加速康复外科模式下初次全髋关节置换术中优化鸡尾酒疗法安全性和有效性的前瞻性随机对照研究  

Optimized cocktail therapy in primary unilateral total hip arthroplasty with enhanced recovery after surgery program: a prospective randomized controlled trial

作　　者：张少云[1] 黄强[1] 曹国瑞[1] 雷一霆 陈果[1] 裴福兴[1] ZHANG Shao-yun;HUANG Qiang;CAO Guo-rui;LEI Yi-ting;CHEN Guo;PEI Fu-xing

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国骨与关节杂志》2017年第12期883-888,共6页Chinese Journal of Bone and Joint

基　　金：2013年度卫生行业科研专项项目(201302007)

摘　　要：目的探讨加速康复外科模式下初次单次全髋关节置换术(total hip arthroplasty,THA)术中优化鸡尾酒疗法(罗哌卡因配伍氨甲环酸切口周围局部注射)的安全性和有效性。方法前瞻性纳入行加速康复外科模式下初次单次THA患者80例,根据术中鸡尾酒疗法方案,以数字表法随机分为试验组(40例,缝皮前切口周围局部浸润注射罗哌卡因200 mg+氨甲环酸80 ml混合溶液100 ml)和对照组(40例,缝皮前切口周围局部浸润注射罗哌卡因200 mg+生理盐水80 ml混合溶液100 ml)。主要指标为最大血红蛋白下降值、总失血量、输血率、视觉模拟疼痛评分(visual analogue scale,VAS);次要指标为补救镇痛率、术后并发症发生率、术后住院日及术后2周血栓发生事件。结果最大血红蛋白下降值:试验组(24.3±9.9)g/L,对照组(24.1±10.9)g/L,差异无统计学意义(P>0.05)。总失血量:试验组(737.4±399.0)ml,对照组(730.1±401.3)ml,差异无统计学意义(P>0.05)。术侧髋关节活动时VAS疼痛评分:术前、术后当天、术后第1、2天,试验组分别为(4.5±0.7)分、(1.7±0.5)分、(1.6±0.6)分、(1.2±0.4)分;对照组分别为(4.5±0.7)分、(1.5±0.5)分、(1.6±0.6)分、(1.1±0.4)分,差异无统计学意义(P>0.05)。术后补救镇痛率:试验组为12.5%,对照组为7.5%,差异无统计学意义(P>0.05)。术后并发症发生率:试验组为10.0%,对照组为17.5%,差异无统计学意义(P>0.05)。术后住院日:试验组为(2.5±0.6)天,对照组为(2.4±0.7)天,差异无统计学意义(P>0.05)。两组均无1例输血,术后2周彩超检查无1例下肢深静脉血栓发生。结论加速康复外科模式下初次单侧THA术后失血少、疼痛轻、康复快,术中优化鸡尾酒疗法虽然是安全的,但其有效性尚需进一步研究证实。Objective To explore the safety and efficacy of the optimized cocktail therapy [ local injection of ropivacaine with tranexamic acid （ TXA ） before incision closure ] in primary unilateral total hip arthroplasty （ THA ） with enhanced recovery after surgery （ ERAS ） program. Methods A total of 80 patients who underwent primary unilateral THA with ERAS program were randomly divided into the experimental group （ 40 patients ） that received local injection of 200 mg ropivacaine with 80 ml TXA before incision closure, and control group （ 40 patients ） that received local injection of 200 mg ropivacaine with 80 ml normal saline relatively. The maximum hemoglobin （ Hb ） drop, total blood loss, transfusion, visual analogue scale （ VAS ） pain score, the incidence for rescue analgesia, postoperative complications, length of stay, and embolism events during 2 weeks＆#39; follow-up were recorded and compared. Results In the experimental group, the maximum Hb drop was （ 24.3 ± 9.9 ） g / L, total blood loss was （ 737.4 ± 399.0 ） ml, which were not statistically significantly different from that in the control group （ 24.1 ± 10.9 ） g / L, （ 730.1 ± 401.3 ） ml （ P 〉 0.05 ）. VAS pain score in mobilization preoperatively, on the day of surgery, and on postoperative day 1 and 3 in the experimental group were respectively on average （ 4.5 ± 0.7 ）, （ 1.7 ± 0.5 ）, （ 1.6 ± 0.6 ） and （ 1.2 ± 0.4 ）, while in the control group were （ 4.5 ± 0.7 ）, （ 1.5 ± 0.5 ）, （ 1.6 ± 0.6 ） and （ 1.1 ± 0.4 ）. VAS pain scores at each time points were not statistically significantly different between the 2 groups （ P 〉 0.05 ）. The incidence for rescue analgesia and the rate of postoperative complications in the experimental group were 12.5% and 10.0%, while that were 7.5% and 17.5% in the control group. The differences were not statistically significant （ P 〉 0.05 ）. There were no statistically significantly differences in postoperative length of stay

关 键 词：关节成形术 置换 髋 氨甲环酸 康复 鸡尾酒疗法 加速康复外科 

分 类 号：R687.4[医药卫生—骨科学] R493[医药卫生—外科学]