Investigation On The Decubitus Angle In Postoperative Degenerative Lumbar Disease Patients

Background Domestic and foreign research reports show that lumbar degenerative disease is a common and prevalent disease in middle-aged and elderly people,and it becomes more severe with age.At present,the incidence of lumbar degenerative disease has become younger.Surgical treatment is one of the important treatment methods to improve the quality of life in patients with degenerative lumbar disease.Traditionally,patients after surgery need to stay in bed for at least 24 hours routinely.When lying in bed,patients need to be turned over regularly to reduce incision pain,promote posture comfort and prevent complications.For postoperative degenerative lumbar disease patients,the spine should be maintained in neutral position when the patients are turned over.Thus,degenerative lumbar disease patients are different from other kind of bedbound patients in many aspects such as position demanding,lower limb self-perception,active motion.However,till now,the results of influence of different postoperative decubitus angles on reducing incision pain,promoting posture comfort and preventing complications in degenerative lumbar disease patients who have to maintain in neutral position postoperatively are still unclear.The evidence is lacking to set the nursing policy to guide proper positional nursing postoperatively.Therefore,the observational study was designed to innvestigate the effect of different decubitus angles for postoperative patients with lumbar degenerative disease,to provide evidence for developing a reasonable routine postoperative care for these patients.Purpose To investigate the effect of different decubitus angles on the maintaining neutral position,pain,postural comfort,postoperative total drainage and complications prevention for patients with lumbar degenerative disease after operation.Methods This study is a descriptive study,using convenience sampling method to extract 201 cases of hospitalized patients with lumbar degenerative disease after surgery from one specialized hospital in Beijing from December 2016 to June 2017.The general information and clinical data of the patients were collected with a self-designed recording chart.The neutral position maintaining time,the pain scale,the postoperative total drainage and status of comfort and complications after surgery for the period of 4-24 hours were recorded using a self-designed postoperative turn-over scale.After collecting data,according to the decubitus angle within 24 hours after the operation,the patients were divided into three groups,group A(decubitus angle sustained ?60°),group B(sustained>60° and ?90°),group C(decubitus angle ?60° or>60° and ?90°),comparisons and analysis were carried among the three groups.At the same time,12 patients were abstracted to be semi-structurally interviewed in terms of self-experience and the underlying causes in different decubitus angles.These data are abstracted and summarized by two well-trained researchers.Results There were 61 cases in group A,80 cases in group B,and 60 cases in group C.(1)201 cases of the postoperative lumbar degenerative disease patients with a median age of 56 years(percentile interval 19,age range 18-79 years)were included,with 97 male cases(48.3%)and104 female cases(51.7%).(2)The neutral position maintaining time among the three groups were significantly different(P<0.001),group B(90(82.5-98.7)min)was the better than group A(52.5(45-60)min),and group C(64.8(56.7-78.9)min)was better than group A but shorter than group B.(3)There were no significant difference in pain scores among the three groups(P>0.05),but within each group,the pain scores after lateral decubitus(group A 4.922±8.344;group B 3.717±1.005;group C 4.732(4-5)were significantly less than the scores before lateral decubitus(group A 5.831±0.752;group B 4.593±1.016;group C 5.450(4.777-5.875))(P<0.001).(4)The status of comfort among the three groups were significantly different(P<0.001),group B(7(6.29-7.47))was the better than group C(5.75(5.38-6.12)),and group C was better than group A(5.11(4.67-5.5))but lower than group B.(5)There was no significant difference in postoperative drainage among the three groups(P>0.05).(6)There were no complications in the three groups.(7)Refining the interview data,analysis shows that patients with lumbar degenerative diseases have a higher demand of side lying postoperatively,especially in the early period after surgery.The side lying angle which makes more comfortable varies from person to person.Conclusions The results of this study showed that decubitus angle over 60 degrees were more beneficial for spine neutral position maintaining and comfort for postoperative lumbar degenerative disease patients.Side lying at different angles postoperatively can relieve pain in patients with a certain extent;meanwhile,it will not increase postoperative total drainage and the incidence of complications.In nursing practice,the habits of decubitus and comfort experience of patients should also be considered.Maintenance the spine neutral position,shortening of turn over interval,choosing the suitable decubitus angle and setting up personalized posture nursing routine policy are all important for patients.