Application of enhanced recovery after surgery in nursing of patients with thoracolumbar fracture with nerve injury / 中华创伤杂志

ABSTRACT

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.