加速康复外科对高龄老年全膝关节置换术患者的疗效分析  

Analysis of the therapeutic effect of enhanced recovery after surgery forelderly patients with total knee arthroplasty

作　　者：王崇佳 顾春江 章志望 王春 郑春雷 WANG Chongjia;GU Chunjiang;ZHANG Zhiwang;WANG Chun;ZHENG Chunlei(Tongxiang First People's Hospital of Hangzhou Medical College,Jiaxing,Zhejiang 314500,China)

机构地区：[1]杭州医学院桐乡市第一人民医院,浙江嘉兴314500

出　　处：《中华全科医学》2025年第2期314-317,共4页Chinese Journal of General Practice

基　　金：浙江省卫生健康科技计划项目(2022KY1277)。

摘　　要：目的 探索老年全膝关节置换术(TKA)患者应用加速康复外科(ERAS)管理的效果和安全性。方法 纳入2018年1月—2022年2月于桐乡市第一人民医院行TKA手术的70岁以上老年患者。采用随机数法分为ERAS组和传统组,并接受不同的围手术期管理方案。记录患者的人口统计学资料、手术时间、术中失血量、输血率、住院时间、术后并发症情况。记录术前、术后第3天、1个月和1年的牛津大学膝关节评分(OKS)和膝关节主动活动度(ROM),并进行组间比较。结果 本研究共纳入202例老年患者,其中ERAS组106例,传统组96例。相比于传统组,ERAS组的术中失血量显著降低[(151.2±9.3)mL vs.(133.7±10.5)mL,P<0.001],住院时间显著缩短[(8.8±1.3)d vs.(10.2±1.7)d,P<0.001],并发症率显著降低[45.8%(44/96)vs. 30.2%(32/106),P=0.022],术后第3天OKS评分更高[(21.6±4.5)vs.(26.8±3.6),P<0.05],术后第3天[(67.8±10.5)°vs.(71.8±7.0)°,P<0.001]和术后1月[(80.7±8.3)°vs.(85.1±7.6)°,P<0.001]时的活动度显著更高。2组1年随访死亡率比较差异无统计学意义(P>0.05)。结论 对于70岁以上高龄老年TKA患者,ERAS可改善术后疼痛,加速术后关节功能恢复,且不增加死亡率。Objective To explore the effect and safety of enhanced recovery after surgery(ERAS)management in elderly patients with total knee arthroplasty(TKA).Methods Elderly patients over 70 years old who underwent TKA surgery in Tongxiang First People's Hospital from January 2018 to February 2022 were included.They were randomized to ERAS and traditional groups and received different perioperative management programs.Patient demographic data,operation time,intraoperative blood loss,blood transfusion rate,length of hospital stay,and postoperative complications were recorded.The Oxford University knee score(OKS)and knee active range of motion(ROM)were recorded before the surgery and on day 3,1 month,and 1 year postoperatively.Comparisons between the two groups were performed using the t-test,chi-square test,or Fisher's exact probability method.Results A total of 202 elderly patients were included in this study,with 106 patients in the ERAS group and 96 patients in the traditional group.Compared with the traditional group,the intraoperative blood loss in the ERAS group was significantly lower[(151.2±9.3)mL vs.(133.7±10.5)mL,P<0.001],and the length of hospital stay was significantly shorter[(8.8±1.3)d vs.(10.2±1.7)d,P<0.001].The complication rate was significantly lower[45.8%(44/96)vs.30.2%(32/106),P=0.022],and the OKS score was higher on the 3rd day after surgery[(21.6±4.5)vs.(26.8±3.6),P<0.05].Activity was significantly higher on the 3rd day[(67.8±10.5)°vs.(71.8±7.0)°,P<0.001]and 1 month[(80.7±8.3)°vs.(85.1±7.6)°,P<0.001]after the surgery.There was no significant difference in 1-year follow-up mortality between the two groups(P>0.05).Conclusion For elderly TKA,ERAS can improve postoperative pain and accelerate postoperative recovery of joint function without increasing mortality.

关 键 词：全膝关节置换术 加速康复外科 老年 安全性 

分 类 号：R687.4[医药卫生—骨科学]