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Protective effect of sevoflurane on lung function of elderly chronic obstructive pulmonary disease patients undergoing total hip arthroplasty
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作者 Yuan Yao Man-Si Zhang +1 位作者 Yue-Bing Li Ming-Zhe Zhang 《World Journal of Clinical Cases》 SCIE 2023年第31期7619-7628,共10页
BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common respiratory disorder that affects the elderly population and increases the risk of postoperative pulmonary complications(PPCs)after major surgeries.Sev... BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common respiratory disorder that affects the elderly population and increases the risk of postoperative pulmonary complications(PPCs)after major surgeries.Sevoflurane is a volatile anesthetic that has been shown to have anti-inflammatory and antioxidant properties and attenuate lung injury in animal models.AIM To evaluate the protective effect of sevoflurane on the lung function of elderly COPD patients undergoing total hip arthroplasty(THA).METHODS In this randomized controlled trial,we randomly assigned 120 elderly patients with COPD,who were scheduled for THA,to receive either sevoflurane(sevoflurane group)or propofol(propofol group)as the maintenance anesthetic.The primary outcome was the incidence of PPCs within seven days after surgery.The secondary outcomes were changes in the lung function parameters,inflammatory markers,oxidative stress markers,and postoperative pain scores.RESULTS The results showed that the incidence of PPCs was significantly lower in the sevoflurane group than in the propofol group(10%vs 25%,P=0.02).Furthermore,the decline in the forced expiratory volume in 1 s,forced vital capacity,and peak expiratory flow was significantly lesser in the sevoflurane group than in the propofol group at 24 h and 48 h after surgery(P<0.05).The interleukin-6,tumor necrosis factor-alpha,malondialdehyde,and 8-hydroxy-2α-deoxyguanosine levels were significantly lower in the sevoflurane group than in the propofol group at 24 h after surgery(P<0.05).The sevoflurane group showed significantly lower postoperative pain scores than the propofol group at 6 h,12 h,and 24 h after surgery(P<0.05).CONCLUSION Sevoflurane protects the lung function of elderly COPD patients undergoing THA under general anesthesia by reducing the incidence of PPCs,attenuating inflammatory and oxidative stress responses,and alleviating postoperative pain. 展开更多
关键词 SEVOFLURANE PROPOFOL Lung function Chronic obstructive pulmonary disease total hip arthroplasty elderly patients inflammatory markers
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Effect of midazolam combined with propofol anesthesia of elderly patients in total hip arthroplasty
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作者 Yun Tian Jie Zheng +1 位作者 Jing-Xi Yang Dan Chen 《Journal of Hainan Medical University》 2018年第14期70-74,共5页
Objective:To investigate the effects of midazolam combined with propofol anesthesia on the level of stress, immune function, blood hypercoagulability, and brain injury in elderly patients undergoing total hip arthropl... Objective:To investigate the effects of midazolam combined with propofol anesthesia on the level of stress, immune function, blood hypercoagulability, and brain injury in elderly patients undergoing total hip arthroplasty.Method: From March 2016 to September 2017, 80 patients were selected to undergo total hip arthroplasty in our hospital, and they were randomly divided into 2 groups, 40 cases in each group, the observation