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护理学报 ›› 2020, Vol. 27 ›› Issue (21): 33-39.doi: 10.16460/j.issn1008-9969.2020.21.033

• 循证护理 • 上一篇    下一篇

全膝关节置换术加速康复循证护理实践方案的构建

单亚维1, 陈维佳2a, 金丽娟2b, 冯海萍2b, 陈茹2c, 冯程程2c   

  1. 1.上海中医药大学 护理学院,上海 201203;
    2.上海中医药大学附属光华中西医结合医院 a.护理部;b.关节外科;c.手术室,上海 200052
  • 收稿日期:2020-07-02 出版日期:2020-11-10 发布日期:2020-12-15
  • 作者简介:单亚维（1988-）,女,江苏常熟人,硕士,讲师。
  • 基金资助:
    上海中医药大学预算内科研项目（18HL50）; 上海市青年科技英才扬帆计划（20YF1449400）

Development of Evidence-based Practice Protocol for Enhanced Recovery after Total Knee Arthroplasty

SHAN Ya-wei1, CHEN Wei-jia2a, JIN Li-juan2b, FENG Hai-ping2b, CHEN Ru2c, FENG Cheng-cheng2c   

  1. 1. School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China;
    2a. Dept. of Nursing Administration; 2b.Dept. of Joint Surgery; 2c. Operating Room,Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 200052, China
  • Received:2020-07-02 Online:2020-11-10 Published:2020-12-15

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摘要： 目的 构建全膝关节置换患者加速康复循证护理实践方案。方法 本研究以爱荷华循证实践模式为指导,开展指南检索、筛选与纳入、推荐意见提取,通过德尔菲专家咨询与患者围手术期症状与治疗体验质性研究,进行指南推荐意见的筛选与行动方案的构建。结果 研究共纳入12篇指南,通过德尔菲专家咨询纳入推荐意见43条,结合患者质性访谈所得8类围手术期健康问题进行整合。形成术前行动方案9个模块,包括预后不良危险因素、焦虑与失眠、疼痛、营养、出血、凝血（深静脉血栓）、感染、便秘、活动;术中行动方案1个模块即手术方案模块;术后行动方案8个模块,内容包括疼痛、营养、便秘、引流与出血、凝血（深静脉血栓）、运动与康复、感染、焦虑与失眠。结论 全膝关节置换患者加速康复循证护理实践方案依托最佳证据、结合临床实践现状、医护人员的专业判断及患者意愿制定,可为促进全膝关节置换术患者加速康复提供管理策略。

关键词: 全膝关节置换术, 加速康复外科, 循证实践

Abstract: Objective To develop an evidence-based protocol to facilitate best practice for enhanced recovery after total knee arthroplasty (TKA). Methods Guided by the lowa model, evidence-based guidelines were retrieved, screened and eventually included. The best practice protocol was developed according to the recommendations synthesized by experts through 2-round Delphi survey and patients' experience by using qualitative interview. Results Consensus was reached on 43 recommendations from 12 evidence-based guidelines. Taking the health problems in perioperative period summarized in qualitative interview into consideration, we synthesized 9 preoperative modules including the risk factor for rehabilitation, anxiety and hyposomnia, pain, nutrition, hemorrhage control, deep venous thrombosis prevention, constipation prevention, infection prevention and rehabilitation training, 1 intraoperative module, namely, the operation and 8 post-operative modules including pain, nutrition, constipation prevention, drainage and bleeding, deep venous thrombosis prevention, exercise and rehabilitation, infection prevention, anxiety and hyposomnia. Conclusion The developed protocol is based on best evidence and combined with clinical practice, the suggestion from medical staff and patients' experience. It provides management strategy for improving quality of rehabilitation services after TKA.

