【作者】 李静；

【导师】 张秀果；

【作者基本信息】 河北医科大学 ， 护理学， 2025， 硕士

【摘要】 目的:全膝关节置换术(TKA)后的睡眠质量和精神心理因素对患者的康复至关重要。本研究旨在探讨分时段围手术期健康宣教对TKA患者围手术期睡眠质量、疼痛及精神心理因素的影响。方法:这项前瞻性随机对照研究纳入了2024年6月至2024年10月期间接受TKA的患者,其中干预组69例,对照组68例患者,随访时间至少为TKA术后1个月。对照组患者在围手术期接受常规健康宣教,干预组患者在门诊就诊日、入院日、手术前1日、手术日、术后第1日、术后第2日、出院前1日及术后第7日等时间点进行分时段健康宣教。采用匹兹堡睡眠质量指数(PSQI)和失眠严重程度指数(ISI)评估睡眠质量。采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、中文版疼痛灾难化量表(PCS-CV)及中文版坦帕运动恐惧症量表(TSK-11)分别评估焦虑、抑郁、疼痛灾难化及运动恐惧症。采用视觉模拟评分法(VAS)和纽约特种外科医院(HSS)评分分别评估疼痛程度和膝关节功能。结果:两组患者入院日的PSQI、ISI、SAS、SDS、PCS-CV、TSK-11、VAS及HSS评分均无统计学差异(P均>0.05)。术后1日,干预组PSQI为13.13±1.76、ISI为15.01±2.26、SAS为50.82±4.93、SDS为52.30±4.72、TSK-11为27.62±4.13,对照组分别为15.32±1.92、17.12±2.84、55.31±4.46、56.47±4.13、31.32±4.20,两组比较均有统计学差异(P均<0.001);两组术后1日PCS-CV、VAS评分无统计学差异(P均>0.05)。术后1周,干预组PSQI为8.17±1.79、ISI为8.20±1.75、SAS为32.27±4.18、SDS为34.58±4.15、PCS-CV为13.71±3.00、TSK-11为19.88±4.82、VAS为3.24±1.32、HSS评分为67.12±5.59,对照组分别为11.36±1.89、10.93±2.24、40.48±4.41、41.92±4.54、18.02±4.82、24.36±4.32、4.64±1.13、58.76±4.89,两组比较均有统计学差异(P均<0.001)。术后1个月,干预组PSQI为5.83±1.82、ISI为5.83±1.62、SAS为26.41±2.10、SDS为28.06±3.10、PCS-CV为9.28±2.62、VAS为2.12±1.23、HSS评分为83.02±4.43,对照组分别为8.82±1.94、7.41±2.24、29.66±3.32、33.03±3.52、13.38±3.37、3.41±1.02、75.42±4.80,两组比较均有统计学差异(P均<0.001)。结论:分时段围手术期健康宣教在TKA术后1个月的随访中,显著改善了患者的睡眠质量,降低了疼痛水平,并减轻了焦虑、抑郁、疼痛灾难化及运动恐惧症等精神心理症状,有利于患者膝关节功能康复。更多还原

【Abstract】 Objective:Sleep quality and psychological factors after total knee arthroplasty(TKA)are crucial for patients’recovery.This study aimed to explore the impact of phased perioperative health education on sleep quality and psychological factors after TKA.Methods:This prospective randomized controlled study included patients who underwent TKA between June 1,2024,and October 1,2024,with 69 patients in the study group and 68 patients in the control group.The follow-up period was at least 1 month after TKA.Patients in the control group received routine health education during the perioperative period,while patients in the study group received phased health education at specific time points,including the outpatient visit day,admission day,1 day before surgery,surgery day,1 day postoperatively,2 days postoperatively,1 day before discharge,and 7 days postoperatively.The Pittsburgh Sleep Quality Index(PSQI)and Insomnia Severity Index(ISI)were used to assess sleep quality.The Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS),Chinese Version of the Pain Catastrophizing Scale(PCS-CV),and Chinese Version of the Tampa Scale for Kinesiophobia(TSK-11)were employed to evaluate anxiety,depression,pain catastrophizing,and kinesiophobia,respectively.The visual analog scoring(VAS)and Hospital for Special Surgery(HSS)score were used to assess pain intensity and knee function,respectively.Results:There were no statistically significant differences in PSQI,ISI,SAS,SDS,PCS-CV,TSK-11,VAS,and HSS scores between the two groups on the admission day(all P>0.05).On the first day after surgery,in the study group,the PSQI was 13.13±1.76,ISI was 15.01±2.26,SAS was 50.82±4.93,SDS was 52.30±4.72,and TSK-11 was 27.62±4.13;in the control group,the corresponding scores were 15.32±1.92,17.12±2.84,55.31±4.46,56.47±4.13,and 31.32±4.20,with statistically significant differences between the two groups(all P<0.001).There were no statistically significant differences in PCS-CV and VAS scores between the two groups on the first day after surgery(all P>0.05).At 1 week postoperatively,in the study group,the PSQI was 8.17±1.79,ISI was 8.20±1.75,SAS was 32.27±4.18,SDS was 34.58±4.15,PCS-CV was 13.71±3.00,TSK-11 was 19.88±4.82,VAS was 3.24±1.32,and HSS score was 67.12±5.59;in the control group,the corresponding scores were 11.36±1.89,10.93±2.24,40.48±4.41,41.92±4.54,18.02±4.82,24.36±4.32,4.64±1.13,and 58.76±4.89,with statistically significant differences between the two groups(all P<0.001).At1 month postoperatively,in the study group,the PSQI was 5.83±1.82,ISI was 5.83±1.62,SAS was 26.41±2.10,SDS was 28.06±3.10,PCS-CV was9.28±2.62,VAS was 2.12±1.23,and HSS score was 83.02±4.43;in the control group,the corresponding scores were 8.82±1.94,7.41±2.24,29.66±3.32,33.03±3.52,13.38±3.37,3.41±1.02,and 75.42±4.80,with statistically significant differences between the two groups(all P<0.001).Conclusion:Phased perioperative education significantly improved sleep quality,reduced pain level,and alleviated psychological symptoms including anxiety,depression,pain catastrophizing,and kinesiophobia during the 1-month follow-up after TKA,thereby leading to better recovery of knee function.更多还原