术后加速康复措施对膝关节置换术患者临床指标的影响

Effect of enhanced recovery after surgery on the clinical indicator of patients undergoing knee replacement

目的探讨术后加速康复措施(ERAS)对膝关节置换术患者临床指标的影响。方法收集2021年1月至2022年3月于蚌埠市第一人民医院接受治疗的104例膝关节置换术患者的临床资料,根据干预方法的不同将其分为常规组(n=52,于2021年1—7月采用常规术后干预)和ERAS组(n=52,于2021年8月至2022年3月采用ERAS干预)。比较两组患者术后恢复指标(首次进食时间、首次排尿时间、首次下床活动时间、住院时间)。干预前后,比较两组患者的视觉模拟评分法(VAS)评分、纽约特种外科医院(HSS)膝关节功能评分、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体(D-D)]、炎性反应指标[红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)、白细胞计数(WBC)]。出院前统计两组患者下肢深静脉血栓(DVT)发生情况及并发症总发生情况。结果ERAS组患者各项术后恢复指标均短于常规组患者,差异均有统计学意义(P<0.05)。干预后,两组患者VAS评分均低于本组干预前,HSS膝关节功能评分均高于本组干预前,且ERAS组患者VAS评分低于常规组患者,HSS膝关节功能评分高于常规组患者,差异均有统计学意义(P<0.05)。干预3 d后,两组患者PT、APTT、TT均短于本组术前,FIB、D-D水平均高于本组术前,但ERAS组患者PT、APTT、TT均长于常规组患者,FIB、D-D水平均低于常规组患者,差异均有统计学意义(P<0.05)。两组患者ESR均快于本组术前,hs-CRP、WBC均高于本组术前,但ERAS组患者ESR慢于常规组患者,hs-CRP、WBC均低于常规组患者,差异均有统计学意义(P<0.05)。ERAS组患者下肢DVT发生率及并发症总发生率均低于常规组患者,差异均有统计学意义(P<0.05)。结论ERAS能够加快膝关节置换术患者术后恢复进程,降低患者术后炎性反应程度,改善患者术后凝血功能,降低下肢DVT的发生风险。

Objective To investigate the effect of enhanced recovery after surgery(ERAS)the clinical indicator of patients undergoing knee replacement.Method The clinical data of 104 patients with knee replacement who were treated in Bengbu First People's Hospital from January 2021 to March 2022 were collected.They were divided into routine group(n=52,given conventional postoperative intervention from January to July 2021)and ERAS group(n=52,given rapid rehabilitation from August 2021 to March 2022)according to the different intervention methods.The postoperative recovery indicators of the first eating time,the first urination time,the first getting out of bed,and the hospitalization time of two groups were compared.The visual analog scale(VAS)score,New York hospital for special surgery(HSS)knee function score,coagulation function indexes of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),and D-dimer(D-D),inflammatory response indicators of[erythrocyte sedimentation rate(ESR),highsensitivity C-reactive protein(hs-CRP),and white blood cell count(WBC)]of two groups before and after the intervention were compared.The incidence of lower extremity deep vein thrombosis(DVT)and the total incidence of complications of two groups were counted before discharge.Result All postoperative recovery indicators in the ERAS group were shorter than those in the routine group,the differences were statistically significant(P<0.05).After intervention,the VAS scores of two groups were lower than those of same group before intervention,the HSS knee function scores of two groups were higher than those of same group before intervention,the VAS score in the ERAS group was lower than that of the routine group,the HSS knee function score in the ERAS group was higher than that of the routine group,the differences were statistically significant(P<0.05).After 3 days of intervention,the PT,APTT,and TT of two groups were shorter,the levels of FIB and D-D were higher than those of same group before operation,however,PT,APTT,and TT in the ERAS group were longer than those in the routine group,the levels of FIB and D-D in ERAS group were lower than those in the routine group,the differences were statistically significant(P<0.05).The ESR of the two groups were faster,the hs-CRP and WBC of two groups were higher than those of the same group before the operation,however,the ESR in ERAS group was slower than that in routine group,the CRP and WBC were lower than those in routine group,the differences were statistically significant(P<0.05).The incidence of lower extremity DVT and the total incidence of complications in the ERAS group were lower than those in the routine group,the differences were statistically significant(P<0.05).Conclusion ERAS could speed up the postoperative recovery process of patients undergoing knee replacement,reduce the degree of postoperative inflammatory response,improve postoperative coagulation function,and reduce the risk of lower extremity DVT.