快速康复外科理论下不留置尿管对单侧人工全膝关节置换术后患者康复的影响  

Effect of non-indwelling urinary catheter on rehabilitation after unilateral total knee arthroplasty under the theory of ERAS

作　　者：杨生森 张晨[2] 董毅[1] 姚羽[3] 陈德胜[1] YANG Shengsen;ZHANG Chen;DONG Yi(Department of Orthopedics,General Hospital of Ningxia Medical University,Yinchuan 750004)

机构地区：[1]宁夏医科大学总医院骨科,银川750004 [2]宁夏医科大学研究生院,银川750004 [3]南通大学附属医院骨科,南通226021

出　　处：《陕西医学杂志》2020年第12期1561-1565,共5页Shaanxi Medical Journal

基　　金：国家自然科学基金资助项目(81760405,81760395,81560364);宁夏回族自治区卫生健康委员会科研课题(19);宁夏医科大学科学研究基金资助项目(XM2020182)。

摘　　要：目的:探讨加速康复外科(ERAS)理论下不留置尿管对单侧人工全膝关节置换术(TKA)后康复的影响。方法:将108例行单侧TKA的患者分成观察组和对照组,各54例。观察组术中减少补液量,不留置尿管。对照组常规补液,留置尿管,术后24 h拔除尿管。对比两组患者手术时间、术前补液量、术中补液量、术中失血量、平均住院天数、术后尿路情况(术后尿潴留、膀胱不适症状、尿路感染)、术后下床时间、膝关节特种外科医院评分(HSS)、术后并发症发生情况以及患者满意度评分。结果:两组患者手术时间、术前补液量、术中失血量、平均住院天数、术后尿路感染、膀胱重度不适病例数比较,差异无统计学意义(P>0.05)。观察组患者术后补液量少于对照组(P=0.002)。观察组中度不适、尿路刺激征及术后尿潴留患者例数均少于对照组(均P<0.05)。观察组患者术后下床时间少于对照组,术后1周及术后1、3个月膝关节HSS评分均高于对照组(均P<0.05)。在随访的1个月中,观察组患者术后并发症发生率低于对照组(7.41%比25.92%),差异有统计学意义(P=0.010)。出院时,观察组患者满意度评分高于对照组(P=0.027)。结论:单侧人工全膝关节置换术中不留置尿管为早期下床活动提供便利条件,加速患者康复过程,可以显著改善患者术后关节功能的恢复,符合术后快速康复理念。Objective:To explore the effect of non-indwelling urinary catheter on rehabilitation after unilateral total knee arthroplasty(TKA)under the theory of enhanced recovery after surgery(ERAS).Methods:108 patients who underwent unilateral TKA were divided into observation group and control group,54 cases in each group.In the observation group,the amount of fluid replacement was reduced during the operation without indwelling catheterization.In the control group,regular fluid replacement and indwelling catheterization were performed.The operation time,preoperative fluid replacement volume,intraoperative fluid replacement volume,intraoperative blood loss,average hospitalization days,postoperative urinary retention,bladder discomfort,urinary tract infection,time of getting out of bed,HSS score,postoperative complications and patient satisfaction score were compared between the two groups.Results:There was no significant difference in the operation time,preoperative fluid replacement volume,intraoperative blood loss,average hospital stay,postoperative urinary tract infection,and the number of cases of severe bladder discomfort between the two groups(P>0.05).The amount of postoperative fluid replacement in the observation group was less than that in the control group(P=0.002).The patients with moderate discomfort,urinary tract irritation and postoperative urinary retention in the observation group were less than those in the control group(all P<0.05).The time of getting out of bed in the observation group was less than that in the control group,and the HSS score of knee joint in the observation group was higher than that in the control group at 1 week,1 month and 3 months after operation(all P<0.05).After 1 month of follow-up,the incidence of postoperative complications in the observation group was lower than that in the control group(7.41%vs.25.92%),the difference was statistically significant(P=0.010).on discharge,the satisfaction score of the observation group was higher than that of the control group(P=0.027).Conclusio

关 键 词：加速康复外科 全膝关节置换术 留置尿管 术后康复 尿潴留 并发症 

分 类 号：R687.4[医药卫生—骨科学]