Construction and application of a rehabilitation nursing program for patients with severe knee joint dysfunction undergoing sequential segmental anesthesia release
基于分次序贯法麻醉下松解术的重度膝关节功能障碍患者康复护理方案的构建与应用

摘要

目的 构建适用于分次序贯法麻醉下松解术的重度膝关节功能障碍患者系统化康复护理方案，并验证其临床应用效果。方法 以康复医学、护理学、加速康复外科（ERAS）理论为核心，融合互动达标与自我效能理论，构建涵盖术前全面准备、术后分阶段康复训练、多模式疼痛管理、并发症精准预防的综合性康复护理方案。采用便利抽样法选取2024年1月至2026年1月于我科行该手术的35例重度膝关节功能障碍患者为研究对象，由多学科团队标准化实施方案，以膝关节功能评分（HSS）、视觉模拟疼痛评分（VAS）、护理满意度、并发症发生率为评价指标，采用SPSS 26.0进行统计学分析。结果 35例患者术后1周、1个月、3个月Lysholm评分分别为（51.6±7.2）、（72.5±8.1）、（86.3±6.8）分，HSS评分分别为（54.8±6.8）、（75.6±7.5）、（88.5±6.2）分，均较术前[（32.8±6.5）、（35.2±7.1）分]显著提升（P<0.05）；术后VAS评分呈持续下降趋势，术后24 h达峰值（7.2±1.3）分，术后3个月降至（0.8±0.3）分，各时间点比较差异有统计学意义（P<0.05）；患者出院时及术后1个月护理满意度均为100%，随访期间未发生深静脉血栓、严重感染等重大并发症，轻微并发症总发生率为8.57%（3/35）。结论 本康复护理方案科学系统、针对性强，能有效促进重度膝关节功能障碍患者术后关节功能恢复，减轻术后疼痛，降低并发症发生风险，提升患者护理满意度，具有较高的临床推广与应用价值。

Abstract

Objective To construct a systematic rehabilitation nursing program for patients with severe knee joint dysfunction undergoing sequential segmental anesthesia release and to verify its clinical efficacy.
Methods Based on the theories of rehabilitation medicine, nursing, and accelerated rehabilitation surgery, integrating interactive standards and self-efficacy theory, a comprehensive rehabilitation nursing program covering comprehensive preoperative preparation, staged postoperative rehabilitation training, multimodal pain management, and precise prevention of complications is constructed. 35 patients with severe knee joint dysfunction who underwent the surgery in our department from January 2024 to January 2026 were selected as the research subjects using convenience sampling method. A standardized implementation plan was implemented by a multidisciplinary team, and knee joint function score, visual simulated pain score, nursing satisfaction, and incidence of complications were used as evaluation indicators. Statistical analysis was conducted using SPSS 26.0.
Results The Lysholm scores of the 35 patients at 1 week, 1 month, and 3 months postoperatively were (51.6±7.2), (72.5±8.1), and (86.3±6.8) points respectively, and the HSS scores were (54.8±6.8), (75.6±7.5), and (88.5±6.2) points respectively, which were significantly higher than the preoperative scores [(32.8±6.5), (35.2±7.1) points] (P<0.05). The VAS scores showed a continuous downward trend, reaching a peak at 24 hours postoperatively (7.2±1.3) points and decreasing to (0.8±0.3) points at 3 months postoperatively, with statistically significant differences at each time point (P<0.05). Nursing satisfaction was 100% at discharge and 1 month postoperatively. No major complications such as deep vein thrombosis or severe infection occurred during follow-up. The total incidence of minor complications was 8.57% (3/35).
Conclusion   This rehabilitation nursing program is scientific, systematic, and highly targeted. It can effectively promote postoperative joint function recovery, reduce postoperative pain, lower the risk of complications, improve patient nursing satisfaction, and has high clinical value for promotion and application.