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Urinary retention is a common complication of bedridden patients in traumatic orthopedics. The severe condition can even cause permanent bladder injury and renal failure, which brings great pain and psychological pressure to patients and seriously hinders their rehabilitation. The traditional Chinese medicine appropriate technologies have the characteristics of safety, effectiveness, low cost, simplicity and easy learning and achieve good clinical effects in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopaedics, including Chinese herbal medicine, acupuncture and moxibustion, massage, etc. The authors summarize the research progress in appropriate technologies of traditional Chinese medicine in the prevention and treatment of bedridden patients with urinary retention in traumatic orthopedics from aspects of action principles, operation methods and effects of acupuncture points, moxibustion therapy, manipulation therapy, external treatment of traditional Chinese medicine and acupoint injection, so as to provide a reference for further nursing research and clinical application.
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Objective@#To investigate the effect of peripheral nerve block combined with venous fast track anesthesia on elderly patients undergoing lower extremity orthopedic surgery.@*Methods@#From September 2015 to December 2017, 64 senile patients with lower extremity orthopedic surgery in the Fifth Hospital of Ningbo were selected in the research.According to the different methods of anesthesia, the patients were divided into observation group (30 cases, application of combined intravenous peripheral nerve block and fast track anaesthesia), and the control group (34 cases, application of simple intravenous general anesthesia). The heart rate, average arterial pressure, spontaneous breathing recovery time, extubation time, complication rate and cognitive function scores of the two groups were compared.@*Results@#The heart rate and average arterial pressure of T1 and T3 in the observation group were significantly lower than those in the control group (P<0.05). The spontaneous breathing recovery time[(8.32±3.26)min] and extubation time[(9.69±4.29)min] in the observation group were significantly shorter than those in the control group[(18.24±5.23)min and (27.24±4.58)min](t=8.961, 15.756, all P<0.05). The incidence rate of postoperative complications in the observation group (3.33%) was significantly lower than that in the control group (20.59%)(χ2=4.338, P<0.05). The cognitive function score of the observation group was significantly higher at 4 h and 8 h after surgery than that of the control group (t=6.745, 8.494, all P<0.05).@*Conclusion@#Peripheral nerve block combined with intravenous fast-track anesthesia is very feasible for elderly patients undergoing lower limb orthopedic surgery.The time for patients to recover from spontaneous breathing and extubation is shorter, and the risk of complications such as delirium, restlessness, nausea and vomiting is lower.
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With the traffic accident, sudden disaster and safety accidents occur year after year, the injured patients often complicated with multiple injuries, how to maximize the treatment of the injury to improve the survival rate, is an important problem faced by orthopedic surgeons.In recent years, damage control orthopaedics (DCO) technology has been gradually developed, DCO aims to control the patients' primary injury, to prevent further deterioration of the disease, compared with the traditional treatment, it can effectively reduce the second strike and complications, is conducive to the recovery of patients.In this paper, the development of DCO concept, the theoretical basis of DCO, the adaptation of DCO, the implementation steps of DCO and the best time, the application of DCO in the treatment of severe multiple injuries and the prospect of DCO application are reviewed.
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With the traffic accident,sudden disaster and safety accidents occur year after year,the injured patients often complicated with multiple injuries,how to maximize the treatment of the injury to improve the survival rate,is an important problem faced by orthopedic surgeons.In recent years,damage control orthopaedics (DCO)technology has been gradually developed,DCO aims to control the patients'primary injury,to prevent further deterioration of the disease,compared with the traditional treatment,it can effectively reduce the second strike and complications,is conducive to the recovery of patients.In this paper,the development of DCO concept,the theoretical basis of DCO,the adaptation of DCO,the implementation steps of DCO and the best time,the application of DCO in the treatment of severe multiple injuries and the prospect of DCO application are reviewed.
