加速康复理念在全膝关节置换术中的应用研究  

Study on enhanced recovery after surgery in total knee arthroplasty

作　　者：张强[1] 宋强[2] 梁钰琪 郭崇军[2] 李立新[2] 刘泽欣 李聪 牛东生[2] 白志刚[2] Zhang Qiang;Song Qiang;Liang Yuqi;Guo Chongjun;Li Lixin;Liu Zexin;Li Cong;Niu Dongsheng;Bai Zhigang(Medical College of Northwest Minzu University,Lanzhou 730000,China;Department of Orthopedics,Ningxia Hui Autonomous Region People's Hospital,Yinchuan 750000,China)

机构地区：[1]西北民族大学,兰州730000 [2]宁夏回族自治区人民医院关节外科,银川750000

出　　处：《中华关节外科杂志（电子版）》2022年第3期295-300,共6页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：西北民族大学2019年中央高校基本科研业务项目(31920190188);宁夏科技厅重点研发项目(2018BFH03022)。

摘　　要：目的:研究在全膝关节置换术(TKA)围手术期间应用加速康复理念(ERAS)的效果评价。方法:选取在宁夏回族自治区人民医院接受TKA治疗的患者60例,分为"常规治疗组"和"ERAS组",对其疼痛视觉模拟评分(VAS)、美国特种外科医院膝关节评分(HSS)、失血量、术后输血人数、术后并发症、住院时间、住院费用及术后满意度进行研究。纳入标准:膝关节骨关节炎;单侧、初次TKA患者。排除标准:炎性关节炎;膝关节不稳定需要特殊假体者。计量资料使用两独立样本t检验,计数资料使用卡方检验或Fisher确切概率法,不同时间相关资料比较采用重复测量方差分析。结果:ERAS组术后1 d静息状态下VAS评分(F=67.67,P<0.05)、术后3 d静息状态下VAS评分(F=146.30,P<0.05)均比常规治疗组低,术后7 d静息状态下VAS评分差异无统计学意义(F=1.20,P>0.05)。ERAS组术后1月的HSS评分(F=485.83,P<0.05)、术后3月的HSS评分较常规治疗组高(F=512.39,P<0.05),术后6月两组的HSS评分差异无统计学意义(F=0.17,P>0.05)。ERAS组在失血量(t=4.27,P<0.05)和输血人数(χ^(2)=4.36,P<0.05)上较常规治疗组低。ERAS组术后恶心呕吐发生率较常规治疗组低(χ^(2)=4.32,P<0.05),两组下肢静脉血栓形成、泌尿系感染及术后切口并发症差异无统计学意义(均为P>0.05)。ERAS组的平均住院时间为(11.9±1.3)d,常规治疗组的平均住院时间为(14.6±1.5)d(t=7.40,P<0.01),ERAS组比常规治疗组住院费用减少(t=2.09,P<0.05)。ERAS组满意度较常规治疗组高(χ^(2)=5.46,P<0.05)。结论:TKA术后不放引流管、术后4 h下地可降低输血率,减轻患者术后疼痛。在TKA围手术期中应用ERAS可减少术后恶心呕吐发生率、降低输血率、节省医疗费用、提高患者满意度。Objective To explore the evaluation of the application of enhanced recovery after surgery(ERAS)during the perioperative period of total knee arthroplasty.Methods A total of 60 patients received TKA treatment in Ningxia Hui Autonomous Region People's Hospital were selected and divided into"conventional treatment group"and"ERAS group".The preoperative and postoperative visual analogue scale(VAS),the Hospital for Special Surgery(HSS)knee scores,blood loss and the number of postoperative blood transfusions,postoperative complications,hospitalization time,hospitalization expenses and postoperative satisfaction were compared.Inclusion criteria:knee osteoarthritis;unilateral,initial TKA patients.Exclusion criteria:inflammatory arthritis;those who need special prosthesis for knee instability.The measurement data used two independent samples t test,the count data used the chi square test or Fisher exact probability method.The comparison of related data at different time points used repeated measures analysis of variance.Results The VAS score in the ERAS group on the first day after the operation(F=67.67,P<0.05)and the VAS score after the operation on the third day after the operation(F=146.30,P<0.05)were lower than those in the conventional treatment group.There was no statistically significant difference in VAS scores in the resting state after seven days(F=1.20,P>0.05).The HSS score(F=485.83,P<0.05)in the ERAS group in one month after the surgery,and the HSS score in three months after the surgery(F=512.39,P<0.05)were higher than those in the conventional treatment group.The HSS scores of the two groups showed no statistically significant difference in six months after the surgery(F=0.17,P>0.05).The blood loss(t=4.27,P<0.05)and the number of blood transfusions(χ^(2)=4.36,P<0.05)in the ERAS group were lower than those in the conventional treatment group.The incidence of postoperative nausea and vomiting in the ERAS group was lower than that in the conventional treatment group(χ^(2)=4.32,P<0.05).The two groups had less

关 键 词：关节成形术 置换 膝 加速康复外科 骨关节炎 膝 

分 类 号：R687.4[医药卫生—骨科学]