Applied Study Of Precision-nursing Based On Damage Control Orthopaedics On The Early Rehabilitation Of Elderly Patients With Hip Replacement

Objective:This study aimed to assess the effect of precision nursing based on damage control orthopaedics on the early rehabilitation of elderly patients after hip replacement,and to provide theoretical basis for clinical nursing intervention.Methods:The study recruited 393 patients who were about to take artificial hip replacement surgery in certain grade III general hospital in Zunyi City from 1 October2018 to 30 September 2019.According to the inclusion criteria,72 elderly patients were selected and were randomly divided into the intervention group and the control group with36 cases each.The control group was treated with traditional nursing,while the intervention group received precision nursing based on DCO besides the routine nursing care,which includes early warning(DORSSSP3.0 assessment system and Caprini risk assessment),precise control and prevention(preoperative pre-rehabilitation exercise,precision psychological care,precision anti-embolism care,postoperative wound ice application and thermostatic rehydration),accurate health education(The Mind Map,QR code,WeChat and WeChat group).Furthermore,Harris Hip Score(HHS),Barthel index scale(BI),state anxiety inventory(S-AI)and Newcastle Satisfaction with Nursing Scales(NSNS)were used to evaluate the hip function,daily self-care ability,state of mental anxiety,and satisfaction of the patients in both groups on discharge day,1and 3months after discharge.Moreover,the time of the first ground movement after operation was recorded to assess the recovery of joint function in two groups.Complications and mortality 30 days after surgery were observed and compared between the two groups.The relevant factors of the patients'rehabilitation effectiveness in the intervention group were analyzed.The data were analyzed by SPSS18.0 statistical software.Results:1.Intervention study results:Although a total of 72 cases were included in the study.due to loss of visit,exit and other reasons.5 patients did not finish participating the study.The shedding rate was5.55%in the intervention group and 8.33%in the control group,therefore,there were 34patients completed the study in the intervention group and 33 in the control group.(1)Before the intervention,no significant difference was observed in general data,Harris hip scores,Barthel index scale scores and total scores of state anxiety inventory between two groups(P>0.05).(2)Hip function:The Harris hip scores were higher in the intervention group than those in the control group at discharge,1 and 3months after discharge(P<0.05).Furthermore,the Harris hip scores in both groups showed an increasing trend with time,and the performance of the intervention group increased faster than that of the control group.(3)Daily self-care ability:The scores of Barthel index scale were higher in the ntervention group than those in the control group at discharge and 1 month after eaving the hospital(P<0.001).The score of Barthel index scale in both groups howed an increasing trend,and the increase in the intervention group was more ignificant than that in the control group.(4)State of mental anxiety:The scores of the State Anxiety Scale in the intervention roup were lower than those in the control group at the time of discharge,1 month fter discharge,and 3 months after discharge(P<0.01).The S-AI scores of both,oups showed a downward trend over time,and the decrease in the intervention roup was more pronounced than that in the control group.(5)The time of the first ground movement after operation,the satisfaction of the patients and the rate of complications and mortality 30 days after surgery:Patients in the ntervention group started getting out of bed and doing functional exercises earlier fter surgery than those in the control group(P<0.01).And patients in the ntervention group had higher satisfaction on nursing services(P<0.01).Furthermore,the complication rate of 30 days after operation in the intervention group was lower han that in the control group(P<0.05).No death occurred in either group during the 30 days after surgery.2.The results of correlation analysis(1)The anxiety level of patients in the intervention group was negatively correlated with he hip function at discharge(r_s=-0.614,P<0.01)and 1 month after discharge(r_s=-0.588,P<0.01)respectively.And the time of patients'first stood-out activity successfully after surgery was positively linearly correlated with the anxiety level of the patients when admitted to hospital(r_s=0.815,P<0.01).(2)The Hemoglobin level at the time of discharge was negatively correlated with the time of first ground activity after surgery(r_s=-0.635,P<0.01)and S-AI when admitted to hospital(r_s=-0.586,P<0.01);The HHS in 1 month after discharge was positively orrelated with HB level at the time of discharge(r_s=0.545,P<0.01).Conclusion:1.Precision nursing based on damage control orthopaedics is a safe nursing mode,which can promote elderly patients to take out of bed activities early after hip replacement surgery,promote the recovery of hip function,improve their daily life self-care ability,alleviate patients'psychological anxiety,and improve patients'satisfaction of nursing service as well.2.Relevance analysis of small samples in the intervention group indicated the correlation among psychological anxiety level,the time of first off-bed activity,HB before discharge and hip function recovery of elderly patients with hip replacement.And it is urgently needed to be proved by further studies with Large sample.