RESUMO
ObjectiveTo observe the effects of Internet plus continuous rehabilitation nursing on older patients after lumbar fusion. MethodsFrom January, 2018 to August, 2021, 157 older patients after transforaminal lumbar interbody fusion (TLIF) in Department of Orthopedics, Chongqing General Hospital were retrospectively studied. A total of 66 patients accepting routine continuous rehabilitation nursing care were as control group, and 91 patients accepting internet plus continuous rehabilitation nursing care were as intervention group. They were assessed with Visual Analog Scale for pain (VAS), Oswestry Disability Index (ODI), Huaxi Emotional-distress Index (HEI) and Adult Health Self-management Skill Rating Scale (AHSMSRS) before, and one and three months after intervention. The compliance and nursing satisfaction were investigated with self-made questionnaire three months after intervention, and the postoperative complications were recorded. ResultsA total of 148 patients finished follow-up of three months, including 61 patients for the control group and 87 patients for the intervention group. The VAS, ODI, HEI and AHSMSRS scores improved in both groups one and three months after intervention (F > 85.4, P < 0.001), and improved more in the intervention group than in the control group (|t| > 3.645, P < 0.001). Both the compliance and nursing satisfaction were better in the intervention group than in the control group (χ2 > 5.478, P < 0.05), and no postoperative complication was observed in both groups. ConclusionInternet plus continuous rehabilitation nursing can promote the recovery of function, pain and psychological emotion, ability of self-management, compliance, and nursing satisfaction.
RESUMO
Objective:To explore the perioperative management strategy for the elderly with hip fractures during the epidemic of corona virus disease 2019 (COVID-19) and evaluate its clinical effect.Methods:A retrospective case series study was conducted on 33 elderly patients with hip fractures admitted to Chongqing General Hospital, University of Chinese Academy of Sciences, from January 20 to February 29, 2020, including 14 males and 19 females, aged 65-92 years [(76.5±6.3)years]. There were 20 patients with intertrochanteric fractures and 14 with femoral neck fractures. In total, 15 patients were combined with hypertension and 9 with diabetes. A total of 19 patients were treated with open reduction and internal fixation and 14 with total hip/semi-hip replacement. The time from injury to admission was 2-14 hours. The temperature measurement, routine blood test and chest CT examination were performed to exclude COVID-19 in all patients, which showed 12 patients with pulmonary infection. The medical staff received different levels of protection: first level protection for those in the special ward, secondary level protection for the emergency isolation ward and tertiary level protection for those collecting the throat swab samples. The time from admission to operation, intensive care unit (ICU) stay time, hospitalization time, visual analogue score (VAS), perioperative complications as well as infection of patients and medical staff were observed and recorded.Results:The time from admission to operation was (3.18±0.19)days for all patients, with (2.24±0.28)days for 21 patients with no obvious pulmonary abnormality and (4.83±0.39)days for 12 with pulmonary infection. The hospitalization time was (10.97±0.31)days in all patients, with (9.71±0.27)days for 21 patients with no obvious pulmonary abnormality and (12.51±0.78)days for 12 with pulmonary infection. After operation, 12 patients were treated in ICU for 1-3 days, and the rest 21 patients were treated in general wards. The pain of all patients was effectively controlled. The time for exercise was (4.0±1.4)days after operation in all patients, among which 19 treated with fracture reduction and internal fixation started at (4.3±1.3)days after operation and 14 treated with total hip/semi-hip replacement started at (3.6±1.3)days after operation. VAS was (4.55±0.29)points at 12 hours before operation, (5.62±1.12)points at 6 hours, (3.54±0.39)points at 24 hours, and (2.42±0.11)points at 72 hours after operation ( P<0.05). Chest CT showed that the pulmonary inflammation was significantly improved one day before discharge. There was no indication of nucleic acid detection, with no urinary tract infection, pressure sore, deep vein thrombosis or other complications were found. No infection of patients or medical staff occurred. Conclusion:During pandemic of COVID-19, early surgical treatment for the elderly with hip fractures can be done in the general wards, based on strictly following the principle of infection prevention and control and carefully evaluating the perioperative risks, which can avoid the probability of infection of patients and medical staff without prolonging the hospitalization time or increasing the incidence of complications.
RESUMO
Objective To investigate the application of enhanced recovery after surgery (ERAS)in the nursing of thoracolumbar fracture with nerve injury.Methods A retrospective case-control study was conducted to analyze the clinical data of 64 patients with bilateral thoracolumbar fractures with nerve injury admitted to the Chongqing General Hospital from November 2013 to November 2017.There were 52 males and 12 females,aged 26-62 years,with an average age of 43 years.The injured segments were located at T11-T12in 28 patients,T12-L1 in 15 patients,L1-L2 in 10 patients,and L2-L3 in 11 patients.According to the Frankel classification of neurological function,there were 14 patients at grade A,18 at grade B,24 at grade C and eight at grade D.All patients were treated with common pedicle screw placement under direct vision combined with dome shaped decompression through small incision.Among the patients,32 received ERAS rehabilitation nursing (ERAS group) and 32 received routine rehabilitation nursing (routine group).The incidence of complications,hospitalization time,hospitalization expense,patients' satisfaction with nursing work,visual analogue scale (VAS),Oswestry dysfunction index (ODI) and Frankel classification of neurological function at 3 months after operation were compared between the two groups.Results The patients were followed up for 8-12 months [(10.2 ±1.3) months].In the ERAS group,one patient had pulmonary infection;in the routine group one patient had wound infection,one had bedsore,and one had venous thrombosis in lower limb (P ＜ 0.01).The hospitalization time of ERAS group was significantly shorter than that of routine group [(9.3 ± 1.2)days:(15.6 ± 1.8) days] (P ＜ O.01).The hospitalization expense of ERAS group was significantly lower than that of routine group [(52 ± 13)thousand yuan (RMB) vs.(63 ± 17) thousand yuan (RMB)](P ＜ 0.05).The satisfaction rates of ERAS group and routine group were 84％ (27/32) and 56％ (18/ 32),respectively (P ＜ 0.05).At 3 months after operation,the ERAS group had significantly lower VAS [(2.6±1.2)pointsvs.(3.8±1.5)points] and ODI (11.4±2.1)pointsvs.(15.8±2.5)points]than the routine group (P ＜ 0.05 or 0.01).At 3 months after operation,according to the Frankel grading,there was one patient at grade A,five at grade B,nine at grade C,five at grade D,and 12 at grade E in the ERAS group;while there were three patients at grade A,seven at grade B,seven at grade C,nine at grade D,and six at grade E.The recovery rate of Frankel grade 1 and/or above in ERAS group was significantly higher than that in routine group [97％ (31/32) vs.91％ (29/32),P ＜0.05].Conclusion Rehabilitation nursing measures of ERAS can help reduce perioperative complications,hospitalization time and hospitalization expenses,relieve pain,promote functional recovery,and gain satisfactory feedbacks from the patients.
RESUMO
@# ObjectiveTo observe the effects of medical membrane of combination of the traditional Chinese medicine with the western medicine on white lesion of the vulva.Methods141 cases of white lesion of the vulva were put on vulvar pathological area with the medical membrane, twice a day.ResultsThe total effective rate was 98.5%.ConclusionThe effect of medical membrane of combining the traditional Chinese medicine with the western medicine is very satisfying.