Madsen Ulla Riis, Hommel Ami, Berthelsen Connie Bøttcher, Bååth Carina
Department of Orthopedic Surgery, Slagelse Hospital, Slagelse, Denmark.
Lund University, Lund, Sweden.
J Clin Nurs. 2017 Nov;26(21-22):3286-3297. doi: 10.1111/jocn.13716. Epub 2017 Feb 21.
To assess the effect of early mobilisation of patients after dysvascular lower limb amputation and to compare the effectiveness of different mobilisation regimens.
Patients who have undergone dysvascular major lower limb amputations are at high risk of postoperative complications, which include loss of basic functions, and early mobilisation interventions might prevent these complications.
Systematic review.
Systematic searches were performed on PubMed (including MEDLINE), CINAHL and EMBASE databases to identify studies investigating the effects of (early) mobilisation interventions in dysvascular lower limb-amputated patients. Data collection and quality assessment were performed using the Cochrane Effective Practice and Organization of Care Review Group data collection checklist and the Cochrane Handbook for Systematic Reviews of Interventions, respectively.
Five studies were included in the review: four pre- to post-case studies and one randomised controlled study. However, none of these studies were of high quality. Four studies investigated early mobilisation promoted by immediate postoperative prosthesis. One study investigated whether reorganizing care increases mobilisation and thereby functional outcome.
This systematic review reveals a lack of evidence to determine whether early mobilisation interventions are beneficial to this vulnerable patient group. Nevertheless, ambulation from the first postoperative day with temporary prosthesis is possible among the heterogeneous population of dysvascular lower limb-amputated patients if the necessary interdisciplinary team is dedicated to the task.
Mobilisation is a fundamental care task often missed for several reasons. Moreover, mobilisation of the newly amputated patient is complex, and knowledge of effective strategies to promote postoperative mobilisation in this vulnerable population is desired. Nurses are urged to take responsibility for this fundamental care task and to engage the necessary collaborative interdisciplinary team to develop, implement and evaluate ambitious early mobilisation interventions.
评估下肢血管性截肢术后患者早期活动的效果，并比较不同活动方案的有效性。
接受下肢大血管性截肢手术的患者术后发生并发症的风险很高，这些并发症包括基本功能丧失，而早期活动干预可能预防这些并发症。
系统评价。
在PubMed（包括MEDLINE）、CINAHL和EMBASE数据库中进行系统检索，以识别调查（早期）活动干预对下肢血管性截肢患者影响的研究。分别使用Cochrane有效实践与护理组织审查组数据收集清单和Cochrane干预措施系统评价手册进行数据收集和质量评估。
该评价纳入了五项研究：四项前后对照研究和一项随机对照研究。然而，这些研究均非高质量研究。四项研究调查了术后立即安装假体促进早期活动的情况。一项研究调查了重新安排护理是否能增加活动量从而改善功能结局。
该系统评价表明，缺乏证据来确定早期活动干预对这一脆弱患者群体是否有益。尽管如此，如果有必要的跨学科团队致力于此项任务，在下肢血管性截肢的异质性患者群体中，术后第一天使用临时假体进行步行是可行的。
活动是一项基本护理任务，由于多种原因常常被忽视。此外，新截肢患者的活动很复杂，人们希望了解在这一脆弱人群中促进术后活动的有效策略。敦促护士承担起这项基本护理任务，并让必要的跨学科协作团队参与进来，以制定、实施和评估雄心勃勃的早期活动干预措施。
