| Objective:The purpose of this study is to construct the perioperative nursing program of total hip arthroplasty based on the concept of Enhanced Recovery After Surgery(ERAS),and evaluate its clinical application effect.Methods:1 Program constructionBased on literature review and group discussion,combined with the actual needs of Orthopaedic patients,a perioperative ERAS nursing program for total hip arthroplasty was initially developed.Based on this,expert consultation questionnaire were designed.Then the Delphi method was used to conduct two rounds of expert consultation among 30 experts,and the perioperative ERAS nursing program for total hip arthroplasty was finally established.2 InterventionA total of 136 patients with primary unilateral total hip arthroplasty who were hospitalized in Nanjing 3A-level hospital between January 2017 and October 2018.68 patients from January to November 2017 were selected as the control group and given conventional nursing plan;68 patients from December 2017 to October 2018 were selected as ERAS group and treated by the perioperative ERAS nursing program.The basic information,operation-related information,the time for the first ambulation,joint function score,self-care ability score,length of stay and hospitalization costs of the two groups were collected.All of the data was analyzed by statistical softwareSPSS20.0 to compare the differences between the two groups,and to evaluate the effect of perioperative ERAS nursing program.Results:1 Perioperative nursing program:The effective recvery rate of the 2 rounds of expert consultation was 96.7% and 96.6 %;the authority coefficient of experts was 0.83 and 0.87;The Kendall coordination coefficients for the importance and operability of the first round were0.227 and 0.290,respectively,the second round is 0.316 and 0.252,the significance test results suggest that p<0.05.A perioperative ERAS nursing program of total hip arthroplasty including 3 primary items,13 secondary items and 36 tertiary items was finally determined.2 Intervention effect:There was no significant difference in preoperative baseline data between the two groups(P>0.05);There was statistically significant difference in time for the first ambulation,activity distance,first exhaust time,and first defecation time between the two groups(P<0.05);The removal time of urinary tube and drainage tube in ERAS group was earlier than that in the control group(P<0.05);The visual analogue pain score(VAS)on the 1st,2nd and 3rd day after surgery in ERAS group was lower than that in the control group(p<0.05);The Harris scores and ADL score of in ERAS group was significantly higher than the control group,there is statistics meanings(p<0.05);The number of postoperative complications in ERAS group was less than that in the control group;Compared with control group,the length of stay and hospitalization costs were lower and satisfaction with nursing services was higher in ERAS group,the results showed statistically significant(P<0.05).Conclusions:The study is based on the Delphi method to construct a perioperative ERAS care program for total hip arthroplasty.It is scientific and reliable to refine and standardize nursing measures from preoperative,intraoperative and postoperative dimensions.The application of this program for patients undergoing total hip arthroplasty can reduce or alleviate the physiological and psychological stress factors associated with surgery,speed up the recovery of patients after surgery,improve hip function andself-care ability,shorten hospital stay and decrease total hospitalization costs.Moreover,it can reduce family and socio-economic pressures and make full use of medical resources,promote the improvement of clinical nursing quality and facilitate the development of ERAS nursing. |
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