ERAS理念在断指再植中的应用研究  

Study on the Application of ERAS Concept in Severed Finger Replantation

作　　者：陈会 江起庭 鞠杰 高会钦 Chen Hui;Jiang Qiting;Jv Jie;Gao Huiqin(Joint Center,Nanjing Bond Orthopedic Hospital,Nanjing City,Jiangsu 210018,China;Department of Hand and Foot Surgery,Nanjing Nangang Hospital,Nanjing City,Jiangsu 211500,China;Department of Hand and Foot Surgery,Nanjing Bond Orthopedic Hospital,Nanjing City,Jiangsu 210018,China)

机构地区：[1]南京邦德骨科医院关节中心,江苏南京210018 [2]南京南钢医院手足外科,江苏南京211500 [3]南京邦德骨科医院手足外科,江苏南京210018

出　　处：《中国烧伤创疡杂志》2020年第6期430-432,共3页The Chinese Journal of Burns Wounds & Surface Ulcers

基　　金：江苏省科技计划重点资助项目(BS2007054);南京军区科技创新重点资助项目(07Z028)。

摘　　要：目的探讨加速康复外科(enhanced recover after surgery,ERAS)理念在断指再植治疗中的应用效果。方法收集2015年5月至2018年8月南京邦德骨科医院收治的26例断指患者作为研究对象,在ERAS理念指导下对其行断指再植术治疗,术前口服药物对症处理,术中优化麻醉方式、减少手术刺激,术后适当抗感染、血栓及痉挛,及早行康复锻炼,观察住院时间及住院费用,并采用Tamai评分评估治疗效果。结果 26例患者均无血管危象发生,术后住院(5.0±1.0) d,住院费用为(3000±100)元;术后随访(9.5±1.2)个月,除5例患者失访外,其余患者再植指均成活,且外形佳、运动可,Tamai评分为(88.0±7.0)分,其中优16例,良4例,可1例,优良率为95.2%。结论在ERAS理念指导下行断指再植治疗,可有效缩短住院时间,降低住院费用,且不影响术后再植成功率及再植指功能,临床应用价值较高。Objective To explore the effect of applying the concept of enhanced recovery after surgery(ERAS)in severed finger replantation.Methods Twenty six patients with severed fingers,admitted to Nanjing Bond Orthopedic Hospital from May 2015 to August 2018,were selected as research subjects.They received severed finger replantation under the guidance of the concept of ERAS.Before the operation,the patients were instructed to take medicines orally to treat symptoms.During the operation,anesthesia protocol was optimized to reduce the stimulation of operation.After the opera⁃tion,measures were taken to prevent infection,thrombosis and spasm,and rehabilitation exercises were advised to be done as early as possible.Duration of hospital stay and hospitalization cost were observed,and Tamai scoring was used to evaluate the treatment effect.Results No vascular crisis occurred among the 26 patients.The duration of hospital stay was(5.0±1.0)days and the hospitalization cost was(3000±100)CNY.During the follow⁃up of(9.5±1.2)months,5 patientswere lost to follow⁃up,while in all the other patients,the replanted fingers were all alive,well⁃shaped and able to move.The Tamai score was(88.0±7.0)points,of which 16 cases were excellent,4 cases were good,and 1 case was fair,and the excellent and good rate was 95􀆰2%.Conclusion Performing the operation of severed finger replantation under the ERAS concept can shorten the duration of hospital stay and reduce hospitalization cost,without impairing the success rate of replantation and the function of the replanted fingers,presenting a high value of clinical application.

关 键 词：加速康复外科 断指 再植 手外伤 

分 类 号：R658.1[医药卫生—外科学]