加速康复理念在全膝关节置换术围手术期的应用

Application of Enhanced Recovery after Surgery Concept in Perioperative Period of Total Knee Arthroplasty

目的:探讨加速康复理念在单侧全膝关节置换术(TKA)围手术期的应用效果。方法:回顾性分析攀枝花市中心医院骨科2017年1月至2021年4月行单侧TKA患者的病例资料,采用随机数字表法将175例患者分为对照组(80例)和实验组(95例)。比较两组患者的住院天数、手术时间、初次下地时间、术中补液量、围手术期输血率、尿管留置率、视觉模拟评分法(VAS)评分、HSS膝关节评分、术后化验指标。结果:与对照组相比,实验组住院天数明显缩短,术中补液量明显降低,初次下地时间明显提前,围手术期尿管留置率和输血率明显降低,差异有统计学意义(P<0.05);实验组术后VAS评分均低于对照组,术后HSS评分均高于对照组,差异有统计学意义(P<0.05);实验组血红蛋白、血细胞比容高于同期对照组,C反应蛋白低于同期对照组,差异有统计学意义(P<0.05)。结论:在TKA围手术期应用加速康复理念能够有效缓解患者的疼痛,改善关节功能,缩短住院时间,促进患者康复,值得临床应用。

Objective:To explore the application effect of enhanced recovery after surgery(ERAS)concept in perioperative period of unilateral total knee arthroplasty(TKA).Methods:The case data of patients undergoing unilateral TKA in the Department of Orthopedics of Panzhihua Central Hospital from January 2017 to April 2021 were retrospectively analyzed.The 175 patients were divided into a control group(80 cases)and an experimental group(95 cases)by random number table method.The lengths of hospitalizations,the operation times,the times of ambulation,the intraoperative rehydration,the perioperative blood transfusion rates,the urinary catheter retention rates,the visual analogue scale(VAS)scores,the HSS knee scores and postoperative laboratory indexes were assessed between the two groups.Results:Compared with the control group,the length of hospitalization in the experimental group was significantly shortened,the amount of intraoperative rehydration was significantly reduced,the time for ambulation was significantly earlier,and the retention rate of urinary catheter and blood transfusion rates in the perioperative period were significantly reduced,and the differences were statistically significant(P<0.05).The postoperative VAS scores of the experimental group were lower than those of the control group,and the postoperative HSS scores were higher than those of the control group,and the differences were statistically significant(P<0.05).The hemoglobin and hematocrit of the experimental group were higher than those of the control group at the same period,and the C-reactive protein was lower than that of the control group at the same period,and the differences were statistically significant(P<0.05).Conclusion:The application of ERAS concept in the perioperative period of TKA can effectively relieve the pain of patients,improve joint function,shorten the hospitalization time,and promote the recovery of patients,which is worthy of clinical application.