加速康复外科措施在类风湿关节炎患者全膝关节成形术围手术期的临床应用效果  

Clinical application of protocol of enhanced recovery after surgery in patients with rheumatoid arthritis undergoing total knee replacement

作　　者：高晨鑫 解骏 孙松涛 康冰心 许辉 肖涟波 Gao Chenxin;Xie Jun;Sun Songtao;Kang Bingxin;Xu Hui;Xiao Lianbo(The Department of Joint Orthopedic Surgery, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200052, China)

机构地区：[1]上海中医药大学附属光华医院关节矫形外科,200052 [2]上海中医药大学研究生院

出　　处：《骨科临床与研究杂志》2021年第6期327-332,共6页Journal Of Clinical Orthopedics And Research

基　　金：上海市科技计划(18401904800)。

摘　　要：目的探讨加速康复外科(ERAS)措施在类风湿关节炎(RA)患者全膝关节成形术(TKA)围手术期临床应用的疗效。方法对2014年1月至2020年1月上海中医药大学附属光华医院关节矫形外科收治的因RA接受初次单侧TKA患者208例的临床资料进行回顾性分析。根据围手术期治疗模式将全部患者分为ERAS组(87例)和传统康复组(121例)。对两组患者术前基线数据进行均衡性检验,包括年龄、性别分布、病程、体质量指数(BMI)、血红细胞沉降率(ESR)、C-反应蛋白(CRP)水平、美国特种外科医院膝关节评分(HSS)和汉密尔顿焦虑评分等。对两组患者术后血红蛋白丢失量,住院时间,术后1、2、4周HSS评分,术后输血发生率,伤口愈合情况,感染发生率,恶心呕吐发生率以及30 d内再入院发生率等指标进行比较。采用SPSS 25.0软件对数据进行统计学处理。P<0.05为差异有统计学意义。结果两组患者基线资料满足均衡性要求,可比较。ERAS组患者血红蛋白丢失量、住院时间、术后输血发生率、术后恶心呕吐发生率均低于传统康复组(均P<0.05);ERAS组术后1周和2周HSS评分较术前改善程度显著优于传统康复组(均P<0.05);两组术后4周HSS评分较术前改善程度无显著差异(P>0.05)。结论在RA患者TKA围手术期采取ERAS措施可有效缩短患者住院时间,减少围手术期血红蛋白丢失量,降低呕吐、输血等并发症的发生率,提高术后膝关节功能的恢复效率。Objective To investigate the clinical efficacy of protocol of enhanced recovery after surgery(ERAS)in patients with rheumatoid arthritis(RA)undergoing total knee arthroplasty(TKA).Methods A retrospective study was conducted on 208 patients with rheumatoid arthritis who underwent primary unilateral TKA in the Department of Joint Orthopedic Surgery,Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2014 to January 2020.According to the perioperative treatment,the patients were divided into 2 groups:ERAS group(n=87)and traditional rehabilitation group(n=121).The preoperative baseline data of the 2 groups including age,sex distribution,course of disease,body mass index(BMI),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),the Hospital of Special Surgery(HSS)knee score and Hamilton Anxiety Scale were compared.Postoperative data including blood lossing,length of hospital stay,HSS score at one,2 and 4 weeks,blood transfusion,wound healing,infection,vomiting and readmission within 30 d were compared between the 2 groups.Data were statistically analyzed by Software of SPSS 25.0 and P>0.05 was considered the statistically significant.Results Baseline data of the 2 groups met the requirements of equalization test(all P>0.05).The blood loss,hospitalization time,postoperative blood transfusion rate and the incidence of postoperative vomiting in the ERAS group were lower than those in the traditional rehabilitation group(all P<0.05).The improvement of HSS scores in the ERAS group at one and 2 weeks after surgery were significantly better than that in the traditional rehabilitation group(P<0.05),and there was no significant difference in the improvement of HSS scores at 4 weeks after surgery between the 2 groups(P<0.05).Conclusion Application of preoperative protoclo of ERAS can effectively shorten the length of hospital stay,reduce perioperative blood lossing,reduce the incidence of complications such as vomiting and blood transfusion,and greatly improve the recovery eff

关 键 词：关节炎 类风湿 关节成形术 置换 膝 围手术期医护 病例对照研究 加速康复外科 

分 类 号：R47[医药卫生—护理学]