人工全髋关节置换术围术期限制性输液联合术前排尿训练的临床研究  

Clinical research on perioperative restrictive fluid therapy combined with preoperative urination training in total hip arthroplasty

作　　者：雷一霆 黄强[1] 张少云[1] 陈果[1] 曹国瑞[1] 裴福兴[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2017年第11期1295-1299,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：卫生部2013年度卫生行业科研专项项目(201302007)~~

摘　　要：目的评价基于加速康复外科(enhanced recovery after surgery,ERAS)理念,人工全髋关节置换术(total hip arthroplasty,THA)围术期限制性输液联合术前排尿训练的安全性及有效性。方法回顾分析2016年11月—2017年4月,初次单侧THA术前行排尿训练及手术当日限制性输液患者70例(试验组)临床资料;以2015年4月—2016年3月手术当日自由性输液患者73例作为对照组。两组患者年龄、性别、体质量、身高、体质量指数、疾病类型以及术前合并症比较,差异均无统计学意义(P>0.05)。比较两组手术时间,术前、术中及术后输液量,手术当日总输液量,术后当日小时尿量,血容量,围术期总失血量;术后利尿剂及尿管使用情况;术后低血压、恶心呕吐、低钠血症、低钾血症等不良事件发生情况;术后住院时间;术前及术后第1、2天C反应蛋白(C reactive protein,CRP)和IL-6水平。结果试验组患者术前、术中、术后输液量以及手术当日总输液量均明显低于对照组(P<0.05);两组手术时间、血容量、围术期总失血量以及术后当日小时尿量比较,差异无统计学意义(P>0.05)。试验组术后利尿剂及尿管使用率均明显低于对照组(P<0.05),两组术后低血压、恶心呕吐、低钠血症、低钾血症发生率比较差异无统计学意义(P>0.05)。试验组术后住院时间明显短于对照组(t=–5.529,P=0.000)。试验组术后第1、2天CRP和IL-6水平均低于对照组(P<0.05)。结论基于ERAS理念,THA围术期限制性输液(手术当日输液量控制在1 200 m L左右)联合术前排尿训练是安全有效的,但该结论仍需要大样本的前瞻性随机对照研究来验证。Objective To evaluate the effectiveness and safety of restrictive fluid therapy combined with preoperative urination training during perioperative period in an enhanced recovery after surgery（ERAS） program for primary total hip arthroplasty（THA）. Methods A retrospective study were conducted in 73 patients who underwent unilateral THA with liberal intravenous fluid therapy on the day of surgery between April 2015 and March 2016（control group） and in 70 patients with restrictive fluid therapy and preoperative urination training between November 2016 and April 2017（trial group）. There was no significant difference in gender, age, weight, height, body mass index, primary disease, and complications between 2 groups（P0.05）. Perioperative related indexes were recorded and compared between 2 groups, including operation time; pre-, intra-, post-operative intravenous fluid volumes, overall intravenous fluid volume on the surgery day; postoperative urine volume per hour after surgery; blood volume; total blood loss during perioperative period; usage rates of diuretics and urine tube; the incidences of hypotension, nausea and vomiting,hyponatremia, and hypokalemia after surgery; postoperative length of stay; and the expressions of inflammatory factors[C reaction protein（CRP）, interleukin-6（IL-6）] before sugery and at 1 st and 2 nd days after surgery. Results The pre-,i ntra-, post-operative intravenous fluid volumes and the overall intravenous fluid volume on the surgery day in trial groupwere significantly lower than those in control group（P0.05）. There was no significant difference in operation time, blood volume, total blood loss during perioperative period, and postoperative urine volume per hour after surgery between2 groups（P0.05）. The usage rates of diuretics and urine tube in trial group were significantly lower than those in control group（P0.05）, while the differences in incidences of hypotension, nausea and vomiting, hyponatremia, and hypokalemia after surgery of 2 groups wer

关 键 词：加速康复外科 人工全髋关节置换术 限制性输液 排尿训练 

分 类 号：R473.6[医药卫生—护理学]