Key words: total knee arthroplasty, enhanced recovery after surgery, evidence-based practice

中图分类号: 

  • R47
[1] Law JI, Adams JB, Berend KR, et al.The Feasibility of Outpatient Revision Total Knee Arthroplasty in Selected Case Scenarios[J]. J Arthroplasty,2020. DOI:10.1016/j.arth.2020.02.021.
[2] Zawadzki N, Wang Y, Shao H, et al.Readmission due to Infection Following Total Hip and Total Knee Procedures: A Retrospective Study[J]. Medicine (Baltimore), 2017, 96(38): e7961.DOI:10.1097/md.0000000000007961.
[3] Hur M, Park SK, Koo CH, et al.Comparative Efficacy and Safety of Anticoagulants for Prevention of Venous Thromboembolism after Hip and Knee Arthroplasty[J]. Acta Orthop,2017,88(6):634-641.DOI:10.1080/17453674.2017.1361131.
[4] Ravi B, Croxford R, Hollands S, et al.Increased Risk of Complications Following Total Joint Arthroplasty in Patients with Rheumatoid Arthritis[J]. Arthritis Rheumatol, 2014, 66(2):254-263. DOI:10.1002/art.38231.
[5] 向娜,马玉芬,高娜,等. 加速康复外科理念下全膝关节置换患者术后早期下床活动现状调查[J].中国护理管理, 2018, 18(11):1544-1549. DOI:10.3969/j.issn.1672-1756.2018.11.024.
[6] Pamilo KJ, Torkki P, Peltola M, et al.Fast-tracking for Total Knee Replacement Reduces Use of Institutional Care Without Compromising Quality[J]. Acta Orthop, 2018, 89(2): 184-198. DOI:10.1080/17453674.2017.1399643.
[7] Kehlet H, Thienpont E.Fast-track Knee Arthroplasty -- Status and Future Challenges[J]. Knee, 2013, 20(Suppl 1): S29-33.DOI:10.1016/s0968-0160(13)70006-1.
[8] Kehlet H, Dahl JB. Anaesthesia, Surgery,Challenges in Postoperative Recovery[J]. Lancet, 2003, 362(9399):1921-1928.DOI:10.1016/s0140-6736(03)14966-5.
[9] Vehmeijer SBW, Husted H, Kehlet H.Outpatient Total Hip and Knee Arthroplasty[J]. Acta Orthop, 2018, 89(2):141-144. DOI:10.1080/17453674.2017.1410958.
[10] Pietsch T, David J, Vergara F.Integrative Review for Patients with Bilateral Total Knee Replacement: A Call for Nursing Practice Guidelines[J]. Orthop Nurs, 2018, 37(4): 237-243.DOI:10.1097/nor.0000000000000465.
[11] Hass S, Jaekel C, Nesbitt B.Nursing Strategies to Reduce Length of Stay for Persons Undergoing Total Knee Replacement: Integrative Review of Key Variables[J]. J Nurs Care Qual, 2015,30(3):283-288.DOI:10.1097/ncq.0000000000000104.
[12] Goh ML, Chua JY, Lim L.Total Knee Replacement Pre-operative Education in a Singapore Tertiary Hospital:A Best Practice Implementation Project[J]. Int J Orthop Trauma Nurs, 2015, 19(1):3-14.DOI:10.1016/j.ijotn.2013.12.006.
[13] Brown CG.The Iowa Model of Evidence-based Practice to Promote Quality Care: An Illustrated Example in Oncology Nursing[J]. Clin J Oncol Nurs, 2014, 18(2):157-159.DOI:10.1188/14.CJON.157-159.
[14] 平卫伟. Delphi法的研究进展及其在医学中的应用[J]. 疾病控制杂志,2003(3):243-246.DOI:10.3969/j.issn.1674-3679.2003.03.032.
[15] Parvizi J, Della Valle CJ.AAOS Clinical Practice Guideline: Diagnosis and Treatment of Periprosthetic Joint Infections of the Hip and Knee[J]. J Am Acad Orthop Surg, 2010,18(12):771-772.DOI:10.5435/00124635-201012000-00007.
