加速康复外科应用于老年股骨转子间骨折围手术期管理的疗效分析

Effect of enhanced recovery after surgery on perioperative management of elderly patients with intertrochanteric fractures

目的探讨应用加速康复外科(enhanced recovery after surgery,ERAS)理念对老年股骨转子间骨折患者进行围手术期管理的临床疗效。方法对2016年1月-2017年12月四川大学华西医院收治的64例老年股骨转子间骨折患者的临床资料进行回顾性分析。其中2017年1月-12月入院的32例患者为ERAS组,2016年1月-12月入院的32例患者为对照组。对照组采用常规骨科围手术期管理措施,ERAS组则在常规治疗措施的基础上结合ERAS理念进行围手术期管理。比较两组患者的围手术期并发症发生率、视觉模拟评分法得分、改良Barthel指数量表评分、住院满意度及住院时长。结果两组患者年龄、性别、美国麻醉师协会分级、合并疾病、入院时改良Barthel指数量表和视觉模拟评分法得分、受伤至手术的时间的差异无统计学意义(P>0.05)。ERAS组围手术期并发症总发生率(12.5%vs.37.5%)和住院时长[(8.09±2.33)vs.(10.41±3.63)d]均低于对照组,差异有统计学意义(P<0.05)。术前、术后第1天和第3天两组患者的视觉模拟评分法得分均较入院时降低(P<0.05)。各时间点两组间比较显示,术前、术后第1天和第3天ERAS组患者视觉模拟评分法得分均低于对照组,差异有统计学意义(P<0.05)。术后第3天及第1、3、6个月两组患者改良Barthel指数量表评分均随时间延长呈不断上升趋势。ERAS组患者的改良Barthel指数量表评分在术后第3天、第1个月和第3个月优于对照组(P<0.05),而术后6个月两组间比较差异无统计学意义(P>0.05)。ERAS组患者住院满意度评分为(95.56±5.12)分,高于对照组(92.84±5.62)分,差异有统计学意义(P<0.05)。结论对老年股骨转子间骨折患者实施ERAS围手术期管理模式可能减少围手术期并发症的发生,减轻患者疼痛,促进患者生活自理能力短期恢复,提升患者住院满意度并缩短住院时长。

Objective To explore the clinical effect of applying the concept of enhanced recovery after surgery(ERAS)to the perioperative management of elderly patients with intertrochanteric fractures.Methods The clinical data of 64 elderly patients with intertrochanteric fractures admitted to West China Hospital of Sichuan University from January 2016 to December 2017 were retrospectively analyzed.Among them,32 patients admitted from January to December in 2017 were in ERAS group,and 32 patients admitted from January to December 2016 were in control group.The control group used conventional orthopedic perioperative management measures,and the ERAS group combined the ERAS concept on the basis of conventional treatment measures for perioperative management.The incidence of perioperative complications,Visual Analogue Scale score,modified Barthel Index score,inpatient satisfaction and length of hospital stay were compared between the two groups.Results There was no significant difference in age,gender,American Society of Anesthesiologists grade,combined disease,modified Barthel Index or Visual Analogue Scale score at admission,or time from injury to surgery between the two groups(P>0.05).The total incidence of perioperative complications(12.5%vs.37.5%)and length of hospital stay[(8.09±2.33)vs.(10.41±3.63)d]in the ERAS group were lower than those in the control group(P<0.05).The Visual Analogue Scale scores of the two groups of patients before operation,on the first day and the third day after operation were lower than those at admission(P<0.05).The comparison between the two groups at each time point showed that the Visual Analogue Scale scores of patients in the ERAS group were lower than those in the control group before operation,on the first day and the third day after operation,and the differences were statistically significant(P<0.05).The modified Barthel Index scores of the two groups of patients on the third day,and1 month,3 months and 6 months after operation showed a rising trend with time.The modified Barthel Index scores of the ERAS group were better than those of the control group on the third day,and 1 month and 3 months after operation(P<0.05).There was no significant difference between the two groups 6 months after operation(P>0.05).The hospitalization satisfaction score of the ERAS group was 95.56±5.12,which was higher than that of the control group(92.84±5.62),and the difference was statistically significant(P<0.05).Conclusions The implementation of ERAS perioperative management for elderly patients with intertrochanteric fractures may reduce the incidence of perioperative complications,relieve patient pain,promote the short-term recovery of activities of daily living of patients,improve the inpatient satisfaction and shorten the length of hospital stay.