加速康复对初次全膝置换血栓形成的影响

Effect of enhanced recovery after surgery on thrombosis in primary total knee replacement

[目的]探讨围术期加速康复(enhanced recovery after surgery,ERAS)管理对初次全膝关节置换术(total knee arthroplasty,TKA)患者术后下肢深静脉血栓(deep vein thrombosis,DVT)发生的影响。[方法]回顾性分析本院关节外科2016年7月—2018年6月行初次TKA且有术前术后下肢血管彩超检查的307例患者,根据医患沟通结果,分为ERAS组88例,常规组219例。对比两组患者临床结果、凝血指标、超声检查结果。[结果] ERAS组手术时间[(107.0±19.4) min vs (134.9±20.7) min,P<0.001]、术后下地时间[(27.8±11.5) d vs (70.6±11.0) d,P<0.001]、住院期间症状血栓[例,无/小腿/全下肢/心肺:(86/2/0/0) vs (196/15/8/0),P=0.046]、确诊血栓事件发生率(9.1%vs 19.6%,P=0.025)显著优于常规组。凝血指标方面,ERAS组患者术后D-D [(3.2±1.7) mg/L vs (3.8±1.7) mg/L,P=0.008]、FIB [(4.9±1.9) g/L vs (5.6±2.3) g/L,P=0.011]均显著低于常规组。超声检查住院期间ERAS组患者血栓分布情况[无/肌间/小静脉/大静脉/肺动脉:(80/2/6/0/0) vs (176/10/20/13/0),P=0.045]显著优于常规组。[结论]围术期ERAS管理能有效减少初次TKA患者术后DVT的发生,有助于血栓的预防。

[Objective] To investigate the effects of enhanced recovery after surgery(ERAS) management on deep vein thrombosis(DVT) in total knee arthroplasty(TKA).[Methods] A retrospective study was done on 307 patients who received primary TKA and underwent preoperative and postoperative lower limb vascular ultrasonography in our hospital from July 2016 to June 2018.According to the doctor-patient discussion,88 cases were divided into ERAS group,while other 219 cases were in the routine group.The clinical results,coagulation test and ultrasound consequence of the two groups were compared.[Results] The ERAS groups proved significantly superior to the routine group in terms of operative time [(107.0±19.4) min vs(134.9±20.7) min,P<0.001] and postoperative ambulation time [(27.8±11.5)days vs(70.6±11.0) days,P<0.001],occurrence of symptomatic thrombosis during hospitalization [non/calf/whole lower limb/cardiopulmonary,(86/2/0/0) vs(196/15/8/0),P=0.046],and the incidence of confirmed thrombotic events(9.1% vs 19.6%,P=0.025).With regard to coagulation assay,ERAS group were significantly lower than the routine group in postoperative D-D [(3.2±1.7) mg/L vs(3.8±1.7) mg/L,P=0.008] and FIB [(4.9±1.9) g/L vs(5.6±2.3) g/L,P=0.011].Regarding to ultrasound,the ERAS was also significantly better than the routine group in distribution of thrombus [none/intermuscular/small vein/large vein/pulmonary artery,(80/2/6/0/0) vs(176/10/20/13/0),P=0.045]during hospitalization.[Conclusion] Perioperative ERAS management can effectively reduce the occurrence of DVT in primary TKA and contribute to the prevention of thrombosis.