目的:通过促进医生对患者的肌肉骨骼能力培养,探索骨科大手术(MOS)后静脉血栓栓塞(VTE)的预防和管理。以金的目标达成理论为指导。
方法:选择接受MOS的患者(n=116)进行研究,分为常规组和观察组,常规组患者接受常规护理和管理,观察组患者根据King的目标达成理论进行肌肉骨骼能力培养。基线数据,肢体血管超声检查,凝血功能,西安大略省和麦克马斯特大学骨关节炎指数(WOMAC)评分,VTE预防功效,自我护理能力锻炼量表(ESCA)评分,并对护理满意度进行比较分析。
结果:基线资料组间差异无统计学意义(P>0.05)。在干预之后,观察组肌肉骨骼综合成像评分有统计学意义的降低,WOMAC分数的各个维度,和D-二聚体(D-D)水平(P<0.05),均与干预前和常规组相比(P<0.05)。此外,观察组干预后凝血酶原时间及ESCA各维度评分均升高(P<0.05),超过干预前水平和常规组获得的水平(P<0.05)。此外,观察组VTE发生率明显低于常规组(P<0.05),护理满意度明显高于常规组(P<0.05)。
结论:护理干预措施,基于King的目标达成理论,利用医生对患者的肌肉骨骼能力培养,已证明对MOS后患者的VTE预防和控制具有显着的临床益处。这种方法不仅有效地预防了MOS后患者的VTE,而且还提高了他们对护理的满意度。
OBJECTIVE: To explore the prevention and management of venous thromboembolism (VTE) following major orthopaedic surgery (MOS) by fostering doctor-to-patient cultivation of musculoskeletal ability, guided by King\'s theory of goal attainment.
METHODS: A cohort of patients (n = 116) undergoing MOS was selected for the study, and were divided into two groups: the regular group and the observation group, with patients in the regular group experiencing routine nursing care and management and those in the observation group undergoing musculoskeletal ability cultivation based on King\'s theory of goal attainment. Baseline data, limb vascular ultrasonography, coagulation function, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, VTE prevention efficacy, Exercise of Self-care Ability Scale (ESCA) score, and nursing satisfaction were analysed comparatively.
RESULTS: There was no significant within-group difference in baseline data (P > 0.05). Following the interventions, the observation group demonstrated statistically significant reductions in the Musculoskeletal-Integrated Imaging Score, various dimensions of WOMAC scores, and D-dimer (D-D) levels (P < 0.05) both in comparison to their levels before interventions and to those observed in the regular group (P < 0.05). Additionally, the observation group exhibited increases in prothrombin time levels and various dimensions of ESCA scores (P < 0.05) post-intervention, surpassing the pre-intervention levels and those obtained in the regular group (P < 0.05). Furthermore, the observation group exhibited a significantly lower incidence of VTE (P < 0.05) and higher nursing satisfaction (P < 0.05) compared to the regular group.
CONCLUSIONS: Nursing intervention measures, utilizing doctor-to-patient cultivation of musculoskeletal ability based on King\'s theory of goal attainment, have demonstrated a significant clinical benefit for VTE prevention and control in post-MOS patients. This approach not only effectively prevented VTE in post MOS patients but also enhanced their satisfaction towards nursing care.