[16] Lieberman J, Pensak M.Prevention of Venous Thromboembolic Disease after Total Hip and Knee Arthroplasty[J]. J Bone Joint Surg Am, 2013,95(19):1801-1811.DOI:10.2106/JBJS.L.01328.
[17] Mcgrory B, Md MS, Weber K, et al.Surgical Management of Osteoarthritis of the Knee: Evidence-based Guideline[J]. J Am Acad Orthop Surg,2016,24(8):e87-e93.DOI:10.5435/JAAOS-D-16-00159.
[18] National Institute for Health Clinical Excellence. Dabigatran Etexilate for the Prevention of Venous Thromboembolism after Hip or Knee Replacement Surgery in Adults[EB/OL].(2011-08-02).https://www.nice.org.uk/guidance/ta157/resources/appendix-a-decision-paper-presented-to-the-institutes-guidance-executive2.
[19] National Institute for Health Clinical Excellence. Rivaroxaban for the Prevention of Venous Thromboembolism after Total Hip or Total Knee Replacement in Adults[EB/OL]. (2012-04-18).https://www.nice.org.uk/guidance/ta170/resources/appendix-a-decision-paper-presented-to-the-institutes-guidance-executive2.
[20] National Institute for Health Clinical Excellence. Apixaban for the Prevention of Venous Thromboembolism after Total Hip or Knee Replacement in Adults[EB/OL]. (2015-03-03). https://www.nice.org.uk/guidance/ta245/resources/venous-thromboembolism-apixaban-hip-and-knee-surgery-appendix-a-rpp-decision-paper-march-20152.
[21] National Institute for Health Clinical Excellence. Venous Thromboembolism in Over 16s Reducing the Risk of Hospital Acquired Deep Vein Thrombosis or Pulmonary Embolism[EB/OL].(2018-03-21).https://www.nice.org.uk/guidance/ng89/resources/venous-thromboembolism-in-over-16s-reducing-the-risk-of-hospitalacquired-deep-vein-thrombosis-or-pulmonary-embolism-pdf-1837703092165.
[22] 周宗科,翁习生,曲铁兵,等. 中国髋、膝关节置换术加速康复—围术期管理策略专家共识[J]. 中华骨与关节外科杂志, 2016,9(1):1-9.DOI:10.3969/j.issn.2095-9958.2016.01-01.
[23] 沈彬,翁习生,廖刃,等.中国髋、膝关节置换术加速康复—围术期疼痛与睡眠管理专家共识[J]. 中华骨与关节外科杂志,2016,9(2):91-97.DOI:10.3969/j.issn.2095-9958.2016.02-01.
[24] 康鹏德,翁习生,刘震宇,等.中国髋、膝关节置换术加速康复—合并心血管疾病患者围术期血栓管理专家共识[J]. 中华骨与关节外科杂志,2016,9(3):181-184.DOI:10.3969/j.issn.2095-9958.2016.03-01.
[25] 岳辰,周宗科,裴福兴,等.中国髋、膝关节置换术围术期抗纤溶药序贯抗凝血药应用方案的专家共识[J]. 中国骨与关节外科杂志,2015, 8(4):281-285.DOI:10.3969/j.issn.2095-9958.2015.04-001.
[26] 周宗科,翁习生,向兵,等. 中国髋、膝关节置换术加速康复—围术期贫血诊治专家共识[J]. 中华骨与关节外科杂志, 2016, 9(1):10-15.
[27] Fervers B,Burgers JS,Voellinger R,et al.Guideline Adaptation: An Approach to Enhance Efficiency in Guideline Development and Improve Utilisation[J]. BMJ Qual Saf,2011, 20(3):228-236. DOI:10.1136/bmjqs.2010.043257.
[28] Piercy KL, Troiano RP, Ballard RM, et al.The Physical Activity Guidelines for Americans Physical Activity Guidelines for AmericansPhysical Activity Guidelines for Americans[J]. JAMA, 2018, 320(19):2020-2028.DOI:10.1001/jama.2018.14854.
[29] 单亚维,陈维佳,李玉霞.基于循证实践指南的膝关节骨关节炎患者健康教育指导模块的构建[J].护理学报, 2019, 26(10):32-37.DOI:10.16460/j.issn1008-9969.2019.10.032.
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