失效模式与效应分析在骨折患者术后护理中的应用

doi:10.3760/cma.j.issn.1007-1245.2024.03.022

摘要/Abstract

摘要：

目的　探讨失效模式与效应分析在骨折患者术后护理中的应用。方法　选取2022年1月至12月在济南市中心医院收治的60例骨折手术患者进行随机对照试验，采用随机数字表法将其分为对照组和观察组，各30例。对照组男19例、女11例，年龄（49.20±2.01）岁，接受常规护理；观察组男17例、女13例，年龄（49.46±2.33）岁，接受失效模式与效应分析护理干预。通过在院调查及跟踪随访，于患者入院当天与术后30 d时，使用运动功能量表（FMA）、欧洲五维健康量表（EQ-5D）评估两组患者运动功能与生活质量情况，并对两组患者术后30 d内的并发症发生情况进行比较。采用t检验、χ²检验。结果　术后30 d，观察组反射活动［（4.65±0.77）分］、共同运动［（12.03±1.37）分］、分离运动［（3.03±1.22）分］、协调/速度评分［（2.59±0.92）分］均高于对照组［（4.01±1.02）分、（11.30±1.26）分、（2.49±1.01）分、（2.10±0.89）分］，差异均有统计学意义（t=2.743、2.148、2.075、2.097，均P<0.05）。术后30 d，观察组行动能力［（2.01±0.64）分］、自我管理能力［（1.95±0.43）分］、活动能力［（1.82±0.26）分］、疼痛或不适［（2.01±0.27）分］、焦虑或抑郁评分［（1.92±0.14）分］均高于对照组［（1.78±0.14）分、（1.72±0.34）分、（1.67±0.27）分、（1.90±0.12）分、（1.78±0.30）分］，差异均有统计学意义（t=2.013、2.298、2.192、2.039、2.316，均P<0.05）。观察组术后并发症发生率［3.33%（1/30）］低于对照组［20.00%（6/30）］，差异有统计学意义（χ²=4.043，P=0.044）。结论　失效模式与效应分析能够改善骨折手术患者运动功能，提升生活质量，有效降低并发症发生率。

关键词:

骨折, 失效模式与效应分析, 运动功能, 生活质量, 并发症

Abstract:

Objective　To analyze the application and influence of failure modes and effect analysis in postoperative care for fracture patients. Methods　Sixty fracture patients surgically treated at Jinan Central Hospital from January to December 2022 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 30 cases in each group. There were 19 men and 11 women in the control group; they were (49.20±2.01) years old. There were 17 men and 13 women in the observation group; they were (49.46±2.33) years old. The control group took routine care; the observation group took the nursing intervention of the failure mode and effect. analysis Through hospital investigation and follow-up, the motor function and quality of life were evaluated by the Fugl-Meyer Assessment (FMA) and European Quality of Life 5-Dimensions (EQ-5D) on the day of admission and 30 d after the surgery. The incidences of complications within 30 d after the surgery were compared between the two groups. t and χ² tests were applied. Results　Thirty days after the surgery, the scores of reflex activity, synergy movement, separated movement, and coordination/speed in the observation group were higher than those in the control group [(4.65±0.77) vs. (4.01±1.02), (12.03±1.37) vs. (11.30±1.26), (3.03±1.22) vs. (2.49±1.01), and (2.59±0.92) vs. (2.10±0.89)], with statistical differences (t=2.743, 2.148, 2.075, and 2.097; all P<0.05). Thirty days after the surgery, the scores of mobility, self-management ability, activity, pain/uncomfortableness, and depression or anxiety in the observation group were higher than those in the control group [(2.01±0.64) vs. (1.78±0.14), (1.95±0.43) vs. (1.72±0.34), (1.82±0.26) vs. (1.67±0.27), (2.01±0.27) vs. (1.90±0.12), and (1.92±0.14) vs. (1.78±0.30)], with statistical differences (t=2.013, 2.298, 2.192, 2.039, and 2.316; all P<0.05). The incidence of postoperative complications in the observation group was lower than that in the control group [3.33% (1/30) vs. 20.00% (6/30)], with a statistical difference (χ²=4.043; P=0.044). Conclusion Failure mode and effect analysis for fracture surgery patients can significantly improve their motor function and quality of life, and effectively reduce the incidence of complications.

