加速康复外科在人工膝关节置换术中的应用效果评价

The evaluation of enhanced recovery post-operation in total knee arthroplasty

目的探讨加速康复外科理念(ERAS)对人工膝关节置换术(TKA)围手术期患者的应用效果评价。方法收集2016年1月-2017年12月在新疆医科大学第一附属医院关节外科收治的TKA患者病历资料200例,其中行ERAS模式康复治疗的100例患者作为ERAS组,行传统模式康复治疗的100例患者作为对照组。比较两组患者术后的疼痛评分(VAS)、功能(HSS)评分、平均住院天数、住院费用及术后并发症的情况。结果与对照组患者术后HSS评分[(72.15±8.74)分]、早期VAS评分[(2.98±1.1)分]比较,ERAS组患者术后HSS评分[(88.71±7.10)分]、早期VAS评分[(5.13±1.2)分]均升高,差异均有统计学意义(P<0.05)。与对照组患者平均住院天数[(10.8±7.6)d]、平均住院费用[(105 344±4 360)元]及术后并发症发生率[下肢深静脉血栓(15%)、泌尿系感染(7%)、肺部感染(8%)]比较,ERAS组患者平均住院天数[(8.5±2.7)d]、平均住院费用[(9 2802±3 451)元]及术后并发症发生率[下肢深静脉血栓(3%)、泌尿系感染(0%)、肺部感染(0%)]均降低,差异均有统计学意义(P<0.05)。结论在行人工膝关节置换术的患者中应用加速康复理念是安全可行的,可以有效减少患者术后并发症,缩短住院时间,且对患者膝关节功能恢复有明显改善。

Objective To evaluate the effect of enhanced recovery after surgery（ERAS）on perioperative patients with total knee arthroplasty（TKA）.Methods This study retrospectively analyzed 200 patients who underwent TKA during January 2016 to December 2017.Among them,100 patients who were treated with ERAS mode were assigned to the ERAS group.The rest receiving traditional treatment were assigned to control group.Postoperative pain scores（VAS）,functional（HSS）scores,average length of hospital stay,hospitalization costs,and postoperative complications were compared between both groups.ResultsCompared with control group,the patients in the ERAS group were better in many aspects：the postoperative HSS score（88.71±7.10 vs 72.15±8.74）,the early VAS score（2.98±1.1 vs 5.13±1.2）,the average length of hospital stay（8.5±2.7 vs 10.8±7.6）,the average hospital expenses（RMB 92802＋3451 vs RMB105344±4360）,lower vein thrombosis（3% vs 15%）,urinary tract infection（0% vs 7%）and pulmonary infection（0% vs 8%）.The differences were statistically significant（P 0.05）.Conclusion It is safe and feasible to apply the ERAS in patients undergoing TKA,which can effectively reduce postoperative complications,shorten hospitalization time,and significantly improve knee function recovery.