加速康复外科理念对下肢肌内静脉畸形患者术后康复的影响

Effect of enhanced recovery after surgery on postoperative rehabilitation of patients with lower extremity intramuscular venous malformation

目的探讨加速康复外科(ERAS)理念对下肢肌内静脉畸形(IMVM)患者术后康复的影响。方法选择2018年1月至2019年12月河南省人民医院收治的下肢IMVM患者81例为研究对象,所有患者行IMVM切除术,根据围手术期护理措施将患者分为观察组(n=41)和对照组(n=40),对照组患者围手术期给予常规护理,观察组患者围手术期给予ERAS理念护理模式。术前、术后1周及术后1、3个月,采用视觉模拟评分(VAS)评估患者术区疼痛程度,采用角度尺测量踝关节活动度,采用美国矫形外科足踝协会踝-足功能量表(AOFAS-AHS)评估患者的踝-足功能,采用关节炎生活质量测量量表2-短卷(AIMS2-SF)评估患者的生活质量。观察2组患者跟腱挛缩、术区出血、术区感染等并发症的发生情况。结果术前2组患者疼痛VAS评分比较差异无统计学意义(P>0.05);2组患者术后1周及1、3个月时疼痛VAS评分显著低于术前(P<0.05),2组患者术后1、3个月时疼痛VAS评分显著低于术后1周(P<0.05),2组患者术后3个月时疼痛VAS评分显著低于术后1个月(P<0.05);术后1周及1、3个月时,观察组患者疼痛VAS评分显著低于对照组(P<0.05)。术前2组患者的踝关节背屈角度、跖屈角度比较差异无统计学意义(P>0.05);2组患者术后1周及1、3个月时踝关节背屈角度、跖屈角度显著大于术前(P<0.05),2组患者术后1、3个月踝关节背屈角度、跖屈角度显著大于术后1周(P<0.05),2组患者术后3个月时候踝关节背屈角度、跖屈角度显著大于术后1个月(P<0.05);术后1周及1、3个月时,观察组患者的踝关节背屈角度、跖屈角度显著大于对照组(P<0.05)。术前2组患者AOFAS-AHS评分比较差异无统计学意义(P>0.05);2组患者术后1周及1、3个月时AOFAS-AHS评分显著高于术前(P<0.05),2组患者术后1、3个月时AOFAS-AHS评分显著高于术后1周(P<0.05),2组患者术后3个月时AOFAS-AHS评分显著高于术后1个月(P<0.05);术后1周及1、3个月时,观察组患者AOFAS-AHS评分显著高于对照组(P<0.05)。术前2组患者AIMS2-SF评分比较差异无统计学意义(P>0.05);2组患者术后1周及1、3个月时AIMS2-SF评分显著高于术前(P<0.05),2组患者术后1、3个月时AIMS2-SF评分显著高于术后1周(P<0.05),2组患者术后3个月时AIMS2-SF评分显著高于术后1个月(P<0.05);术后1周及1、3个月时,观察组患者AIMS2-SF评分显著高于对照组(P<0.05)。观察组和对照组患者并发症发生率分别为7.32%(3/41)、37.50%(15/40),观察组患者并发症发生率显著低于对照组(χ^(2)=9.451,P<0.05)。结论在下肢IMVM术后康复训练中应用ERAS理念可有效减轻IMVM患者的疼痛,提高患者踝-足关节功能和生活质量,降低并发症发生率。

Objective To investigate the effect of enhanced recovery after surgery(ERAS)on the postoperative rehabilitation of patients with lower extremity intramuscular venous malformation(IMVM).Methods Eighty-one patients with lower extremity IMVM admitted to Henan Provincial People′s Hospital from January 2018 to December 2019 were selected as the study subjects.All patients underwent IMVM resection.The patients were divided into the observation group(n=41)and the control group(n=40)according to perioperative nursing measures.The patients in the control group were given routine nursing during the perioperative period,and the patients in the observation group were given ERAS nursing mode during the perioperative period.At the time points of before operation and 1 week,1 month and 3 months after operation,the pain in the operation area of patients was evaluated with visual analogue scale(VAS),the range of motion of ankle joint of patients was measured with the angle ruler,the ankle-foot function of patients was evaluated with the American Orthopaedic Foot and Ankle Society-ankle-hindfoot scale(AOFAS-AHS),and the quality of life of patients was evaluated with the short form of arthritis impact measurement scale 2(AIMS2-SF).The complications such as achilles tendon contracture,bleeding and infection in the operation area were observed.Results There was no significant difference in VAS score of pain of patients between the two groups before operation(P>0.05).The VAS score of pain of patients in the two groups at 1 week,1 month and 3 months after operation was significantly lower than that before operation(P<0.05).The VAS score of pain of patients in both groups at 3 months after operation was significantly lower than that at 1 month after operation(P<0.05).The VAS score of patients in the observation group was significantly lower than that in the control group at 1 week,1 month and 3 months after operation(P<0.05).There was no significant difference in ankle dorsiflexion angle and plantar flexion angle of patients between the two groups before operation(P>0.05).The ankle dorsiflexion angle and plantar flexion angle of patients in the two groups at 1 week,1 month and 3 months after operation were significantly greater than those before operation(P<0.05).The ankle dorsiflexion angle and plantar flexion angle of patients in the two groups at 1 month and 3 months after operation were significantly greater than those at 1 week after operation(P<0.05).The ankle dorsiflexion angle and plantar flexion angle of patients in the observation group were significantly higher than those in the control group at 1 week,1 month and 3 months after operation(P<0.05).There was no significant difference in AOFAS-AHS score of patients between the two groups before operation(P>0.05).The AOFAS-AHS score of patients in both groups at 1 week,1 month and 3 months after operation was significantly higher than that before operation at 1 week,1 month and 3 months after operation(P<0.05).The AOFAS-AHS score of patients in the two groups at 1 and 3 months after operation was significantly higher than that at 1 week after operation(P<0.05).The AOFAS-AHS score of patients in the two groups at 3 months after operation was significantly higher than that at 1 month after operation(P<0.05).The AOFAS-AHS score of patients in the observation group were significantly higher than that in the control group at 1 week,1 month and 3 months after operation(P<0.05).There was no significant difference in AIMS2-SF score of patients between the two groups before operation(P>0.05).The AIMS2-SF score of patients in both groups at 1 week,1 month and 3 months after operation were significantly higher than that before operation(P<0.05).The AIMS2-SF score of patients in the two groups at 1 month and 3 months after operation was significantly higher than that at 1 week after operation(P<0.05).The AIMS2-SF score of patients in the two groups at 3 months after operation was significantly higher than that at 1 month after operation(P<0.05).The AIMS2-SF score of patients in the observation group was significantly higher than that in the control group at 1 week,1 month and 3 months after operation(P<0.05).The incidence of complications in the observation group and the control group was 7.32%(3/41)and 37.50%(15/40),respectively.The incidence of complications in the observation group was significantly lower than that in the control group(χ^(2)=9.451,P<0.05).Conclusion The application of ERAS concept in the rehabilitation training of patients after lower extremity IMVM surgery can effectively reduce the pain,improve the ankle-foot joint function and quality of life,and decrease the incidence of complications.