中西医结合加速康复外科理念在全膝关节置换围手术期中的临床价值研究

Clinical value of integrated traditional Chinese and Western medicine based on the concept of enhanced recovery after surgery in the perioperative period of total knee arthroplasty

目的:探讨中西医结合加速康复外科(ERAS)理念在全膝关节置换围术期的临床价值。方法:选取桐庐县中医院2018年7月至2019年6月收治的初次行单侧全膝关节置换术患者60例为观察对象,采用单双号法分为观察组和对照组,每组30例。对照组采用传统康复治疗方案,观察组采用中西医结合ERAS理念进行围手术期康复管理。记录两组患者围术期疼痛、相关并发症、住院费用及住院时间等指标;通过视觉模拟评分(VAS)评估两组患者疼痛程度,关节活动度及美国特种外科医院(HSS)膝关节评分评估疗效。结果:观察组术后3 d、7 d、2周、6周膝关节活动度评分[(63.40±2.80)分、(86.20±4.40)分、(90.30±6.48)分、(100.5±3.39)分]及术后6周HSS评分[(89.40±5.18)分]比对照组[(48.50±4.20)分、(55.40±3.58)分、(77.50±4.38)分、(87.60±4.58)分、(70.50±6.44)分]均明显增加,差异均有统计学意义(t=0.029、0.013、0.032、0.039、0.042,均P<0.05);术后静息状态下6 h、12 h、24 h、48 h的VAS评分[(3.62±0.40)分、(2.41±0.52)分、(2.05±0.62)分、(1.93±0.28)分]和活动状态下24 h、48 h的VAS评分[(2.15±0.21)分、(1.71±0.39)分]比对照组[(5.71±0.63)分、(4.60±0.31)分、(3.84±0.22)分、(3.30±0.21)分、(5.50±0.49)分、(4.80±0.21)分]均明显降低,差异均有统计学意义(t=0.040、0.035、0.046、0.042、0.027、0.024,均P<0.05);术后尿潴留、精神障碍、输血构成比均低于对照组,住院时间、住院费用均短于、少于对照组(χ^(2)=0.003、0.005、0.017,t=0.040、0.048,均P<0.05)。结论:中西医结合ERAS理念可使术后疼痛减轻,围手术期并发症明显减少,促进患者膝关节功能恢复,值得临床推广应用。

Objective To investigate the clinical value of integrated traditional Chinese and Western medicine based on the concept of enhanced recovery after surgery(ERAS)in the perioperative period of total knee arthroplasty.Methods Sixty patients who underwent primary unilateral total knee arthroplasty in Tonglu Hospital of Traditional Chinese Medicine from July 2018 to June 2019 were included in this study.They were randomized as odd numbers to the control group(n=30)and even numbers to the observation group(n=30).The control group was treated with conventional rehabilitation treatment,while the observation group was subjected to integrated traditional Chinese and Western medicine based on the concept of ERAS in the perioperative period of total knee arthroplasty.The perioperative pain,related complications,hospitalization expenses and length of hospital stay were recorded in each group.The Visual Analogue Scale(VAS)was used to evaluate the degree of pain and range of motion of the knee joint.The Hospital for Special Surgery(HSS)knee score was also measured to evaluate the curative effects.Results At 3 and 7 days,2 and 6 weeks after surgery,knee range of motion score was(63.40±2.80)points,(86.20±4.40)points,(90.30±6.48)points,(100.5±3.39)points,respectively,and at 6 weeks after surgery,HSS knee score was(89.40±5.18)points,in the observation group,which were significantly higher those in the control group[(48.50±4.20)points,(55.40±3.58)points,(77.50±4.38)points,(87.60±4.58)points,(70.50±6.44)points,t=0.029,0.013,0.032,0.039,0.042,all P<0.05].In the observation group,the VAS score in resting state at 6,12,24 and 48 hours after surgery were(3.62±0.40)points,(2.41±0.52)points,(2.05±0.62)points,(1.93±0.28)points respectively,and the VAS score in active state at 24 and 48 hours were(2.15±0.21)points and(1.71±0.39)points,respectively,which were significantly lower than those in the control group[(5.71±0.63)points,(4.60±0.31)points,(3.84±0.22)points,(3.30±0.21)points,(5.50±0.49)points,(4.80±0.21)points,t=0.040,0.035,0.046,0.042,0.027,0.024,all P<0.05].The proportions of patients experiencing postoperative urinary retention,mental disorder,or blood transfusion,length of hospital stay,and hospitalization expenses in the observation group were lower or shorter than those in the control group(χ^(2)=0.003,0.005,0.017,t=0.040,0.048,all P<0.05).Conclusion Integrated traditional Chinese and Western medicine based on the concept of ERAS can mitigate postoperative pain,reduce perioperative complications,and promote the recovery of knee joint function,and thereby deserves clinical application.