ERAS在股骨头缺血性坏死行人工全髋关节置换术中的临床应用效果研究

Study on clinical effect of ERAS in total hip arthroplasty for ischemic necrosis of the femoral head

目的 探讨外科快速康复理论(ERAS)在股骨头缺血性坏死行人工全髋关节置换术中的临床应用效果。方法 选取70例股骨头缺血性坏死行人工全髋关节置换术的患者为研究对象,采用随机排列法分为对照组和实验组,各35例。对照组围术期给予常规护理干预,实验组围术期给予ERAS干预。比较两组患者围术期指标、并发症发生情况、髋关节Harris评分。结果 实验组手术时间(130.85±24.36)min、术后排气时间(35.17±3.88)h、术后肠鸣音恢复时间(33.97±4.28)h、术后排便时间(46.95±8.74)h、术后进食时间(6.55±1.02)h、术后住院时间(15.63±2.50)d均短于对照组的(172.04±26.21)min、(58.26±5.74)h、(45.18±5.27)h、(72.39±10.24)h、(13.05±2.44)h、(20.04±2.33)d,术后48 h引流量(68.92±2.52)ml少于对照组的(80.35±12.88)ml,差异具有统计学意义(P<0.05)。实验组并发症发生率2.86%低于对照组的17.14%,差异具有统计学意义(P<0.05)。术后即刻,两组患者髋关节Harris评分比较差异无统计学意义(P>0.05);干预3、6、12个月,实验组患者的髋关节Harris评分分别为(79.58±3.94)、(83.67±4.11)、(93.67±3.28)分,均明显高于对照组的(74.15±4.37)、(79.58±4.25)、(84.14±3.12)分,差异具有统计学意义(P<0.05)。结论 股骨头缺血性坏死行人工全髋关节置换术的患者实施ERAS干预可以促进术后生理功能恢复,减少术后并发症发生,缩短住院时间,使髋关节功能得到有效恢复,效果显著。

Objective To discuss the clinical effect of enhanced recovery after surgery(ERAS)in total hip arthroplasty for ischemic necrosis of the femoral head.Methods A total of 70 patients with ischemic necrosis of the femoral head undergoing total hip arthroplasty were divided into a control group and an experimental group according to the random arrangement method,with 35 cases in each group.The control group was given routine nursing intervention during perioperative period,and the experimental group was given ERAS intervention during perioperative period.The perioperative indexes,complications and Harris hip score were compared between the two groups.Results In the experimental group,the operative time was(130.85±24.36)min,the postoperative exhaust time was(35.17±3.88)h,the postoperative bowel sound recovery time was(33.97±4.28)h,the postoperative defecation time was(46.95±8.74)h,the postoperative eating time was(6.55±1.02)h,and the postoperative hospitalization time was(15.63±2.50)d,which were shorter than those of(172.04±26.21)min,(58.26±5.74)h,(45.18±5.27)h,(72.39±10.24)h,(13.05±2.44)h,and(20.04±2.33)d in the control group;the drainage volume of(68.92±2.52)ml in the experimental group at 48 h postoperatively was lower than that of(80.35±12.88)ml in the control group;the differences were statistically significant(P<0.05).The complication rate of 2.86%in the experimental group was lower than that of 17.14%in the control group,and the difference was statistically significant(P<0.05).Immediately after surgery,there was no statistically significant difference in Harris hip score between the two groups(P>0.05).After 3,6 and 12 months of intervention,the Harris hip score in the experimental group were(79.58±3.94),(83.67±4.11)and(93.67±3.28)points,which were significantly higher than those of(74.15±4.37),(79.58±4.25)and(84.14±3.12)points in the control group.The differences were statistically significant(P<0.05).Conclusion ERAS intervention is effective for patients with ischemic necrosis of the femoral head undergoing total hip arthroplasty,and can promote the recovery of physiological function after surgery,reduce the occurrence of postoperative complications,shorten the hospitalization time,and effectively restore hip function.