目的 探讨多学科整合护理路径联合手术室优质护理对下肢骨折的应用效果及对术后下肢静脉血栓发生率的影响。方法 选择2021年1月—2022年10月我院收治的70例下肢骨折患者,随机分为联合组与常规组,每组各35例。常规组患者实施常规护理,联合组患者实施多学科整合护理路径联合手术室优质护理,对比两组患者护理效果。结果 联合组患者首次下床活动时间、术后视觉模拟量表（VAS）评分低于常规组（P<0.05）,二者住院时间以及引流管拔除时间比较差异无统计学意义（P>0.05）;经过护理干预后,两组的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）均延长,血浆纤维蛋白原（FIB）降低,联合组优于常规组（P<0.05）,且联合组下肢静脉血栓发生率低于常规组（0% vs 17.14%,P<0.05）;联合组患者护理满意度更高（P<0.05）;术后1个月两组患者日常生活活动能力（ADL）评分、Fugl-Meyer评分均升高,联合组高于常规组（P<0.05）。结论 多学科整合护理路径联合手术室优质护理可改善下肢骨折患者围术期指标和血液高凝状态,降低患者下肢静脉血栓发生率,提升护理满意度及患者远期日常生活能力、肢体运动功能。

Objective To explore the application effect of multidisciplinary integrated nursing path combined with high-quality nursing in operating room on patients with lower limb fracture and the effect on postoperative lower limb venous thrombosis．Methods From January 2021 to October 2022,70 patients with lower limb fracture admitted to our hospital were randomly divided into combination group and conventional group,with 35 cases in each group．Patients in the conventional group received routine nursing,and patients in the combined group received multidisciplinary integrated nursing path combined with high-quality nursing in the operating room．The nursing effect of the two groups was compared．Results The first time of getting out of bed in the combined group was earlier and postoperative VAS score was lower than those in the conventional group（P<0.05）,and the length of hospital stay and drainage tube removal time were not significantly different between the two groups（P>0.05）．After nursing intervention,the prothrombin time（PT）and activated partial thromboplastin time（APTT）of the two groups were prolonged,and the plasma fibrinogen（FIB）decreased,and the change range of the combined group was greater（P<0.05）．The incidence of venous thrombosis in the combined group was significantly lower than that in the conventional group（0.00% vs 17.14%,P<0.05）．The nursing satisfaction of patients in combination group was higher（P<0.05）．The activities of daily living score and Fugl-Meyer score of both groups increased one month after surgery,and the combined group was higher than the conventional group（P<0.05）．Conclusions Multidisciplinary integrated nursing path combined with high-quality nursing in operating room can improve perioperative indicators and blood hypercoagulability of patients with lower limb fractures,reduce the incidence of lower limb venous thrombosis,improve nursing satisfaction,long-term daily living ability and limb motor function of patients．

目的 探讨手术室环境对人工股骨头置换术患者等待期应激反应的影响。方法 回顾性选取2021年1月1日—2023年7月31日入院的84例患者,患者均需要接受人工股骨头置换术治疗。根据患者接受治疗时手术室的环境将患者分为两组,对照组42例患者,其接受手术治疗时手术室环境未改造升级;观察组42例患者,其接受手术治疗时手术室环境已改造升级。对比两组应激反应（肾上腺素、皮质醇水平）、情绪状态[汉密尔顿抑郁量表（HAMD）评分、汉密尔顿焦虑量表（HAMA）评分]、血压（收缩压、舒张压、心率）、生活质量评分、患者对手术室环境的满意度。结果 T₁时刻,两组肾上腺素、皮质醇水平均升高,但对照组升高幅度[（43.48±4.59）pg/L、（268.48±13.55）ng/L]大于观察组[（38.15±5.28）pg/L、（240.15±12.48）ng/L],对比差异有统计学意义（t=4.937、9.967,P<0.05）。T₁时刻,两组HAMD、HAMA评分均升高,对照组水平[（22.84±3.26）（24.03±3.47）分]大于观察组[（19.75±3.73）（20.76±3.36）分],对比差异有统计学意义（t=4.042、4.387,P<0.05）。T₁时刻,两组收缩压、舒张压、心率水平均显著升高,但对照组升高幅度[（129.34±7.25）mmHg、（94.25±6.62）mmHg、（88.58±3.27）次/分]大于观察组[（117.62±8.13）mmHg、（85.63±5.38）mmHg、（82.16±3.66）次/分],对比有统计学意义（t=6.973、6.549,8.477,P<0.05）。术后5 d,两组各维度评分均显著升高,观察组各维度评分高于对照组（P<0.05）。观察组患者对手术室环境的满意率高于对照组（97.62% vs 85.71%,χ²=3.896,P=0.048）。结论 手术室环境改造升级对人工股骨头置换术患者具有积极作用,可有效降低患者等待期应激反应,减轻患者等待期焦虑、抑郁情绪,降低患者等待期血压、心率上升幅度,有利于提升患者术后生活质量,提高患者对手术室环境的满意度。

