强直髋全髋置换术的医疗团队资源管理

Team resource management used in total hip arthroplasty for ankylosed hip secondary to ankylosis spondylitis

摘要:

[目的]探讨医疗团队资源管理(team resource management, TRM)在强直性脊柱炎(ankylosing spondylitis, AS)强直髋全髋关节置换术(total hip arthroplasty, THA)中的应用效果。[方法]回顾性分析本院关节外科 2018 年 8 月—2021 年 9 月收治的 37 例 (45 髋) AS 强直髋行 THA 患者的临床资料。依据医患沟通结果，20 例 (23 髋) 住院期间给予 TRM 干预 (TRM 组)；17 例(22 髋)住院期间给予常规医疗护理干预(常规组)。比较两组住院期间临床与血检验资料。[结果]两组患者均顺利完成手术，术中均无严重并发症。TRM 组麻醉时间显著优于常规组(P＜0.05)。TRM 组手术时间、下地行走时间以及住院时间优于常规组，但差异无统计学意义 (P＞0.05)。常规组切口长度显著短于 TRM 组 (P＜0.05)，术中失血量显著少于 TRM 组 (P＜0.05)。两组患者切口愈合等级的差异无统计学意义(P＞0.05)。 术后 3 d，TRM 组 Hb、Hct 均优于常规组(P＜0.05)，而两组间 CRP 及 ESR 的差异无统计学意义(P＞0.05)[结论]AS 强直髋患者住院期间接受 TRM 可以提升术前准备的工作效率，并提升患者满意度。

Abstract:

[Objective] To evaluate the outcomes during hospitalization of team resource management (TRM) used in total hip arthro- plasty (THA) for ankylosed hip secondary to ankylosing spondylitis (AS) . [Methods] A retrospective study was done on 37 patients (45 hips) who underwent THA for ankylosed hip after AS in our hospital from August 2018 to September 2021. According to doctor- patient communication, 20 patients (25 hips) received TRM intervention during hospitalization (TRM group) , while the remaining 17 patients (22 hips) received routine medical care intervention (routine group) . The clinical and blood test data during hospitalization were compared be- tween the two groups. [Results] All patients in both groups were successfully operated on without serious complications. The TRM group proved significantly superior to the routine group in terms of intra-operative anesthesia time and VAS score at 7 days postoperatively (P＜ 0.05) . Regarding to blood test, the TRM group was better than the routine group in Hb and Hct (P＜0.05) . [Conclusion] The TRM does im- prove preoperative preparation efficiency with considerably improved satisfaction of patient with ankylosed hip after AS.