱退行性疾病相关 [1].脊柱退行性疾病是中老年人的常见病、多发病,其病理特点为脊柱关节软骨(包括关节突及椎间盘等)逐渐退化(变薄、直至消失),在关节边缘及软骨下区形成新骨,即骨赘,导致椎间隙、椎间孔或椎管等狭窄,或造成关节不稳、滑脱等改变,引起颈、背、腰部疼痛,甚至上肢或下肢疼痛等症状的一组症候群 [2].该病有病程长、反复发作的特点,给患者造成沉重的生理及心理压力,严重影响生活质量.脊柱内固定手术是脊柱退行性疾病的一种有效的治疗手段 [3],影像学 MRI 检查是术前辅助诊断基本方法之一,成像质量高低直接影响医生手术方案的制定.通常情况下普通 MRI 检查时患者需独处在环境密闭、空间狭小、光线较暗的环境中,再加上患者对检查过程不了解,多数会产生紧张恐惧情绪,甚至有幽闭恐惧感.据报道 [4],在临床 MRI 检查中,有 3％～10％ 的患者会出现紧张、恐慌反应甚至因疾病原因产生的疼痛、麻木感,不能配合完成检查.我院骨科护理人员基于以上原因对患者进行有效的综合护理干预,用 G-san Brio:0.25T 开放式 DMRI 成像,其利用磁场与人体内氢质子发生共振而形成的有规律图像 [5],使部分影响因素减低甚至得到控制 [6],提高 DMRI成像质量,现将我院骨科脊柱退行性疾病行 DMRI检查的 100 例患者的护理体会报道如下.

目的 探讨开展品管圈活动在脊柱科护士专科查体中的应用效果.方法 成立品管圈小组,针对脊柱科护士专科查体的现状,运用品管圈手法进行现状把握、目标设定、要因分析、对策拟定并实施成立品管圈.结果 开展品管圈活动后,脊柱科护士专科查体准确率由29.7％提高至86.67％(P<0.05),进步率为56.97％.结论 品管圈活动有效提高了脊柱科护士专科查体的准确率,效果显著.