改良ERAS方案对膝关节置换患者围手术期的效果观察

The Effect of Modified ERAS Scheme in Perioperative Period of Knee Joint Replacement Patients was Observed

目的探讨一种改良ERAS方案对初次膝关节置换患者住院时间的影响。方法回顾性分析2015年8月～2017年8月我院收治的行初次膝关节置换患者252例,围手术期分别采用常规ERAS方案(ERAS组,126例)和改良ERAS方案(ERAS改良组,126例),分析两组患者术后住院时间、出院后自理能力、术后VAS评分、阿片类药物使用量、30 d内再入院率、院内跌倒、围手术期输血、术后恶心发生率、术后平地步行距离等指标。结果 ERAS改良组患者平均住院时间为(56.10±16.51)h,短于ERAS组的(76.60±18.91)h,差异具有统计学意义(P<0.05)。ERAS改良组中41.27%的患者在出院后就能够基本生活自理,而ERAS组中只有21.43%的患者能够在出院后生活自理,更多的患者出院后还需要额外的家庭护理(P<0.05)。ERAS改良组患者术后当天VAS评分高于ERAS组,术后1 d、2 d VAS评分低于ERAS组,差异具有统计学意义(P<0.05)。术后第1天和第2天,改良ERAS组阿片类药物使用量和出现恶心的发生率均低于ERAS组,差异具有统计学意义(P<0.05)。两组患者30 d内再入院率和院内跌倒率比较,差异无统计学意义(P>0.05)。改良ERAS组患者在围手术期输血率低于常规ERAS组(P<0.05)。术后当天、第1天和第2天,改良ERAS组平地步行距离均优于ERAS组(P<0.05)。结论改良ERAS方案能明显缩短初次膝关节置换患者住院时间,节约医疗费用。

Objective To investigate the effect of an improved ERAS scheme on hospitalization time of patients with primary knee arthroplasty.Methods A retrospective analysis from August2015to August2017line of our hospital,252patients with primary knee arthroplasties,perioperative respectively using conventional scheme(ERAS group,126cases)and the improvement scheme(ERAS improved group,126cases),compared two groups of patients with postoperative hospital stay,postoperative self-care ability,after discharge VAS score,opioid usage within30d,readmission rate,in the fall,perioperative blood transfusion and postoperative incidence of nausea,postoperative walking distance index.Results The average hospitalization time in the modified group was(56.1±16.5)h,which was shorter than that in the ERAS group(76.6±18.9),the difference was statistically significant(P<0.05).In the ERAS improved group,41.27%of the patients in the ERAS improved group were able to live and take care of themselves after discharge,while only21.43%of the patients in the ERAS improved group were able to live and take care of themselves after discharge,and more patients needed additional home care after discharge(P<0.05).The VAS score of the modified group was higher than that of the ERAS group on the postoperative day,and the VAS score of the1d and2d postoperative days was lower than that of the ERAS group,with statistically significant difference(P<0.05).On the first and second days after surgery,the ERAS in the modified group had a lower incidence of opioid use and nausea than the ERAS in the modified group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in readmission rate and nosocomial fall rate between the two groups within30d(P>0.05).The perioperative transfusion rate in the modified ERAS group was lower than that in the conventional ERAS group(P<0.05).The pedestrian distance in the improved ERAS group was superior to that in the ERAS group on the day,day1and day2after surgery(P<0.05).Conclusion The modified ERAS scheme can significantly shorten the hospitalization time of patients with primary knee arthroplasty and save medical costs.