group and the control group were set. The observation group received midazolam and propofol anesthesia, and the control group received propofol anesthesiabefore the anesthesia (T0), 30 min after the surgery (T1), 6 h after the operation (T2), and 4 h after the operation(T3), to compare the stress response, immune function, blood hypercoagulability and brain injury indicators in the two groups.Results:The levels of cortisol (Cor), epinephrine (E), and norepinephrine (NE) remained unchanged in the two groups before anesthesia, the difference was not significant;the Cor, E and NE levels in the observation group were lower than the control group at 30 min after the end of the surgery, 6 h after the end of the surgery, and 12 h after the end of the surgery, the differences were all significant;The levels of CD3+, CD4+, CD8+ and CD4+/CD8+ remained unchanged in the two groups before anesthesia, the difference was not significant, the CD3+, CD4+, CD8+ and CD4+/CD8+ levels in the observation group were higher than those in the control group at 30 min after the end of the surgery, 6 h after the end of the surgery, and 12 hours after the end of the surgery;The levels of Fib and D-D remained unchanged in the two groups before anesthesia, the Fib and D-D levels in the observation group were lower than the control group at 30 min after the end of the surgery, 6 hours after the end of the surgery,and 12 h after the end of the surgery, differences were all significant;The levels of S-100β and NSE remained unchanged in the two groups before anesthesia, the S-100β and NSE levels in the observation group were lower than the control group at 30 min after the end of the surgery, 6 h after the end of the surgery, and 12 h after the end of the surgery, differences were all significant. Conclusion: Midazolam was combined with propofol anesthesia which has good clinical effects in elderly patients who were undergo total hip arthroplasty. It can effectively relieve stress, regulate immune function, improve blood hypercoagulability, reduce brain injury, and improve sedation after anesthesia. 展开更多
关键词 MIDAZOLAM PROPOFOL total hip arthroplasty elderly patients
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Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures
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作者 何锐 《外科研究与新技术》 2011年第2期116-117,共2页
Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the e... Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients 展开更多
关键词 THA head Control study of short-term curative effect of minimally invasive total hip arthroplasty using metal-on-metal large-diameter femoral head for the elderly patients with femoral neck fractures
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Total hip arthroplastyvs. osteosynthesis in acute complex acetabular fractures in the elderly:Evaluation of surgical management and outcomes 被引量:3
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作者 Serafino Carta Gabriele Falzarano +7 位作者 Giuseppe Rollo Predrag Grubor Mattia Fortina Luigi Meccariello Antonio Medici Alberto Riva Luca Sampieri Paolo Ferrata 《Journal of Acute Disease》 2017年第1期12-17,共6页
Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. <br> Me... Objective: To retrospectively evaluate the open reduction internal fixation and total hip arthroplasty directions, results and complications associated with internal fixation in managing these fractures. <br> Methods: In 8 years at 4 centers, 61 patients with associated acetabular fractures (Letournel classification) were treated. The patients were divided into two groups. The total hip arthoplasty (THA) group consisted of 30 patients, while the open reduction internal fixation group had 31 patients. The average age of the patients was 74.7 years. The following parameters were compared: the duration of surgery and hospitalization, the international unit of red blood cell concentrate transfusion, the time for the verticalization of the patient, perioperative complications, Harris hip score, and the short form (12) health survey. The clinical and radiographic follow-up was performed at 1 month, 3 months, 6 months and 12 months and annually thereafter. Patients with post-traumatic osteoarthritis formed the third comparison group.P≤ 0.05 was considered statistically significant according to the analytical Student’s t-test. <br> Results: TheP < 0.05 in favor of theTHAgroup was: surgical time, length of stay, number of the international unit of red blood cell concentrate transfusions, verticalization, quality of life and hip function, a reduction of perioperative complications and reinterventions. <br> Conclusions: Our experience shows that theTHA treatment for acetabular fractures in the elderly is to be preferred. 展开更多
关键词 ACETABULUM Fracture elderly OSTEOPOROSIS total hip arthroplasty OSTEOSYNTHESIS
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Examining the“revisability”benefit of hip resurfacing arthroplasty
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作者 Jose George Adam J Taylor Thomas P Schmalzried 《World Journal of Orthopedics》 2024年第6期554-559,共6页
BACKGROUND Hip resurfacing arthroplasty(HRA)is an alternative to total hip arthroplasty(THA)that is typically reserved for young active patients because it preserves bone.However,the benefits of HRA only hold true if ... BACKGROUND Hip resurfacing arthroplasty(HRA)is an alternative to total hip arthroplasty(THA)that is typically reserved for young active patients because it preserves bone.However,the benefits of HRA only hold true if conversion THA after failed HRA provides acceptable outcomes.AIM To compare patient reported outcomes for conversion THA after HRA failure to primary THA.METHODS A retrospective review of 36 patients(37 hips)that underwent conversion THA for failed HRA between October 2006 and May 2019 by a single surgeon was performed.Patient reported outcomes[modified Harris Hip Score(mHHS),University of California Los Angeles(UCLA)activity score]were obtained via an email-based responder-anonymous survey.Outcomes were compared to normative data of a primary THA cohort with similar demographics.Subgroup analysis was performed comparing outcomes of conversion THA for adverse local tissue reaction(ALTR)vs all other causes for failure.RESULTS The study group had a lower mHHS than the control group(81.7±13.8 vs 90.2±11.6,P<0.01);however,both groups had similar UCLA activity levels(7.5±2.3 vs 7.2±1.6,P=0.51).Patients that underwent conversion for non-ATLR causes had similar mHHS(85.2±11.5 vs 90.2±11.6,P=0.11)and higher UCLA activity levels(8.5±1.8 vs 7.2±1.6,P<0.01)compared to the control group.Patients that underwent conversion for ATLR had worse mHHS(77.1±14.5 vs 90.2±11.6,P<0.01)and UCLA activity levels(6.1±2.3 vs 7.2±1.6,P=0.05)when compared to the control group.CONCLUSION Patient outcomes equivalent to primary THA can be achieved following HRA conversion to THA.However,inferior outcomes were demonstrated for ALTR-related HRA failure.Patient selection and perhaps further studies examining alternative HRA bearing surfaces should be considered. 展开更多
关键词 total hip arthroplasty hip resurfacing arthroplasty Conversion total hip arthroplasty Adverse local tissue reaction Patient reported outcome measures
