Qu Lingyan, Li Yulian, Hong Dongyue
Department of Orthopedics, The First People's Hospital of Tongxiang City, Tongxiang, Zhejiang, China.
Department of Nursing, The First People's Hospital of Tongxiang City, Tongxiang, Zhejiang, China.
Medicine (Baltimore). 2025 Aug 29;104(35):e43870. doi: 10.1097/MD.0000000000043870.
Hip fractures in the elderly are frequently associated with complications and unfavorable outcomes. Managing postoperative delirium, pain, sleep disturbances, and overall quality of life presents significant challenges in clinical care. This study aimed to explore the effectiveness of refined nursing interventions in improving postoperative recovery and patient satisfaction among elderly patients undergoing hip fracture surgery. A retrospective analysis was conducted on 252 elderly patients with surgically treated hip fractures admitted to Zhejiang Provincial People's Hospital and Tongxiang First People's Hospital between January 2021 and June 2024. To minimize selection bias, participants were allocated into 2 groups using propensity score matching, ensuring comparable baseline characteristics between the groups. The observation group (n = 126) received refined nursing care tailored to individual needs, while the control group (n = 126) received standard nursing care. Key outcomes assessed included the incidence and duration of postoperative delirium, hospital length of stay, pain intensity (visual analog scale), sleep quality (Pittsburgh Sleep Quality Index), quality of life (SF-36), recovery quality (the quality of recovery-40), and satisfaction with nursing care. Compared to the control group, patients in the observation group showed a marked reduction in both the incidence and duration of postoperative delirium. They also experienced shorter hospital stays and reported lower pain scores by the third postoperative day. Sleep quality was notably better on the first and third days following surgery. Moreover, assessments at 1 and 2 months postoperatively revealed significantly higher scores in both quality of life and recovery. Nursing satisfaction was also significantly enhanced in the refined care group (P < .05 for all comparisons). Refined nursing interventions, with a focus on personalized, comprehensive care strategies, significantly improve postoperative outcomes in elderly patients with hip fractures. These measures not only mitigate delirium and pain but also promote better sleep, faster recovery, improved life quality, and greater patient satisfaction, demonstrating meaningful clinical application.
老年人髋部骨折常伴有并发症和不良后果。在临床护理中，管理术后谵妄、疼痛、睡眠障碍和整体生活质量面临重大挑战。本研究旨在探讨精细化护理干预对改善髋部骨折手术老年患者术后恢复及患者满意度的效果。对2021年1月至2024年6月期间收治于浙江省人民医院和桐乡市第一人民医院的252例接受手术治疗的老年髋部骨折患者进行回顾性分析。为尽量减少选择偏倚，采用倾向得分匹配法将参与者分为两组，确保两组之间的基线特征具有可比性。观察组（n = 126）接受根据个体需求量身定制的精细化护理，而对照组（n = 126）接受标准护理。评估的关键结局包括术后谵妄的发生率和持续时间、住院时间、疼痛强度（视觉模拟量表）、睡眠质量（匹兹堡睡眠质量指数）、生活质量（SF - 36）、恢复质量（恢复质量 - 40）以及对护理的满意度。与对照组相比，观察组患者术后谵妄的发生率和持续时间均显著降低。他们的住院时间也更短，术后第三天的疼痛评分更低。术后第一天和第三天的睡眠质量明显更好。此外，术后1个月和2个月的评估显示，生活质量和恢复方面的得分均显著更高。精细化护理组的护理满意度也显著提高（所有比较P < 0.05）。以个性化、全面护理策略为重点的精细化护理干预显著改善了老年髋部骨折患者的术后结局。这些措施不仅减轻了谵妄和疼痛，还促进了更好的睡眠、更快的恢复、改善了生活质量并提高了患者满意度，具有重要的临床应用价值。
