| Objective: To construct the rehabilitation nursing scheme for total knee arthroplasty under enhanced recovery after surgery,and to explore its effect on patients with total knee arthroplasty.Methods: 1.According to the literature review,semi-structured interview and Delphi expert inquiry,constructed the fast rehabilitation nursing scheme of total knee arthroplasty.2.Empirical study: A total of 96 total knee arthroplasty patients from January to November 2019 were randomly divided into control group(n=48)or intervention group(n=48).The control group using traditional nursing care,intervention group used rehabilitation nursing scheme under enhanced recovery after surgery.The scores of anxiety,pain and activity of daily living were compared between the two groups.The effect of knee joint function,the incidence of complications,the length of hospitalization,the cost of hospitalization,and the satisfaction of nursing work were compared between the two groups.Results: 1.The rehabilitation nursing scheme under enhanced recovery after surgery constructed,including 3 first grade indexes,12 second grade indexes and49 third grade indexes.The expert authority coefficient was 0.88-0.96,and the average authority coefficient was 0.92.The Kendall harmony coefficient of expert advice coordination degree was 0.53.2.The results of empirical study: 1)Baseline results: there was no significant difference between the two groups in terms of age,gender,preoperative joint function,pain score,and operation duration(P>0.05).2)The score of anxiety in the preoperative 1d,postoperative 1d,postoperative 3d and discharge from hospital was compared between the two groups,there were statistically significant(P<0.05).3)there was significant difference in the "pain" score between the two groups at postoperative 6 h,24 h,48 h and 72 h(P<0.05).4)Clinical observation indexes: there were statistically significant differences in the duration of catheter retention,the first active straight legelevation,the first out of bed activity,the incidence of complications,the length of stay and the cost of hospitalization between the two groups(P<0.05).5)There were significant differences in HSS score and range of motion between the two groups at the time of discharge,1 month after discharge and 3 months after discharge(P<0.05).6)There were significant differences in ADL scores between the two groups at postoperative 3 d,discharge and 1 month after discharge(P<0.05).7)There was significant difference in SF-36 scores between the two groups at 1 and 3 months after discharge(P<0.05).8)There was significant difference between the two groups in the satisfaction of nursing work(P<0.05).Conclusion: The rehabilitation nursing scheme of total knee replacement under enhanced recovery after surgery can reduce the patients' anxiety,relieve the pain,shorten the time of the first postoperative rehabilitation exercise,reduce the postoperative complications.It can improve the effect of postoperative knee joint function recovery and the ability of daily life self-care.It can shorten the length of hospitalization,reduce the cost of hospitalization,improve the overall health status and the satisfaction of nursing work,which has the value of clinical promotion. |
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