| ObjectivesBased on the theoretical basis of enhanced recovery after surgery,we established the nursing scheme of early postoperative application plantar arteriovenous pump combined with cryotherapy nursing in patients who underwent Total Knee Arthroplasty.Then we designed randomized controlled trial to evaluate the effect of the constructed nursing scheme on accelerating the rehabilitation of knee joint function after operation.It provides a scientific basis for early postoperative effective nursing intervention in such patients.MethodsThis study is an intervention study.The study surveyed 150 patients who underwent unilateral total knee arthroplasty for the first time in a three-level general hospital in Shandong province from October 2018 to December 2019.The subjects were divided into Group A,Group B and Group C according to the random number table method,with 50 patients in each group.There was no significant difference in the general information of patients among the three groups(P>0.05).All patients were given orthopedic routine nursing,intravenous analgesic pump and the same analgesic drug,and they were guided to carry out rehabilitation exercise.The differences in postoperative nursing interventions among the three groups were as follows:for patients in Group A,plantar arteriovenous pump combined with cryotherapy using ice blanket machine were used on the operated limb on the day after operation,then twice a day,40 minutes each time,at the time points of 8:00 and 16:00;for patients in Group B,plantar arteriovenous pump was used on the day after operation,then twice a day,40 minutes each time,at the time points of 8:00 and 16:00;for patients in Group C:neither the plantar arteriovenous pump nor the cryotherapy was used.Evaluation indicators include range of motion(ROM),numerical rating scale(NRS),knee swelling degree at postoperative 72 hours,situation of first postoperative ambulation,incidence rate of postoperative lower extremity deep vein thrombosis and calf muscular vein thrombosis on the 5th day after operation,the number of cases of additional use of postoperative analgesics within 5 days after operation,hospital days and hospitalization costs.The collected datas were analyzed by the SPSS21.0 statistical software.The enumeration datas were expressed by frequency,?2 test and Fisher exact probability method were used for inter-group comparisons;the measurement datas were expressed as mean ± standard deviation(x±s),variance analysis and pairwise comparisons were used;rank sum test was used for grade datas,and P<0.05 was used to determine statistically significant differences.Results1.Knee range of motion:there was no significant difference in the passive range of motion of the operated knee in patients among the three groups(P>0.05);the passive range of motion of the operated knee on days 1,3 and 5 after operation,group A was significantly higher than group B and C,and the differences were statistically significant(P<0.05).2.Pain score:there was no statistical difference in static NRS score after operation,4 hours among group A,B,and C(P>0.05);the static NRS score after operation,8 hours,12 hours and the activity NRS score after operation,24 hours,48 hours,72 hours in group A were significantly lower than score in group B and C,and the difference was statistically significant(P<0.001).3.Degree of swelling:There were different degrees of swelling of the operated limbs 72 hours after TKA among group A,B,and C,the degrees of swelling in group A and B were lighter than that in group C,and there was a significant difference in patients from group A and B compared with that in group C(P<0.05).4.In the time,the form and the willingness of the first postoperative ambulation,there was significant difference among the three groups(P<0.05).In terms of assistance for ground activity,there was no significant difference among group A,B and C(P>0.05).5.None of the patients in group A,B and C had lower extremity deep vein thrombosis after operation,and the difference had no statistical significance.In terms of the incidence of calf muscular vein thrombosis,the rates of patients in group A,B and C were 4%(2/50),6%(3/50)and 16%(8/50)respectively,and there was significant difference among the three groups(P<0.05);the incidence of patients in group A and B was lower compared with group C,there was significant difference(P<0.05).6.There was a significant difference in the number of cases of additional use of postoperative analgesics within 5 days after operation in patients among group A,B and C(P<0.05);there was a significant difference in the number of cases of additional use of postoperative analgesics in patients from group A respectively compared with those from group B and C(P<0.05).7.In terms of hospital days,the difference between the three groups was statistically significant(P<0.05);there was no significant difference in the hospital days between patients in group A and B(P>0.05);the hospital days in groupA and B were less than that in group C,there was significant difference respectively compared with patients in group C(P<0.001).There was no significant difference in hospitalization costs in patients among group A,B,and C(P>0.05).ConclusionsBased on the theoretical basis of Enhanced Recovery After Surgery,we established the nursing scheme of early postoperative application plantar arteriovenous pump combined with cryotherapy nursing in patients who underwent Total Knee Arthroplasty.The nursing scheme can effectively reduce the postoperative pain,the degree of postoperative limb swelling.It also can promote early ambulation and carry out effective knee joint functional exercises,which can effectively reduce the incidence of postoperative calf muscular vein thrombosis,shorten the hospital days and accelerate the rehabilitation of patients.The study provides a scientific basis for the selection of effective nursing intervention for practice,which is worthy of promotion for clinical application. |
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