Key words:

Fracture, Failure mode and effect analysis, Motor function, Quality of life, Complications

杨静刘阳子.

失效模式与效应分析在骨折患者术后护理中的应用 [J]. 国际医药卫生导报, 2024, 30(3): 460-464.

Yang Jing, Liu Yangzi.

Application of failure mode and effect analysis in postoperative care for fracture patients [J]. International Medicine and Health Guidance News, 2024, 30(3): 460-464.

参考文献

[1] 赵加庆,赵子豪,于先凯,等. 骨质疏松椎体压缩性骨折研究进展[J]. 国际医药卫生导报,2022,28(13):1806-1809.DOI:10.3760/cma.j.issn.1007-1245.2022.13.006.
[2] 中国康复医学会骨质疏松预防与康复专业委员会. 骨质疏松性椎体压缩骨折诊治专家共识(2021版)[J]. 中华医学杂志,2021,101(41):3371-3379.DOI:10.3760/cma.j.cn112137-20210625-01436.
[3] 孔令文,黄光斌,易云峰,等. 创伤性肋骨骨折手术治疗中国专家共识(2021版)[J]. 中华创伤杂志,2021,37(10):865-875.DOI:10.3760/cma.j.cn501098-20210604-00327.
[4] 董瑞一,朱仕文,苏永刚. TiRobot辅助骨折手术的应用进展[J]. 中华创伤骨科杂志,2022,24(2):179-184.DOI:10.3760/cma.j.cn115530-20211114-00517.
[5] 杨亮,储建军. 胫骨平台骨折术后康复治疗研究进展[J]. 中国临床保健杂志,2020,23(4):570-573.DOI:10.3969/J.issn.1672-6790.2020.04.033.
[6] 徐鹏,薛栋,赵文国. 快速康复外科在老年髋部骨折中的应用进展[J/CD]. 世界最新医学信息文摘(连续型电子期刊),2020,20(16):77-78.DOI:10.19613/j.cnki.1671-3141. 2020.16.038.
[7] 赵丹,黄孝玲. 骨科康复护理模式及快速康复护理进展[J/CD]. 世界最新医学信息文摘(连续型电子期刊),2020,20(9):246-247.DOI:10.19613/j.cnki.1671-3141. 2020.09.158.
[8] 杨冬菊,覃俊妮,陈万平,等. 失效模式与效应分析在我国护理风险管理中的研究进展[J]. 海南医学,2021,32(24):3254-3257.DOI:10.3969/j.issn.1003-6350.2021.24.035.
[9] 周龙月,高荣峦,文春瑾,等. 皮肤管理结合FMEA模式对急性肾衰患者血液透析中导管感染的预防效果[J]. 中国急救复苏与灾害医学杂志,2022,17(8):1038-1042.DOI:10.3969/j.issn.1673-6966.2022.08.015.
[10] 陶静怡,张达颖,王志剑,等. FMEA模式在带状疱疹神经痛病人HIV筛查期医院感染防控中的应用[J]. 中国疼痛医学杂志,2022,28(6):433-438.DOI:10.3969/j.issn.1006-9852. 2022.06.006.
[11] Watanabe Nemoto M, Nozaki-Taguchi N, Togasaki G, et al. New approach to relieving pain and distress during high-dose-rate intracavitary irradiation for cervical cancer[J].Brachytherapy,2015,14(5):642-647.DOI:10.1016/j.brachy.2015.04.009.
[12] 陈瑞全. 中文版Fugl-Meyer运动功能评定量表的最小临床意义变化值[D].合肥:安徽医科大学,2015.DOI:10.7666/d.D708086.
[13] 戴琳,温玉成,路桃影,等. 简短版中医健康量表和欧洲五维健康量表在脑卒中患者中的测量特性评价[J]. 首都医科大学学报,2019,40(4):627-634.DOI:10.3969/j.issn. 1006-7795.2019.04.024.