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Objective To investigate the effect of stellate ganglion block ( SGB ) on early postoperative cognitive function in elderly patients undergoing orthopedic surgery .Methods 115 elderly patients with orthopedic surgery were selected as study objects ,and they were randomly divided into observation group (55 cases) and control group(60 cases) according to the digital table .The observation group received epidural anesthesia after SGB ,while the control group only received routine epidural anesthesia .Preoperation and postoperative 6h,3d and 7d,the mini mental state examination ( MMSE ) scores were measured and compared , the cognitive function was assessed .The MMSE score and postoperative cognitive dysfunction ( POCD) occurrence before and after surgery in the two groups were compared.Results In the observation group,the preoperative MMSE score was (29.36 ±2.54) points,the MMSE scores of 6h,3d and 7d after operation were (22.69 ±3.01) points,(25.33 ±2.69) points,(28.32 ± 3.04)points,respectively.The difference between preoperation and postoperation was statistically significant ( F =51.26,P <0.05).In the control group,the MMSE scores of before surgery and 6h,3d,7d after surgery were (29.69 ±2.17)points,(20.24 ±3.59)points,(21.87 ±2.02)points and (27.66 ±3.07)points,respectively,the difference was statistically significant (F=103.70,P<0.05).Before surgery,the MMSE score between the observa-tion group and control group had no statistically significant difference .6h and 3d after surgery,the MMSE scores of the observation group were higher than those of the control group (t=3.947,7.745,all P<0.05);7d after operation,the MMSE score between the two groups had no statistically significant difference (P>0.05).6h after surgery,the inci-dence rate of POCD of the observation group was 3.64％,which of the control group was 11.67％.3d after operation, the incidence rate of POCD was 1.82％ in the observation group and 3.33％ in the control group.There was no statistically significant difference in the incidence of POCD between the two groups at 6 and 3d after operation ( P>0.05).7d after operation,POCD was not detected in the observation group ,and the incidence rate of the control group was 3.33％.The total incidence rate of POCD was 5.45％ in the observation group and 18.33％ in the control group,and the incidence rate of the observation group was lower (χ2 =4.452,P<0.05).Conclusion SGB can improve the cognitive function of elderly patients after orthopedic surgery ,and it is worthy of clinical recommendation .
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Objective To analyze the application effect of nursing intervention under the guidance of pain care quality in pain management of patients undergone orthopedic surgery, and to provide reference for the standardized management of pain in patients undergone orthopedic surgery. Methods A total of 124 cases of patients who were to undergo orthopedic surgery and admitted to hospital from January 2015 to June 2016 were selected as the research objects,and divided into the observation group and the control group using the random number table method,with 62 cases in each group.Patients in the control group were performed routine pain nursing intervention after orthopedic surgery, including pain propaganda and education, pain prevention and pain symptomatic treatment. Patients in the observation group were performed nursing intervention under the guidance of pain nursing quality indexes.The pain related indicators, pain nursing quality related indexes and pain related complications of patients in the two groups were compared. Results The scores of visual analogue scale(VAS)0 d,1 d and 3 d after the operation in the observation group were respectively 2.82 ± 0.42, 2.45 ± 0.40 and 1.85 ± 0.32, the corresponding scores in the control group were respectively 4.14±0.56,3.25±0.52 and 2.21±0.36,and the difference between the two groups was statistically significant (t=14.848, 9.601, 5.885, P<0.05 or 0.01). The sleep hours 0d,1d and 3d after the operation in the observation group were respectively(5.16±0.71)h, (6.01 ± 0.82)h and (6.84 ± 1.02) h, the corresponding sleep hours in the control group were respectively (4.12±0.62)h,(4.65±0.72)h and(6.01±0.75)h,and the difference between the two groups was statistically significant (t=8.689, 9.613, 5.162, P<0.05 or 0.01). The unplanned anesthetic medication times in the observation group and the control group were respectively(2.32±0.45)times and(3.45±0.56)times,and the difference between the two groups was statistically significant (t=12.385, P<0.01). The observation timeliness rate,nursing record pass percent,pain intervention effective rate and management satisfaction degree in the observation group were respectively 98.39%(61/62), 96.77%(60/62), 96.77%(60/62) and 96.77%(60/62),the corresponding values in the control group were respectively 88.71%(55/62),87.10% (54/62), 85.48%(53/62)and 87.10%(54/62). The difference between the two groups was statistically significant (χ2=4.810, 3.916, 4.888, 3.916, all P<0.05). The incidence rates of delayed incision healing, insomnia and constipation in the observation group were respectively 0,9.68%(6/62)and 1.61%(1/62), the corresponding incidence rates in the control group were respectively 6.45%(4/62), 24.19%(15/62) and 11.29%(7/62), and the difference between the two groups was statistically significant(χ2=4.133, 4.644, 4.810, all P<0.05). Conclusions Nursing intervention under the guidance of pain care quality can help alleviate the pain degree of patients undergone orthopedic surgery, improve the sleep quality, reduce postoperative complications and enhance the management level of pain nursing.
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We constructed a home care platform for orthopedics,and clinical nurse specialists in orthopedics in Jiangsu Province opened online clinics on it.Patients with knee or hip joint replacement could be added to the platform,and the clinical nurse specialists provided patients with professional home care service when discharged.In the interviews of clinical nurse specialists,they said that the application of the platform was conducive to enhance their own values,and expressed their willingness to continue to use it.The joint function and quality of life scores of the intervention group were significantly higher than those of the control group (P＜0.001).The application of the home care platform is conducive to give full play to the role of clinical nurse specialists to provide professional home care services for patients.