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Ultrasound-guided,direct suprainguinal injection for fascia iliaca block for total hip arthroplasty:A retrospective study 被引量:4
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作者 Ya-Li Wang Yun-Qing Liu +6 位作者 Hua Ni Xin-Lei Zhang Li Ding Fei Tong Hong-Ye Chen Xin-Hua Zhang Ming-Jian Kong 《World Journal of Clinical Cases》 SCIE 2021年第15期3567-3575,共9页
BACKGROUND Peripheral regional block combined with general anesthesia might be a preferable anesthetic regimen for elderly patients undergoing total hip arthroplasty.AIM To investigate whether ultrasound-guided,direct... BACKGROUND Peripheral regional block combined with general anesthesia might be a preferable anesthetic regimen for elderly patients undergoing total hip arthroplasty.AIM To investigate whether ultrasound-guided,direct suprainguinal injection for fascia iliaca block accelerated recovery after general anesthesia and relieved postoperative pain after total hip arthroplasty.METHODS Patients who underwent total hip arthroplasty under general anesthesia in 2015 or 2019 at The Second Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.The patients were grouped based on whether preoperative suprainguinal fascia iliaca block was performed or not.The time to tracheal extubation and time spent in the post-anesthesia care unit(PACU),intraoperative remifentanil dosage,fentanyl consumption in the PACU,postoperative cumulative fentanyl consumption within 48 h after operation,visual analogue scale at rest and during movement on the first and second days after surgery,and adverse reactions were compared.RESULTS Thirty-one elderly patients who underwent total hip arthroplasty were included in the study(block group,n=16;no-block group,n=15).The visual analog scale scores at rest and during movement on the first and second days were significantly lower in the block group than in the no-block group(all P<0.05).Compared with the no-block group,the intraoperative remifentanil dosage was lower,the time to tracheal extubation and the time spent in the PACU were shorter in the block group(all P<0.01).Fentanyl consumption in the PACU and postoperative cumulative fentanyl consumption in 48 h after operation were lower in the block group(all P<0.01).The incidence of dizziness was higher in the no-block group than in the block group(P=0.037).CONCLUSION Ultrasound-guided,direct suprainguinal injection for fascia iliaca block led to faster recovery after general anesthesia and early postoperative pain relief in elderly patients undergoing total hip arthroplasty. 展开更多
关键词 Suprainguinal fascia iliaca block elderly patients total hip arthroplasty General anesthesia recovery Postoperative pain
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Total hip arthroplasty following the failure of intertrochanteric nailing:First implant or salvage surgery? 被引量:3
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作者 Giuseppe Solarino Davide Bizzoca +4 位作者 Pasquale Dramisino Giovanni Vicenti Lorenzo Moretti Biagio Moretti Andrea Piazzolla 《World Journal of Orthopedics》 2023年第10期763-770,共8页
BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechani... BACKGROUND Proximal femur fractures,including both intracapsular(femoral neck fractures)and extracapsular fractures(intertrochanteric femoral fractures,IFFs),affect around 1.5 million people per year worldwide.Mechanical failures of intertrochanteric nailing in IFFs could be managed with revision total hip arthroplasty(THA).AIM To describe the surgical complexity and the procedure-related complication rates in patients with trochanteric nailing failure and treated with THA.METHODS Patients referred to our level I trauma center between April 2012 and July 2018 with failed cephalomedullary nailing following trochanteric fractures were retrospectively recruited.All patients underwent a salvage surgical procedure,i.e.,cephalomedullary nail removal and conversion to THA.The same surgical and anesthesiology team performed the surgical procedures under spinal anesthesia.All patients underwent clinical and radiographic follow-ups for at least 24 mo.Complications and re-operations were recorded.RESULTS Seventy-four patients met the inclusion criteria(male:29;female:45;mean age:73.8-years-old;range:65-89)and were included in the current study.The average operative time was 117 min(76-192 min).The average blood loss was 585 mL(430-1720 mL).Among the 74 patients,43(58.1%)required transfusion of three or more blood units.Two patients died within the 4th d after surgery because of pulmonary embolism,and 1 patient died 9 mo after surgery due to ischemic myocardial infarction.The complication rate in the 71 patients who completed the minimum 24-mo follow-up was 22.5%.In 3 cases out of 71(4.2%)periprosthetic acetabular fracture was observed during the followup.One of these periacetabular fractures occurred intraoperatively.An intraoperative periprosthetic femur fracture was observed in 5 patients out of 71(7.0%).Four of these patients needed a re-operation to fix the fracture with plates and cerclages;in one of these patients,femoral stem revision was also necessary.In 4 patients out of 71(5.6%),an early THA dislocation was observed,whereas in 1 case(1.4%)a late THA dislocation was observed.Three patients out of 71(4.2%)developed a periprosthetic joint infection during the study follow-up.CONCLUSION The present study demonstrated that salvage options for IFF fixation failure are complex procedures with a relevant intraoperative and postoperative complication rate. 展开更多
关键词 Femoral nailing total hip arthroplasty Proximal femur fractures OSTEOPOROSIS Fragility fractures Geriatric patients hip traumatology hip replacement
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Comparison of clinical outcomes between total hip replacement and total knee replacement 被引量:1
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作者 Alexander Green Alex Walsh Oday Al-Dadah 《World Journal of Orthopedics》 2023年第12期853-867,共15页
BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for whic... BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for which remains unknown.This study compares clinical outcomes between THR and TKR.AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures(PROMs).METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre-and post-operatively.RESULTS A total of 131 patients were included in the study which comprised the THR group(68 patients)and the TKR group(63 patients).Both groups demonstrated significant post-operative improvements in all PROM scores(P<0.001).There were no significant differences in post-operative PROM scores between the two groups:Hip and Knee Osteoarthritis Outcome scores(P=0.140),Western Ontario and McMaster Universities Osteoarthritis Index pain(P=0.297)stiffness(P=0.309)and function(P=0.945),Oxford Hip and Knee Score(P=0.076),EuroQol-5D index(P=0.386)and Short-Form 12-item survey physical component score(P=0.106).Subgroup analyses showed no significant difference(P>0.05)between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference(P>0.05)between cemented and uncemented fixation in the THR group.Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.CONCLUSION Contrary to some literature,THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs.The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome.Obesity had a greater influence on the outcome following TKR than that of THR. 展开更多
