加速康复外科模式下全膝关节置换术中“鸡尾酒”复合液不同使用方案的疗效分析

Clinical effect analysis on different using methods of Cocktail compound liquid in total knee replacement under enhanced recovery after surgery mode

目的研究加速康复外科(enhanced recovery after surgery,ERAS)模式下全膝关节置换术中"鸡尾酒"复合液不同使用方案的有效性及安全性。方法纳入南京医科大学附属苏州医院关节外科2016年6月-2018年6月行全膝关节置换术患者120例,采用数字表法随机分为3组:A组将复合液全部进行关节周围浸润注射,B组将复合液完全行关节腔内注射,C组将复合液一半行关节周围浸润注射,另一半行关节腔内注射,每组40例。观察并比较患者年龄、性别、BMI、VAS评分及术后主要观察指标等。结果术后6、8、12、24 h VAS评分,B组最高,C组最低,差异有统计学意义(均P<0.05);术后48 h、72 h VAS评分差异无统计学意义(均P>0.05);术后24 h补救镇痛率B组最高,C组最低,差异有统计学意义(P<0.05);术后最大血红蛋白下降值,C组最低,B组最高,差异具有统计学意义(P<0.05);术后24 h内引流量C组最低,B组最高,差异具有统计学意义(P<0.05);C组患者术后膝关节活动度最大,差异具有统计学意义(P<0.05);术后3 d,C组HSS评分高于其他2组,差异有统计学意义(P<0.05)。3组其他指标比较差异均无统计学意义(均P>0.05)。结论ERAS模式下全膝关节置换术中局部浸润联合关节腔注射"鸡尾酒"复合液,能减轻患者疼痛,减少患者术后失血,并且安全有效,有利于患者术后康复。

Objective To study the clinical effects and safety of different applications of cocktail treatment in total knee replacement under enhanced recovery after surgery(ERAS)mode.Methods Total 120 cases of total knee replacement during June 2016 to June 2018 in the Department of Joint Surgery of the Affiliated Suzhou Hospital of Nanjing Medical University were included.Patients were randomly divided into three groups:group A(total complex liquids of cocktail were infused and injected to the surroundings of the knees),group B(the cocktail was injected to the knee cavities),and group C(one part of the complex liquids of cocktail was infused and injected to the surroundings of knees,and the other part was injected to the knee cavities).Age,gender,BMI and other related indicators were observed and compared.Results In 6 hours,8 hours,12 hours,24 hours postoperative VAS assessment,group B had the highest score and group C had the lowest score,the difference had statistical significance(all P<0.05).In 48 hours,72 hours postoperative VAS assessment,the difference had no statistical significance(all P>0.05).In postoperative relief analgesic rate during 24 hours,group B had the highest score and group C had the lowest score(P<0.05).In the postoperative maximal decreased value of hemoglobin,group C had the lowest score and group B had the highest score(P<0.05).In the volume of drainage during 24 hours after surgery,group C had the lowest volume,group B had the highest volume(P<0.05).The patients in group C could have functional exercise in a larger scale(P<0.05).Compared with the other two groups,group C had a higher 3 days postoperative HSS assessment(P<0.05).There was no significant difference in the other indicators(all P>0.05).Conclusion The method of local infiltration combined with intraarticular injection of cocktail compound liquid in total knee arthroplasty under ERAS mode can effectively reduce patients’pain and blood loss after operation,which is safe and beneficial to patients’postoperative recovery.