基于加速康复外科理念的多学科协作诊疗模式在高龄髋部骨折患者中的临床疗效评价

Evaluation of the Clinical Efficacy of Multidisciplinary Treatment Model Based on the Concept of Enhanced Recovery after Surgery in Elderly Hip Fracture Patients

目的:探讨基于加速康复外科(enhanced recovery after surgery,ERAS)理念的多学科协作(multidisciplinary treatment,MDT)诊疗模式在高龄髋部骨折患者的临床疗效评价。方法:选取2019年10月—2020年9月承德市中心医院接受髋部骨折手术治疗的50例高龄患者作为对照组,2020年10月—2021年9月承德市中心医院接受髋部骨折手术治疗的50例高龄患者作为观察组。对照组采取常规治疗模式,观察组采取应用基于ERAS理念的MDT诊疗模式。比较两组患者术前等待时间、术后进食时间、术后下床时间、住院时间、并发症发生率、48 h内手术率和出院后1年的病死率。结果:观察组患者的术前等待时间、术后进食时间、术后下床时间,住院时间均短于对照组,48 h内手术率高于对照组,差异有统计学意义(t=8.307、15.105、9.217、4.924;χ^(2)=13.306,P<0.05);观察组患者术后肺炎、泌尿系感染、下肢深静脉血栓发生率,观察组1年内病死率低于对照组,差异有统计学意义(χ^(2)=4.432、5.005、5.316、3.107,P<0.05)。结论:基于ERAS理念的MDT诊疗模式能够减少高龄髋部骨折患者术前等待时间、术后进食时间、术后下床时间和住院时间,提高48h内手术率,降低并发症的发生率和病死率。

Objective:To investigate the clinical efficacy of the multidisciplinary treatment(MDT)model based on the concept of enhanced recovery after surgery(ERAS)in elderly hip fracture patients.Methods:50 cases of elderly patients who received sur⁃gical treatment for hip fracture in the hospital from October 2019 to September 2020 were selected as the control group,and 50 cases of elderly patients who received surgical treatment for hip fracture in the hospital from October 2020 to September 2021 were selected as the observation group.The control group adopted the conventional treatment mode,and the observation group adopted the application of MDT mode based on the concept of ERAS.The waiting time before operation,feeding time after operation,get⁃ting out of bed time after operation,hospitalization time,complication rate,operation rate within 48 h,and morbidity and mortality rate 1 year after discharge were compared between the two groups.Results:The preoperative waiting time,postoperative feeding time,postoperative getting out of bed time,and hospitalization time of the patients in the observation group were shorter than that of the control group,and the rate of surgery within 48 h was higher than that of the control group,and the difference was statistical⁃ly significant(t=8.307,15.105,9.217,4.924;χ^(2)=13.306,P<0.05).The incidence of postoperative pneumonia,urinary tract infec⁃tion,and lower extremity deep vein thrombosis in patients in the observation group,and the mortality rate within 1 year in the ob⁃servation group was higher than that in the control group,and the difference was statistically significant(χ^(2)=4.432,5.005,5.316,3.107,P<0.05).Conclusion:The MDT model based on the ERAS concept can reduce the preoperative waiting time,postoperative feeding time,postoperative getting out of bed time,and hospitalization time of elderly hip fracture patients,increase the operation rate within 48 h,and reduce the incidence of complications and the morbidity and mortality.