关键词 OBESITY OSTEOARTHRITIS Patient reported outcome measures total hip arthroplasty total knee arthroplasty
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微创双切口与改良Harding入路全髋关节置换术在高龄患者中的疗效比较 被引量:3
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作者 杨建平 王黎明 +3 位作者 桂鉴超 喻忠 侯明夫 徐燕 《中国微创外科杂志》 CSCD 2008年第8期691-693,共3页
目的比较微创双切口与改良Harding入路全髋关节置换术在高龄患者中的疗效。方法2003年5月~2006年12月,采用微创双切口技术对21例高龄患者(平均82岁)行全髋关节置换术,与同期采用改良Harding入路对39例高龄患者(平均83岁)行全髋关节置... 目的比较微创双切口与改良Harding入路全髋关节置换术在高龄患者中的疗效。方法2003年5月~2006年12月,采用微创双切口技术对21例高龄患者(平均82岁)行全髋关节置换术,与同期采用改良Harding入路对39例高龄患者(平均83岁)行全髋关节置换术的疗效进行比较。结果双切口组术中出血量(270±94)ml与改良Harding组(280±107)ml比较差异无显著性(t=-0.360,P=0.720)。术后第2天,双切口组病人能做主动直腿抬高的动作,且术后第10天抬高角度(53±12)°与改良Harding组(32±16)°比较差异有显著性(t=5.262,P=0.000),但双切口组术后6个月的Harris评分(80.6±12.6)与改良Harding组(79.5±13.2)比较并无统计学意义(t=0.313,P=0.756)。双切口组骨科系统并发症发生率(9.5%,2/21)与改良Harding组(8.1%,3/37)比较差异无显著性(χ2=0.000,P=1.000),其他系统并发症发生率(19.0%,4/21)与改良Harding组(37.8%,14/37)比较也无统计学意义(χ2=2.210,P=0.137)。结论在高龄患者中,选择性地采用微创双切口技术能取得相对满意的短期效果,但其远期疗效与改良Harding入路并无显著差异。 展开更多
关键词 双切口 改良Harding入路 全髋关节置换术 高龄患者
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全髋关节置换术患者结果期望及影响因素的研究
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作者 陈志霞 王素霞 +6 位作者 刘玉荣 潘景梅 陈世霞 祝宪庭 张华钰 贾玉臻 张晓丽 《中国疗养医学》 2024年第10期98-104,共7页
目的了解中国基层县市区域三级甲等综合医院住院患者全髋关节置换术(THA)术前结果期望,探讨相关影响因素,为医护人员临床决策提供依据。方法选取潍坊市某县级城市三级甲等综合医院2023年1月至2024年3月拟行髋关节置换的住院患者255例,术... 目的了解中国基层县市区域三级甲等综合医院住院患者全髋关节置换术(THA)术前结果期望,探讨相关影响因素,为医护人员临床决策提供依据。方法选取潍坊市某县级城市三级甲等综合医院2023年1月至2024年3月拟行髋关节置换的住院患者255例,术前1 d利用简体中文版《首次全髋关节置换术患者结果期望调查问卷》进行问卷调查,当场指导填写,当场回收后进行统计学分析。结果患者结果期望值总分为(61.62±5.81)分,均值(3.41±0.33)分,得分最高前5项依次为自己穿鞋袜(3.91±0.29)分、心理健康(3.87±0.34)分、减少药物应用(3.85±0.31)分、改善疼痛(3.81±0.39)分、摆脱辅助器械(3.80±0.40)分;相关性分析发现年龄、文化程度及照护者类型与期望值强相关(P<0.01);进一步回归分析发现,年龄是患者结果期望的主要影响因素(P<0.01)。结论THA患者术前对手术结果的期望较高,医护人员应根据患者的年龄、文化程度及照护者类型、手术原因制订个性化干预措施,优化患者的结果期望。 展开更多
关键词 全髋关节置换术 患者 结果期望 影响因素
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基于“三因制宜”理念的中医辨证护理在全髋关节置换术患者中的应用效果分析
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作者 褚俊链 郭容弟 《西部中医药》 2024年第3期126-130,共5页
目的:观察“三因制宜”理念的中医辨证护理在全髋关节置换术患者中的应用效果。方法:将88例全髋关节置换术(total hip arthroplasty,THA)患者按随机数字表法分为对照组和三因组各44例。对照组给予西医常规护理,三因组在对照组的基础上... 目的:观察“三因制宜”理念的中医辨证护理在全髋关节置换术患者中的应用效果。方法:将88例全髋关节置换术(total hip arthroplasty,THA)患者按随机数字表法分为对照组和三因组各44例。对照组给予西医常规护理,三因组在对照组的基础上给予“三因制宜”理念的中医辨证护理。观察两组患者术前及术后6天视觉模拟量表(visual analogue scale,VAS)和汉密尔顿焦虑量表(hamilton anxiety scale,HAMA)评分、术后7天炎症指标[白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factorα,TNF-α)]、术后5个月Harris髋关节评分、并发症及护理满意度。结果:术后6天两组患者VAS和HAMA评分均低于术前(P<0.05),三因组低于对照组(P<0.05);术后7天两组患者血清IL-6、TNF-α水平均高于术前(P<0.05),三因组低于对照组(P<0.05);术后5个月,三因组患者Harris髋关节疼痛评分低于对照组(P<0.05),活动度、功能评分均高于对照组(P<0.05),畸形评分与对照组比较差异无统计学意义(P>0.05);三因组患者并发症总发生率为2.27%(1/44),低于对照组的13.64%(6/44)(P<0.05);三因组患者总满意度为95.45%(42/44),高于对照组的79.55%(35/44)(P<0.05)。结论:基于“三因制宜”理念的中医辨证护理可有效缓解THA患者疼痛,抑制炎症反应、改善髋关节功能,降低术后并发症,提高护理满意度。 展开更多
关键词 全髋关节置换术 三因制宜 中医辨证护理 效果分析
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老年单侧全髋关节置换术围术期输血风险预测模型的构建 被引量:2
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作者 臧晗 胡嫒 +1 位作者 许轩奇 许力 《基础医学与临床》 2024年第1期98-102,共5页
