老年膝骨性关节炎全膝关节置换术患者疾病体验的纵向质性研究及护理对策 [中文引用][英文引用]

目的  探讨老年膝骨性关节炎（knee osteoarthritis，KOA）患者在全膝关节置换术前至出院后的疾病体验，为解决患者在不同时期所面临的困境及健康问题提供依据。方法  采用描述质性研究方法，采用目的抽样法，选取于 2024 年 3 月至 11 月在新乡市某三级甲等综合医院骨科行手术治疗的 16 例老年膝骨性关节炎患者作为研究对象，进行 3 次半结构式访谈。以 Schmitt 战略体验模块理论（strategic experiential modules，SEMs）为框架，采用 Colaizzi 7 步分析法对访谈资料进行分析。结果  共提取 4 个主题与 12 个亚主题，即感官体验（术前病理性疼痛与功能受限、术后创伤性疼痛及控制失调、恢复期功能改善与症状残留），情感体验（术前疾病焦虑与未知恐惧、术后期待落差与康复焦虑、恢复期成就感满足与复发隐忧），思考体验（术前信息不足与治疗方式选择、术后效果评估与自我怀疑、恢复期自我反思与健康管理重铸），行动体验（术前被动适应、术后主 -被动配合、恢复期积极应对）。结论  全膝关节置换术老年膝关节炎患者的疾病体验呈现动态变化，医护人员应在患者不同时期给予针对性措施以解决其健康问题，改善其生活质量。

Objective To explore disease experience of elderly patients with knee osteoarthritis（KOA）from pre-total knee arthroplasty（TKA）to post-discharge，thereby addressing their challenges and health issues. ?Methods Using purposive sampling， 16 elderly patients hospitalised in the Department of Orthopaedics at a Tier-IIIA hospital in Xinxiang City were enrolled between March 2024 and November 2024 for three semi-structured interviews. Guided by Schmitt’s Strategic Experiential Modules theory，data were analysed through the phenomenological Colaizzi’s method. ?Results Four main themes and 12 subthemes emerged：sensory experience（preoperative pathological pain and functional limitations，postoperative traumatic pain and loss of control，functional improvement and residual symptoms during recovery），emotional experience（preoperative disease-related anxiety and fear of the unknown，postoperative unmet expectation and rehabilitation anxiety，sense of achievement and recurrence concerns during recovery），cognitive experience （preoperative information insufficiency and treatment choice dilemmas，postoperative efficacy evaluation and self-doubt，post-recovery self-reflection and health management restructuring），behavioural experience（preoperative passive adaptation，postoperative activepassive collaboration，proactive coping during recovery）. ?Conclusion Disease experience of elderly KOA-patients undergoing TKA evolves dynamically. Healthcare providers should implement the stage-specific interventions to address health issues and enhance the quality of life of patients.