[14] 杨霞,崔颖,李国宏,等. 加速康复外科理念下老年髋部骨折手术体温管理研究进展[J]. 实用老年医学,2022,36(11):1088-1091.DOI:10.3969/j.issn.1003-9198.2022.11.003.
[15] 季文帅,胡浩然,程东生,等. 脆性骨折死亡率预测因素研究进展[J]. 国际骨科学杂志,2022,43(4):213-217.DOI:10.3969/j.issn.1673-7083.2022.04.004.
[16] 高辉,吕宝胜. 老年股骨颈骨折患者术后镇痛方式研究进展[J]. 医学综述,2022,28(9):1746-1750.DOI:10.3969/j.issn.1006-2084.2022.09.015.
[17] 郑秋宝. 骨盆骨折疗效评价指标的研究进展[J]. 中国骨与关节损伤杂志,2022,37(12):1338-1340.DOI:10.7531/j.issn.1672-9935.2022.12.031.
[18] 王静萍,贠雯洁,侯水亮. 基于FMEA模式的护理干预对宫颈癌PICC化疗患者的护理效果及并发症的影响[J]. 海南医学,2021,32(16):2170-2173.DOI:10.3969/j.issn.1003- 6350.2021.16.036.
[19] 顾婷婷,赵锋婷. 失效模式与效应分析在骨折患者术后深静脉血栓形成预防管理中的应用[J]. 血栓与止血学,2022,28(3):1069-1070,1073.DOI:10.3969/j.issn.1009-6213. 2022.03.323.
[20] 乔虹. 医疗失效模式与效应分析在髋部骨折老年患者术后谵妄中的应用[J]. 国际医药卫生导报,2020,26(18):2800-2804.DOI:10.3760/cma.j.issn.1007-1245. 2020.18.041.
[21] 李娜,黄天雯,陈晓玲,等. 基于FMEA理论的老年髋部脆性骨折患者术后谵妄风险管理应用研究[J]. 中国实用护理杂志,2022,38(22):1701-1707.DOI:10.3760/cma.j.cn211501-20220217-00428.
[22] 胡梦梦,高远,尹鹏滨. 脆性骨折危险因素及护理实践研究进展[J]. 中国实用护理杂志,2022,38(22):1756-1761.DOI:10.3760/cma.j.cn211501-20211217-03471.
[23] 刘一儒,李楷,赵军,等. 老年髋部骨折术后慢性疼痛的护理研究进展[J]. 实用医院临床杂志,2022,19(6):203-206.DOI:10.3969/j.issn.1672-6170.2022.06.060.
[24] 王丽春,黄芳艳. 四肢骨折病人早期康复锻炼依从性的研究进展[J]. 全科护理,2022,20(26):3625-3628.DOI:10.12104/j.issn.1674-4748.2022.26.006.
[25] 冷继扬,徐瑞,王朝鲁. 桡骨远端骨折术后康复的研究进展[J]. 中国临床医生杂志,2021,49(2):158-160. DOI:10.3969/j.issn.2095-8552.2021.02.008.
[26] 来晓玲,齐向飞. 基于FMEA模型的渐进性康复护理在股骨颈骨折术后患者中的应用[J]. 中华现代护理杂志,2022,28(15):2062-2065.DOI:10.3760/cma.j.cn115682- 20210706-02967.
[27] 郑欣欣. 动机行为转化的护理模式对年龄>60岁股骨粗隆间骨折患者术后疼痛程度及生活质量的影响[J]. 临床研究,2022,30(2):26-29.DOI:10.12385/j.issn.2096-1278(2022)02-0026-04.
[28] 冼佩玲,杨帅智,杨祥妹,等. 连续被动活动和功能锻炼应用于四肢骨折患者术后的效果分析[J]. 国际医药卫生导报,2021,27(16):2435-2438.DOI:10.3760/cma.j.issn.1007- 1245. 2021.16.002.
[29] 屈玲艳,沈霞勤,沈月红. 基于失效模式和效果分析模型的健康教育在老年人股骨颈骨折术后的应用效果观察[J]. 中国基层医药,2021,28(5):772-775.DOI:10.3760/cma.j.issn.1008-6706.2021.05.029.
[30] 王媛媛,吕冬梅,刘晓风. 多元化康复模式护理干预对胫骨平台骨折手术患者的影响[J]. 齐鲁护理杂志,2022,28(14):14-16.DOI:10.3969/j.issn.1006-7256.2022.14.005.