目的分析老年单侧全髋关节置换术围术期输血危险因素并建立风险预测模型。方法回顾性收集于2013年1月至2021年10月在北京协和医院接受单侧初次全髋关节置换术的老年患者467例。将全部数据的70%划分为训练集,30%划分为测试集。根据是否... 目的分析老年单侧全髋关节置换术围术期输血危险因素并建立风险预测模型。方法回顾性收集于2013年1月至2021年10月在北京协和医院接受单侧初次全髋关节置换术的老年患者467例。将全部数据的70%划分为训练集,30%划分为测试集。根据是否接受围术期输血将训练集中的患者划分为输血组和非输血组。通过单因素与多因素Logistic回归分析患者的人口学特征、手术信息和术前实验室指标,识别围术期输血的危险因素,结合临床经验构建预测模型并绘制列线图。在测试集中使用受试者工作特征(ROC)曲线和校准曲线评估模型性能。结果在纳入的467例患者中,91例(19.5%)患者接受围术期输血。多因素Logistic回归分析显示合并冠心病、手术时间增加和术前低血红蛋白是围术期输血的危险因素(P<0.05)。根据统计分析结果与临床经验,纳入是否合并冠心病、手术时间、术前血红蛋白、年龄和是否美国麻醉医师协会(ASA)分级>Ⅱ级等因素构建预测模型,模型的受试者工作特征曲线下面积(AUC)为0.809。结论老年单侧全髋关节置换术围术期输血风险预测模型的表现良好,可以为临床工作提供帮助。 展开更多
关键词 围术期输血 全髋关节置换术 老年患者 输血风险预测
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老年全髋关节置换术后患者直立不耐受发生率及影响因素分析
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作者 薄士荣 苏萌萌 +1 位作者 薛婷 魏丽丽 《中国护理管理》 CSCD 北大核心 2024年第7期1003-1007,共5页
目的:调查老年全髋关节置换术后患者首次离床活动直立不耐受的发生率及影响因素,为临床实践提供参考。方法:采用便利抽样法,选取2022年6月至2023年3月某三级甲等医院关节外科接受住院治疗的65岁及以上的196名全髋关节置换术后患者,采用... 目的:调查老年全髋关节置换术后患者首次离床活动直立不耐受的发生率及影响因素,为临床实践提供参考。方法:采用便利抽样法,选取2022年6月至2023年3月某三级甲等医院关节外科接受住院治疗的65岁及以上的196名全髋关节置换术后患者,采用患者直立不耐受风险因素调查表、直立不耐受症状问卷、疼痛数字评分法及修订版跌倒效能量表对患者进行调查,分析直立不耐受影响因素。结果:42.4%的老年患者在术后出现直立不耐受症状,Logistic回归分析结果显示,跌倒效能、年龄、血红蛋白下降水平、体质量指数、疼痛数字评分、体位适应性训练是发生直立不耐受的危险因素。结论:全髋置换术后老年患者首次离床直立不耐受发生率较高。临床工作人员须重视老年全髋关节置换术后患者直立不耐受症状的发生,加强患者心理建设,并进行体位适应性训练,以帮助患者实现快速康复。 展开更多
关键词 全髋关节置换术 老年患者 直立不耐受 早期康复 影响因素
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静脉复合髋关节囊周围神经阻滞镇痛在全髋关节置换术中的应用效果
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作者 刘新 夏海禄 +3 位作者 崔静静 王建华 井郁陌 柳洁 《河北医药》 CAS 2024年第13期1994-1997,共4页
目的 探讨静脉复合髋关节囊周围神经阻滞镇痛在全髋关节置换术中的应用效果。方法 选取2023年1~8月行全髋关节置换术的患者50例,按数字随机表法分为对照组和观察组,每组25例。对照组给予静脉自控镇痛,观察组给予静脉复合髋关节囊周围神... 目的 探讨静脉复合髋关节囊周围神经阻滞镇痛在全髋关节置换术中的应用效果。方法 选取2023年1~8月行全髋关节置换术的患者50例,按数字随机表法分为对照组和观察组,每组25例。对照组给予静脉自控镇痛,观察组给予静脉复合髋关节囊周围神经阻滞镇痛。比较2组患者的镇痛效果、术后炎性反应、不良事件发生情况、术后康复质量。结果 观察组术后24、36、48 h时静息与运动状态下的视觉模拟评分法(VAS)评分均低于对照组(P<0.05);观察组术后24 h的肿瘤坏死因子α(TNF-α)、白介素-1β(IL-1β)、C-反应蛋白(CRP)水平低于对照组,差异有统计学意义(P<0.05);观察组不良事件发生率为4.00%低于对照组的28.00%,差异有统计学意义(P<0.05);观察组首次下床活动时间、住院时间短于对照组(P<0.05),且观察组术后4周恢复质量量表(QoR-15)、髋关节Harris评分高于对照组,差异有统计学意义(P<0.05)。结论 静脉复合髋关节囊周围神经阻滞镇痛用于全髋关节置换术中,可进一步提升镇痛效果,减少不良事件的发生,并降低术后炎性反应,提升术后康复质量。 展开更多
关键词 静脉自控镇痛 髋关节囊周围神经阻滞 全髋关节置换术 疼痛 康复
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老年股骨颈骨折患者初次行全髋关节置换术的近期疗效及影响因素分析 被引量:2
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作者 吴海洋 索欢 《中外医学研究》 2024年第8期121-125,共5页
目的:探讨老年股骨颈骨折患者初次行全髋关节置换术治疗的近期疗效及影响因素。方法:选取2020年9月—2022年3月海安市中医院骨科收治的80例首次全髋关节置换术患者为研究对象。观察术后6个月的手术疗效,分析影响近期疗效的相关因素。结... 目的:探讨老年股骨颈骨折患者初次行全髋关节置换术治疗的近期疗效及影响因素。方法:选取2020年9月—2022年3月海安市中医院骨科收治的80例首次全髋关节置换术患者为研究对象。观察术后6个月的手术疗效,分析影响近期疗效的相关因素。结果:首次全髋关节置换术后,64例老年患者Harris≥75分,优良率为80.00%(64/80)。术后1个月、3个月、6个月,患者Harris髋关节评分随时间延长而上升,且各维度不同时间点之间两两比较,差异有统计学意义(P<0.05)。疗效优良组合并糖尿病、ASA分级为Ⅰ级、Ⅱ级、手术至开始功能锻炼时间为9~12 h、微创入路、术后即刻双下肢长度差为1~10 mm、未合并并发症、术中出血量<300 mL患者占比高于疗效不良组,差异有统计学意义(P<0.05)。logistic回归分析显示,术后合并并发症、手术至开始功能锻炼时间短、术中出血量≥300 mL及术后即刻双下肢长度差大为老年全髋关节置换术后近期疗效的独立危险因素(P<0.05);微创入路为老年全髋关节置换术后近期疗效独立保护因素(P<0.05)。结论:老年全髋关节置换术患者术后的短期疗效受多种因素共同影响,术后适时开展功能锻炼,减少术中出血量及并发症,避免双下肢长度差过大,对于有条件的患者,优先选择微创入路。 展开更多
关键词 全髋关节置换术 老年患者 近期疗效 影响因素
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三种常见麻醉方式对全髋关节置换术的老年患者术后转归的影响 被引量:72
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作者 高翔 夏晓琼 +2 位作者 王亮 夏书江 査显忠 《临床麻醉学杂志》 CAS CSCD 北大核心 2018年第7期669-672,共4页
