Clinical Application Of Cluster Nursing For Patients With Abdominal Distension And Constipation After Thoracolumbar Fracture

Objective To explore relevant studies that the cluster care for the care of patients after thoracolumbar fracture surgery, and to observe the effect of the cluster care on distension and constipation after thoracolumbar fracture surgery, thus providing a theoretical and practical basis for the care that aims to reduce the concurrency of distension and constipation after thoracolumbar fracture surgery.Methods Eighty patients with thoracolumbar fractures admitted from June 2013 to May 2014, who underwent open surgery, were selected as subjects. They were randomly divided into two groups: experimental group with 40 cases, in which apart from routine care, cluster intervening measures were also applied, including preoperative and postoperative cluster interventions, and control group with 40 cases, in which routine care was also applied. Through statistical analyses, such as T test, chi-square test, rank sum test and regression analysis, the self-efficacy level as well as occurrence of abdominal distension and constipation between these two groups were compared.Results 1 In the univariate analysis of abdominal distension and constipation after thoracolumbar fracture surgery, they were analyzed by being associated with potential variables, including injury severity, age, water intake, bed activity level, amount of fruits and vegetables taken after operation, postoperative use of sedatives and Self-efficacy level. After association with the occurrence of abdominal distension and constipation, multivariate regression analysis showed that injury severity,bed activity level and amount of fruits and vegetables taken after operation were independent factors for postoperative abdominal distension and constipation. 2 Nine cases of abdominal distension were observed among the 40 cases of experimental group, including six cases, two cases and one case of mild, moderate and severe patients, respectively; twenty-one cases of abdominal distension were observed in the control group, including four cases, twelve cases and five cases of mild, moderate and severe patients, respectively. The difference between the two groups was statistically significant( P <0.05). 3 Fifteen cases of constipation were observed among the 40 cases of experimental group, and 24 cases in the control group, with a statistically significant difference(c2 = 4.053, P<0.05); the constipation integral in the experimental group was 5.1±3.6 points, and 6.4±3.7 points in the control group, with a statistically significant. difference between them(P <0.05). 4 The self-efficacy score of patients after thoracolumbar fracture surgery was 56.45 ± 19.22, in which 12.5% fell in high level, 57.5% in medium level and 24% in low level. 5 The comparison of self-efficacy without the intervention showed no statistical significance between these two groups(P>0.05); the comparison of self-efficacy after the intervention showed statistical significance(P<0.05). After the intervention in the experimental group, the self-efficacy of patients was significantly improved, with scores increased to67.43±18.55 from54.20±17.67, showing a statistically significant difference(P<0.01); the difference in self-efficacy scores twice before and after intervention in the control group was not statistically significant(P>0.05).Conclusions 1 Abdominal distension and constipation are common complications after thoracolumbar fracture surgery, and the self-efficacy level of such patients is generally low. 2 The cluster care for the care of patients with distension or constipation after thoracolumbar fracture surgery can increase patient’s self-efficacy. 3 The cluster care for the care of patients with distension or constipation after thoracolumbar fracture surgery mitigate and reduce the occurrence of abdominal distension and constipation,...