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Objective To establish nursing prevention strategies for patients with deep venous thrombosis in department of orthopedics,so as to guide the specific context of clinical nursing practice,offer evidence-based evidence.Methods Clinical practice guidelines and original researches at home and abroad were retrieved using systematic review approach,and appraisal of literatures was conducted using Australia JBI based Quality Evaluation Center for health care evaluation methods and Johns Hopkins standard.The preliminary nursing prevention strategies for patients with deep venous thrombosis in department of orthopedics and Delphi mail questionnaire were developed.Using Delphi method,the operational feasibility of the final evidence strategies was improved for clinical evidence application through two rounds of consultation from clinical experts.Results A total of 111 articles were included in this study.Forty-nine prevention strategies were established under 3 dimensions including "risk assessment graded prevention" and "education and instruction" through systematic review and Delphi method.Conclusion Nursing prevention strategies in department of orthopedics for patients with deep venous thrombosis based on systematic review and Delphi method have scientific practicability and operability,and can provide objective reference and implementation strategies for nursing practice,assisting the implementation of effective preventive measures.
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Objective To study the effects about using separated bed transfer to handle orthopedic patients.Methods According to the characteristics of carrying orthopedic patients,separated bed transfer was developed and made followed by trials in trial departments.A questionnaire survey of 214 patients and 27 users was completed and the related situation using separated bed transfer to handle orthopedic patients was surveyed,the results were compared with those of dead lift.Results Compared with traditional dead lift,there was obvious difference in the number of handling participators[≥5 persons:6.07％ (13/214) vs.21.96％(47/214);4 persons:35.51％ (76/214) vs.48.13％(103/214)],patients' comfort during handling [28.97％ (62/214) vs.84.11％(180/214)],x2=43.027,154.381,all P ＜ 0.05.Conclusions It can reduce the number of participators and patients' pain when handling patients using separated bed transfer.It is widely used with lower cost,which is worth being promoted in clinic.
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Objective To investigate the inter-arm invasive blood pressure differences during hip replacement in patients with lateral position and its relationship with position.Methods Sixty-six patients having underwent hip replacement in orthopedic surgery with lateral position were enrolled.Invasive blood pressure measurements were obtained from bilateral radial artery in all patients every 5 minutes.Simultaneously bilateral invasive blood pressure measurements were obtained and compared.Results At supine position,systolic pressure,diastolic pressure and mean arterial pressure of the uninjured side were (128.16 ±20.09),(69.47 ± 8.64) and (89.03 ± 10.42) mmHg (1 mmHg =0.133 kPa);systolic pressure,diastolic pressure and mean arterial pressure of the injured side were (127.90 ± 20.44),(69.86 ± 8.81) and (89.21 ± 10.71) mmHg.There was statistical difference in inter-arm diastolic pressure (P ＜ 0.05),but inter-arm systolic pressure and mean arterial pressure had no statistical differences (P ＞ 0.05).At left-lateral position,systolic pressure,diastolic pressure and mean arterial pressure of the uninjured side were (129.12 ± 21.93),(69.23 ± 8.92) and (89.19 ± 11.35) mmHg;systolic pressure,diastolic pressure and mean arterial pressure of the injured side were (129.01 ± 21.72),(69.51 ± 9.02) and (89.34 ± 11.35) mmHg.There was statistical difference in inter-arm diastolic pressure (P ＜ 0.05),but inter-arm systolic pressure and mean arterial pressure had no statistical differences (P ＞ 0.05).At right-lateral position,systolic pressure,diastolic pressure and mean arterial pressure of the uninjured side were (128.78 ± 20.34),(69.54 ± 9.06) and (89.29 ± 10.82) mmHg;systolic pressure,diastolic pressure and mean arterial pressure of the injured side were (128.27 ± 20.56),(70.00 ± 9.09) and (89.43 ± 10.89) mmHg.There were statistical differences in inter-arm systolic pressure and diastolic pressure (P ＜ 0.05),but inter-arm mean arterial pressure had no statistical difference (P ＞ 0.05).The bilateral radial artery blood pressure difference under different positions was ＜ 1 mmHg,and had no clinical practical significance.There was no correlation between blood pressure and age,sex,body mass index.Conclusion Bilateral radial artery in the same patients with invasive blood pressure has no clinical difference,and patients with lateral position operation for radial artery puncture pressure need not consider the differences of blood pressure between arms.