加速康复外科理念在人工全髋关节置换围手术期的临床应用  

The application of the concept of fast track surgery in the perioperative period of total hip arthroplasty

作　　者：李雅欣[1] 王凌[1] 冯德宏[1] 高剑锐[1] 丁育健 LI Yaxin;WANG Ling;FENG Dehong(Department of Orthopedic,Wuxi People's Hospital, Jiangsu ,Wuxi 214002,China)

机构地区：[1]江苏省无锡市人民医院骨科,214002

出　　处：《临床外科杂志》2018年第12期955-958,共4页Journal of Clinical Surgery

摘　　要：目的探讨加速康复外科理念在人工全髋关节置换围手术期的临床应用。方法行人工全髋关节置换术病人100例,根据围手术期干预方法不同分为观察组和对照组,每组各50例。对照组病人给予常规干预,观察组在对照组基础上采用加速康复干预模式。比较两组术中失血、输血情况,检测并比较两组病人手术前后髋关节状况、自理能力及血流变学水平,分析两组术后并发症发生情况及护理满意度。结果与对照组比较,观察组病人护理满意度明显升高(P <0. 05),术中总失血量、输血率、第1天血红蛋白降低值均显著降低(P <0. 05),术后下床活动时间、术后住院时间显著缩短(P <0. 05)。术后3个月两组病人日常活动能力与步态、关节活动、Harris总分均较术前显著升高,疼痛以及关节畸形得分较术前显著降低,视觉模拟评分量表(VAS)评分均较术前显著降低,Barthel指数均较术前显著升高,术后7天两组血浆中D-二聚体水平均显著升高,两组间上述指标比较,差异有统计学意义(P <0. 05)。术后7天观察组病人全血高切黏度、全血低切黏度、血沉以及血浆比黏度均较术前明显降低,低于对照组(P <0. 05)。两组并发症发生率比较无明显差异(P> 0. 05)。结论对行人工全髋关节置换术的病人给予加速康复外科干预模式,可提高病人髋关节功能和自理能力,加快血流速度,减轻疼痛。Objective To investigate the application of the concept of fast track surgery in the perioperative period of total hip arthroplasty. Methods 100 cases of total hip arthroplasty in our hospital were retrospectively analyzed. The patients were divided into observation group and control group,50 cases in each group,according to the perioperative intervention measures. The control group received routine intervention,and the observation group adopted enhanced recovery after surgery intervention mode on the basis of the control group. The blood loss and blood transfusion were compared between the 2 groups. The hip joint function,pain and self-care ability of the 2 groups were detected and compared before and 3 months after operation. The hemorrheology indexes of the 2 groups were detected and compared before and 7 d after operation. The incidence of postoperative complications and nursing satisfaction in the 2 groups were statistically analysed. Results Compared with the control group,the nursing satisfaction of the observation group was significantly higher( P < 0. 05). The total blood loss,blood transfusion rate,the 1 st d hemoglobin reduction of the observation group decreased significantly( P < 0. 05),the time of ambulation and the time of postoperative hospitalization of the observation group shortened significantly( P < 0. 05). The daily activity and gait,joint activity and Harris total scores of the 2 groups after 3 months operation were significantly higher than those before the operation,the scores of pain and joint deformity were significantly lower than those before operation,the score of Visual analogue scale( VAS) in the 2 groups after 3 months operation was significantly lower than that before the operation,the Barthel index was significantly higher than that before the operation,the plasma levels of D-dimer in 7 d of the 2 group were significantly higher than those before the operation,there were significant differences between the two groups in the above indexes( P < 0. 05). The high viscosity of whole

关 键 词：加速康复外科 全髋关节置换术 髋关节功能 疼痛 血流变学 

分 类 号：R473.6[医药卫生—护理学]