加速康复外科理念在髋膝关节置换术围术期的应用研究

Application of enhanced recovery after surgery in the perioperative period of hip or knee arthroplasty

背景:髋膝关节置换术后强调早期下床活动,但术后疼痛是影响患者康复锻炼的重要因素。术后予充分的药物抗凝,因存在出血风险,其使用仍存在争议。本研究采用多模式机械抗凝。目的:探讨加速康复外科(enhanced recovery after surgery,ERAS)理念在髋膝关节置换围术期的应用。方法:选取86例人工髋膝关节置换患者,采用加速康复治疗44例,常规治疗42例,比较两组术后疼痛(VAS评分)、术后并发症、术后感染、住院天数和费用、患者满意度。结果:与常规治疗组比较,加速康复治疗组患者术后疼痛、术后并发症明显减少(P<0.01),住院天数和住院费用减少(P<0.05),患者满意度增加(P<0.01),但两组术后感染发生率比较,差异无统计学意义(P>0.05)。结论:ERAS理念治疗下,患者的术后疼痛减轻、并发症明显减少;住院天数减少、费用明显降低,能促进患者快速康复,降低患者的医疗成本。

Background： After hip or knee arthroplasty, emphasis is placed on early activity, but postoperative pain is an important factor in the rehabilitation of the patients;adequate anticoagulant drug is often administered but may lead to the risk of bleeding,so its use is controversial. This study adopted the multimodal mechanical anticoagulation. Objective： To explore the application of the concept of enhanced recovery after surgery（ERAS） in the perioperative period of hip or knee arthroplasty. Methods： A total of 86 patients with hip or knee arthroplasty were selected and divided into enhanced recovery after surgery group（n=44） and conventional therapy group（n=42）, and postoperative pain（VAS）, complications, infection,hospital stay and costs, and patient satisfaction were compared between the two groups. Results： Compared with the conventional therapy group, postoperative pain, complications, hospital stay and costs were significantly reduced and patient satisfaction was improved in ERAS group（P〈0.05）, but postoperative infection was not significant different between the two groups（P〈0.05）. Conclusions： With the concept of ERAS, postoperative pain and complications of the patients are significantly reduced. Hospital stay and costs decrease. It can promote the rapid recovery of patients and meanwhile reduce the medical costs of patients.