| Objectives:To explore the effect of non-pharmaceutical intervention based on ESA(European Society of Anaesthesiology)guidelines on the prevention and treatment of postoperative delirium(POD,Postoperative Delirium)in elderly patients with hip fractures,and observe the incidence of postoperative complications in elderly patients with hip fractures,Pain,self-care ability of patients,nutritional status and hip function of patients,and finally get the effect of the intervention method on the incidence of delirium and the duration of delirium in such patients.Methods:This study adopts the method of clinical randomized controlled trials,and selects 88 elderly hip fracture patients undergoing hip arthroplasty who were admitted to the Department of Orthopedics of a tertiary hospital in Kunming from December 2019 to December 2020 as the research objects,which will meet the criteria for inclusion and exclusion.Of elderly patients with hip fractures were assigned to the control group and intervention group by random number method.The control group adopted traditional perioperative nursing methods,and the intervention group applied perioperative non-drug intervention based on EAS guidelines on the basis of traditional perioperative nursing methods.Carry out personalized care and implement interventions around the five dimensions of delirium diagnosis in terms of improving pain,improving audiovisual,improving cognition,reducing noise,maintaining circadian rhythm,avoiding unnecessary catheters,early activities,and early nutrition.By comparing the two groups The incidence of postoperative complications,postoperative pain scores,nutritional scores,self-care scores,hip Harris scores,and hospitalized patients’ satisfaction were analyzed.Non-pharmacological interventions were used to prevent and treat the incidence of postoperative delirium and delirium in elderly hip fractures.The effect of duration.Results:1.Main outcome indicatorsComparison of postoperative delirium incidence,delirium duration and postoperative complications between the two groupsThe incidence of postoperative delirium in the intervention group was 2/44(4.55%),which was lower than the incidence of delirium in the control group was 9/44(20.45%),the difference was statistically significant(p=0.024,p<0.05)The duration of delirium in the intervention group was(0.07 ± 0.33)days,which was lower than the duration of delirium in the control group was(0.43±0.93)days,the difference was statistically significant(p=0.000,p<0.001);the two groups of patients had postoperative complications Compared with symptoms,the incidence of intervention group was 3/44(6.82%)lower than that of control group 7/44(15.91%),but the difference was not statistically significant(p=0.541,p>0.05).2.Secondary outcome indicators2.1.Comparison of the incidence of postoperative complications between the two groupsComparing the incidence of postoperative complications between the two groups,the incidence of the intervention group was 6/44(13.6%)lower than that of the control group 11/44(25.0%),but the difference was not statistically significant(p=0.687,p>0.05)).There was no statistically significant difference between the two groups in terms of unplanned extubation rates,pressure ulcers,urinary/respiratory infections,deep vein thrombosis,and incision infections in terms of types of complications.But in terms of the number of occurrences,the intervention group 3/44(6.8%)was lower than the control group 10/44(22.7%),the difference was statistically significant(p=0.035,p<0.05).2.2.Comparison of postoperative VAS score between the two groupsIn the comparison of pain scores between the two groups of patients at different times after surgery,the VAS score of the intervention group(4.20±0.79)was lower than that of the control group(5.41 ± 1.42)at 12 hours after the operation,and the difference was statistically significant(p=0.002,p<0.05);The VAS score(1.98±0.85)of the intervention group was lower than the control group(5.18±1.48)at 24 hours postoperatively,and the difference was statistically significant(p=0.006,p<0.05);the VAS score of the intervention group at 48 hours postoperatively(1.30±0.59))Was lower than the control group(1.55±0.76),the difference was statistically significant(p=0.007,p<0.05);72 hours after the operation,the intervention group’s VAS score(1.09±0.29)and the control group(1.09 ± 0.42)had no difference Statistically significant(p=0.904,p>0.05).2.3.Comparison of BI before and after the two groups of patientsThere was no significant difference between the intervention group(57.84±9.49)and the control group(56.82 ± 9.03)at admission(p=0.821,p>0.05);the BI index intervention group(58.30±9.02)was higher on the day before surgery The control group(58.07±7.17),the difference was statistically significant(p=0.034,p<0.05);the BI index intervention group(84.66 ± 4.50)was higher than the control group(77.05±8.09)at five days postoperatively,the difference was statistically significant Significance(p=0.004,p<0.05).2.4.Comparison of NRS2002 scores between the two groups of patients before and after surgeryThere was no statistically significant difference between the intervention group(1.45±0.70)and the control group(2.07 ± 1.19)at admission(p=0.413,p>0.05);the NRS2002 score of the intervention group(1.41±0.68)was lower on the day before surgery The control group(2.02±1.13),the difference was not statistically significant(p=0.088,p>0.05);the NRS2002 score of the intervention group(0.80±0.63)was lower than the control group(1.50 ± 1.32)at five days after the operation,the difference was statistically significant Significance(p=0.010,p<0.05).2.5.Comparison of Harris scores between the two groups at five days after surgeryThe Harris scores of the two groups were compared five days after the operation.The Harris score of the intervention group(78.14±5.01)was higher than that of the control group(63.82±7.65),and the difference was statistically significant(p=0.035,p<0.05).At the same time,in terms of comparing the scores of the various dimensions in the Harris score,the joint function score item of the intervention group(31.70 ±4.60)is greater than the control group(27.72±3.62),and the difference is statistically significant(p=0.030,p<0.05).In pain,deformity In terms of activity,the difference was not statistically significant.2.6.Comparison of inpatient satisfaction between the two groupsThe satisfaction degree of inpatients in the intervention group(97.09±1.20)was higher than that of the control group(91.70±2.02),and the difference was statistically significant(p=0.004,p<0.05).Conclusions:1.Non-pharmaceutical interventions based on ESA guidelines can effectively reduce the incidence of POD in elderly patients with hip fractures and reduce the duration of POD in patients.Therefore,it is recommended to use this non-pharmacological intervention in clinical practice to prevent POD.However,it is not statistically significant in reducing the incidence of postoperative complications in patients,which may be related to factors such as insufficient sample inclusion.2.Non-pharmaceutical interventions based on ESA guidelines can improve patients’ postoperative cognition,reduce postoperative pain,improve patients’self-care ability,and improve patients’ nutritional status.3.Non-pharmaceutical intervention measures based on ESA guidelines have improved the patient’s hip function from an evidence-based perspective,improved the postoperative quality of life of the patient,and enhanced the patient’s satisfaction with the hospital.It is worthy of promotion and use in orthopedics. |
PDF Full Text Request