Objective To investigate the effect of operating room environment on stress response during the waiting period in patients with artificial femoral head replacement．Methods Eighty-four patients admitted between January 1,2021 to July 31,2023 required artificial femoral head replacement．According to the operating room environment during treatment,the patients were divided into two groups．Forty-two patients in the control group received the surgical treatment in the original operating room environment and 42 patients received surgical treatment in upgraded environment．Comparing two groups of stress response（adrenaline,cortisol）,emotional status[HAMD score,HAMA score],blood pressure（systolic blood pressure,diastolic blood pressure,heart rate）,quality of life,patient satisfaction with the operating room environment of two groups were compared．Results At time T₁,epinephrine and cortisol levels were significantly increased in the two groups,but the control group increased[（43.48±4.59）pg/L,（268.48±13.55）ng/L] greater than the observation group[（38.15±5.28）pg/L,（240.15±12.48）ng/L],which were statistically significant（t=4.937,9.967,P<0.05）．At time T₁,the HAMD and HAMA scores were significantly higher in both groups,but the increase[（22.84±3.26）and（24.03±3.47）] was greater than the observation group[（19.75±3.73）and（20.76±3.36）],which showed statistical significance（t=4.042,4.387,P<0.05）． At time T₁,SBP,DBP and heart rate increased significantly in both groups,but the control group increased[（129.34±7.25）mmHg,（94.25±6.62）mmHg,（88.58±3.27）][（117.62±8.13）mmHg,（85.63±5.38）mmHg,（82.16±3.66）/min] grater than the observation group（t=6.973,6.549,8.477,P<0.05）．Five days after surgery,the scores of each dimension increased significantly in both groups,but the observation group increased more than the control group（P<0.05）．The observation group patients showed a higher satisfaction rate of the operating room environment than the control group（97.62% vs 85.71%,χ²=3.896,P=0.048）．Conclusion sThe transformation and upgrading of the operating room environment has a positive effect on the patients with artificial femoral head replacement,which can effectively reduce the stress response of patients during the waiting period,reduce the anxiety and depression of patients during the waiting period,and reduce the rise in blood pressure and heart rate of patients during the waiting period,which is conducive to improving the quality of life of patients after surgery and improving the satisfaction of patients with the operating room environment．

目的 探讨流程化(CICARE)沟通模式在中下段尿路结石患者中的应用价值。方法 回顾性分析2018年8月—2019年11月我院80例中下段尿路结石患者,均行输尿管镜下钬激光碎石术,2018年8月—2019年5月的37例患者作为对照组,采用常规沟通流程,2019年6月—2019年11月的43例患者作为研究组,采用CICARE沟通模式。对比两组手术时间、沟通满意度及干预前后手术室注意事项知晓程度、贝克焦虑量表(BAI)、贝克抑郁量表21项版(BDI-21)评分。结果 研究组手术时间较对照组短(P＜0.05);干预后,研究组手术室注意事项知晓程度较对照组高(P＜0.05);干预后,研究组BAI、BDI-21评分较对照组低(P＜0.05);研究组沟通满意度95.35%(41/43)较对照组81.08%(30/37)高(P＜0.05)。结论 CICARE沟通模式应用于中下段尿路结石患者,可提高患者手术室注意事项知晓程度,减轻负性情绪,缩短手术时间,且具有较高沟通满意度。

Objective To explore the application value of CICARE communication model in patients with middle and lower urinary calculi. Methods From August 2018 to November 2019, eighty patients with middle and lower urinary calculi in our hospital were analyzed retrospectively. All patients underwent ureteroscopic holmium laser lithotripsy.Thirty-seven patients from August 2018 to May 2019 served as a control group, using a routine communication process, forty-three patients from June 2019 to November 2019 served as the study group and adopted the CICARE communication model. The two groups were compared in surgical time, communication satisfaction, awareness of operating room precautions before and after intervention, Baker Anxiety Scale (BAI), and Baker Depression Scale 21 item (BDI-21)scores. Results The operation time in the study group was shorter than that in the control group (P＜0.05). After the intervention, the awareness degree of the operating room precautions in the study group was higher than that in the control group (P<0.05). After the intervention, the BAI and BDI-21 scores in the study group were lower than those in the control group (P<0.05). The communication satisfaction of the study group was 95.35% (41/43),higher than the control group of 81.08% (30/37)(P<0.05). Conclusion The application of CICARE communication mode in patients with middle and lower urinary calculi may improve patient's awareness of precautions in the operating room. It may reduce negative emotions, shorten the operation time, and has higher communication satisfaction.