个体化快速康复策略在初次人工膝关节置换围术期应用研究
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摘要
目的探讨个体化快速康复策略(ERAS)在初次人工膝关节置换术(TKA)患者围术期应用的效果。方法选取自2017年1—12月收治的行初次人工TKA患者78例为研究对象,根据干预措施将其分为个体化快速康复组(n=39)与传统康复组(n=39)。比较两组患者的失血量、住院天数,术后1周及1、3、6个月美国膝关节协会评分(KSS),术后1、3、5、7 d患者的疼痛视觉模拟评分(VAS),以及并发症发生情况。结果所有患者平均随访6个月。个体化快速康复组的失血量、住院天数均低于传统康复组(P <0. 05);术后1周、1个月的KSS评分高于传统康复组(P <0. 05);术后1、3、5、7 d的VAS评分及并发症发生率低于传统康复组(P <0. 05)。结论个体化快速康复策略与传统康复策略比较,可有效降低围术期并发症的发生率、减少失血量、缩短住院时间、减轻疼痛、提高术后膝关节功能,患者术后满意度高。
Objective To investigate the effect of individualized ERAS in the perioperative period of patients undergoing primary total knee arthroplasty(TKA). Methods A retrospective study was performed on 78 cases of patients who underwent TKA from January to December 2017. According to different interventions,patients were divided into the enhanced recovery after surgery(ERAS) group(n = 39) and the traditional recovery group(n = 39). The total blood loss,hospitalization time,postoperative 1 week,1 month,3 months and 6 months KSS score,postoperative 1,3,5 and 7 days visual analogue score(VAS),and other complications rate were compared between two groups. Results All patients received follow-up for 6 months. The blood loss and length of stay in the individualized rapid rehabilitation group were lower than those in the traditional rehabilitation group(P < 0. 05). KSS scores 1 week and 1 month after surgery were higher than those in the traditional rehabilitation group(P < 0. 05). VAS score and complication rate at 1,3,5 and 7 days after surgery were lower than those in traditional rehabilitation group(P < 0. 05). Conclusion Compared with traditional rehabilitation strategies,individualized ERAS can effectively reduce the incidence of perioperative complications,reduce blood loss,shorten the length of hospital stay,reduce pain,and improve the postoperative knee function of patients,with high postoperative satisfaction.
Objective To investigate the effect of individualized ERAS in the perioperative period of patients undergoing primary total knee arthroplasty(TKA). Methods A retrospective study was performed on 78 cases of patients who underwent TKA from January to December 2017. According to different interventions,patients were divided into the enhanced recovery after surgery(ERAS) group(n = 39) and the traditional recovery group(n = 39). The total blood loss,hospitalization time,postoperative 1 week,1 month,3 months and 6 months KSS score,postoperative 1,3,5 and 7 days visual analogue score(VAS),and other complications rate were compared between two groups. Results All patients received follow-up for 6 months. The blood loss and length of stay in the individualized rapid rehabilitation group were lower than those in the traditional rehabilitation group(P < 0. 05). KSS scores 1 week and 1 month after surgery were higher than those in the traditional rehabilitation group(P < 0. 05). VAS score and complication rate at 1,3,5 and 7 days after surgery were lower than those in traditional rehabilitation group(P < 0. 05). Conclusion Compared with traditional rehabilitation strategies,individualized ERAS can effectively reduce the incidence of perioperative complications,reduce blood loss,shorten the length of hospital stay,reduce pain,and improve the postoperative knee function of patients,with high postoperative satisfaction.
引文
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[12] Wynell-Mayow W,Saeed MZ. Much ado about nothing:the effect of tourniquet time on an accelerated rehabilitation programme following total knee replacement(TKR)[J]. Eur J Orthop Surg Traumatol,2018,28(6):1177-1182.
[2] Rana AJ,Iorio R,Healy WL. Hospital economics of primary THA decreasing reimbursement and increasing cost,1990 to 2008[J].Clin Orthop Relat Res,2011,469(2):355-361.
[3]周宗科,翁习生,曲铁兵,等.中国髋、膝关节置换术加速康复—围术期管理策略专家共识[J].中华骨与关节外科杂志,2016,9(1):1-9.
[4] Nadler SB,Hidalgo JH,Bloch T. Prediction of blood volume in normal human adults[J]. Surgery,1962,51(2):224-232.
[5] Zhao D,Ma XL,Wang WL,et al. Effectiveness evaluation between enhanced recovery after surgery and traditional treatment in unilateral total knee arthroplasty[J]. Zhonghua Yi Xue Za Zhi,2018,98(7):519-523.
[6] Spicka J,Lostak J,Gallo J,et al. Influence of enhanced recovery regime on early outcomes of total knee arthroplasty[J]. Acta Chir Orthop Traumatol Cech,2017,84(5):361-367.
[7] Scott CE,Bugler KE,Clement ND,et al. Patient expectations of arthroplasty of the hip and knee[J]. J Bone Joint Surg Br,2012,94(7):974-981.
[8] Inacio MC,Kritz-Silverstein D,Raman R,et al. The impact of preoperative weight loss on incidence of surgical site infection and readmission rates after total joint arthroplasty[J]. J Arthroplasty,2014,29(3):458-464.
[9] Shen HL,Li Z,Feng ML,et al. Analysis on hidden blood loss of total knee arthroplasty in treating knee osteoarthritis[J]. Chin Med J(Engl),2011,124(11):1653-1656.
[10] Louie GH,Tektonidou MG,Caban-Martinez AJ,et al. Sleep disturbances in adults with arthritis:prevalence,mediators,and subgroups at greatest risk. Data from the 2007 National Health Interview Survey[J]. Arthritis Care Res(Hoboken),2011,63(2):247-260.
[11] Apfel CC,Laara E,Koivuranta M,et al. A simplified risk score for predicting postoperative nausea and vomiting:conclusions from cross-validations between two centers[J]. Anesthesiology,1999,91(3):693-700.
[12] Wynell-Mayow W,Saeed MZ. Much ado about nothing:the effect of tourniquet time on an accelerated rehabilitation programme following total knee replacement(TKR)[J]. Eur J Orthop Surg Traumatol,2018,28(6):1177-1182.
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