目的比较三种常见麻醉方式对全髋关节置换术的老年患者术后转归的影响。方法择期行单次全髋关节置换术的老年患者150例,男84例,女66例,年龄67~92岁,BMI 19.6~23.4kg/m2,ASAⅡ或Ⅲ级。随机分为三组:全身麻醉组(GA组),腰麻-连续硬膜外麻醉... 目的比较三种常见麻醉方式对全髋关节置换术的老年患者术后转归的影响。方法择期行单次全髋关节置换术的老年患者150例,男84例,女66例,年龄67~92岁,BMI 19.6~23.4kg/m2,ASAⅡ或Ⅲ级。随机分为三组:全身麻醉组(GA组),腰麻-连续硬膜外麻醉组(CSEA组),腰丛-坐骨神经阻滞组(PCSNB组),每组50例。GA组常规麻醉诱导:咪达唑仑0.05mg/kg、丙泊酚1~2mg/kg、舒芬太尼0.4~0.6μg/kg、罗库溴铵0.8~1.0mg/kg。插管后,持续静注丙泊酚6~8mg·kg-1·h-1。CSEA组在L2-3间隙穿刺,蛛网膜下腔注入1%罗哌卡因1.5ml+10%葡萄糖注射液0.2ml,硬膜外置管。PCSNB组在超声引导下于腰丛位置L3-4间隙注射0.375%罗哌卡因25ml,坐骨神经周围注射0.375%罗哌卡因20 ml。记录三组患者麻醉操作时间,术中出血量,术中补液量,手术时间。记录术后24h静脉自控镇痛(PCA)用药量,下床活动时间、术后住院时间。记录肺栓塞、肺炎、肾衰竭、心肌梗死、脑卒中、机械通气、术后7dPOCD等术后并发症情况。结果与GA组比较,CSEA组和PCSNB组麻醉操作时间明显延长(P<0.05),术中出血量明显减少(P<0.05),手术时间明显缩短(P<0.05),术后24hPCA用药量明显减少(P<0.05),下床活动时间和术后住院时间均明显缩短(P<0.05),术后肺炎和术后7dPOCD发生率明显降低(P<0.05)。CSEA组与PCSNB组各指标差异均无统计学意义。三组术后肾衰竭、心肌梗死、脑卒中和机械通气发生率差异无统计学意义。结论本研究为老年患者全髋关节置换术麻醉方式的比较。腰麻-连续硬膜外麻醉和腰丛-坐骨神经联合神经阻滞麻醉应用全髋关节置换术老年患者,可减少术中出血量,缩短手术时间,镇痛效果好,术后并发症发生率低,术后恢复快。虽然CSEA与PCSNB之间并无差异,PCSNB对于有椎管内麻醉禁忌证的患者更为适用。 展开更多
关键词 老年患者 全髋关节置换 术后转归
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全髋关节置换术后患者报告结局现状及影响因素分析 被引量:9
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作者 王艳琼 宁宁 +1 位作者 李佩芳 刘欢 《重庆医科大学学报》 CAS CSCD 北大核心 2018年第10期1399-1406,共8页
目的:了解全髋关节置换术患者术后3个月患者报告结局的现状并探讨其影响因素。方法:采用横断面调查,选取2016年5月至2016年10月行全髋关节置换术的患者。应用"髋关节功能障碍和骨性关节炎评分-简体中文版"等测量全髋关节置换... 目的:了解全髋关节置换术患者术后3个月患者报告结局的现状并探讨其影响因素。方法:采用横断面调查,选取2016年5月至2016年10月行全髋关节置换术的患者。应用"髋关节功能障碍和骨性关节炎评分-简体中文版"等测量全髋关节置换术后患者报告结局,并分析其个人因素、疾病相关因素以及术前期望等因素是否对其造成影响。Excel录入数据,SPSS19.0进行统计分析,选用t检验等行单因素分析,多元线性回归行多因素分析。结果:纳入全髋关节置换术后患者共326例,其术后3个月患者报告结局得分为(372.05±54.79)分;通过多元线性回归分析,发现:术后疗效满意度(β=58.837,95%CI=54.773~61.958,P=0.000)、年龄(β=-0.928,95%CI=-0.992~-0.575,P=0.000)、出院后依从性(β=9.749,95%CI=6.008~11.827,P=0.000)、术后是否有并发症(β=-13.968,95%CI=-17.211~-8.123,P=0.000)、出院时患者报告结局得分(β=0.174,95%CI=0.064~0.224,P=0.002)、出院后是否有非计划再入院(β=-27.514,95%CI=-37.446~-17.702,P=0.002)、术前疼痛评分(β=-1.506,95%CI=-2.368~-0.639,P=0.034)和术前期望康复时间(β=1.905,95%CI=1.257~3.347,P=0.036)是全髋关节置换术后患者报告结局的影响因素,回归方程决定系数R2=0.661。结论:应高度重视入院时疼痛程度重、高龄、术前期望值高、术后发生并发症、术后疗效不满意、术后存在非计划再入院以及出院时患者报告结局得分较低者,并加强住院期间有效干预及出院后延续性护理。 展开更多
关键词 患者报告结局 全髋关节 置换术 期望 满意度
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术前康复训练指导对老年髋关节置换术患者康复效果的影响 被引量:27
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作者 林俊 廖建玲 +2 位作者 杨芳梅 袁月环 李怡 《护士进修杂志》 2013年第19期1759-1760,共2页
目的探讨术前康复训练指导对老年髋关节置换术后患者康复效果的影响。方法随机将60例75岁以上老年髋关节置换术患者分为实验组和对照组,每组30例,实验组在常规治疗护理的基础上,术前实施康复训练指导,术后加强锻炼;对照组实施常规的术... 目的探讨术前康复训练指导对老年髋关节置换术后患者康复效果的影响。方法随机将60例75岁以上老年髋关节置换术患者分为实验组和对照组,每组30例,实验组在常规治疗护理的基础上,术前实施康复训练指导,术后加强锻炼;对照组实施常规的术后康复训练程序。住院当天、术后2周分别对两组患者进行临床康复效果评价。术后2周比较两组患者并发症的发生情况及对患者满意度进行比较。结果两组患者在住院当天髋关节Harris评分及ADL评分差异无显著意义(P>0.05),术后2周Harris评分、ADL评分及患者满意度比较,观察组较对照组明显上升,差异有显著意义(P<0.05)。术后第2周,实验组便秘的发生情况显著低于对照组,差异有显著意义(P<0.05)。结论对高龄髋关节置换术患者术前实施康复训练指导,可提高术后肢体康复训练的效率,降低并发症的发生,提高患者的满意度。 展开更多
关键词 康复训练 高龄患者 全髋关节置换术 康复
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右美托咪定与布托啡诺用于老年全髋关节置换术后自控镇痛效果的比较 被引量:20
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作者 杨帅 华丽 +2 位作者 王雄 王两忠 陈勇 《四川医学》 CAS 2017年第1期36-39,共4页
目的对右美托咪定和布托啡诺用于老年患者全髋关节置换术后自控镇痛的安全性和有效性进行比较。方法选择我院2015年2月至2016年3月期间择期行全髋关节置换术的患者60例,患者自愿要求实施术后镇痛,患者年龄65~85岁,美国麻醉医师协会分级... 目的对右美托咪定和布托啡诺用于老年患者全髋关节置换术后自控镇痛的安全性和有效性进行比较。方法选择我院2015年2月至2016年3月期间择期行全髋关节置换术的患者60例,患者自愿要求实施术后镇痛,患者年龄65~85岁,美国麻醉医师协会分级Ⅰ~Ⅱ级,随机分为两组(D组和B组),每组30例。D组患者术后镇痛采用右美托咪定1.5μg/kg+舒芬太尼1μg/kg+昂丹司琼0.3mg/kg加生理盐水至200m L;B组患者术后镇痛采用布托啡诺0.2mg/kg+舒芬太尼1μg/kg+昂丹司琼0.3kg/kg加生理盐水至200m L。观察两组患者术前和术后2h,4h,8h,12h,48h时无创血压情况、心率、视觉模拟评分(VAS评分)、Ramsay评分、布氏舒适评分(BCS)、PCIA有效按压次数、不良反应发生情况。结果 D组血流动力学较B组更为平稳,差异有统计学意义(P<0.05),D组各时间点VAS评分和BCS评分与B组比较无统计学意义(P>0.05),D组Ramsay评分优于B组,差异有统计学意义(P<0.05);两组患者术后48h PCIA按压次数差异有统计学意义(P<0.05);D组不良反应发生情况少于B组,差异有统计学意义(P<0.05)。结论右美托咪定用于老年患者全款置换术后镇痛的有效性优于布托啡诺,但不良反应尚需进一步研究。 展开更多
关键词 右美托咪定 布托啡诺 全髋置换术 自控镇痛
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麻仁丸配合腹部按摩在髋关节置换术后老年便秘患者中的应用 被引量:11
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作者 董文君 胡三莲 +1 位作者 钱燕 周玲 《现代临床护理》 2011年第8期48-49,共2页
目的探讨麻仁丸和腹部按摩在治疗髋关节置换术后老年便秘患者中的应用效果。方法选择行髋关节置换术后的老年便秘患者100例,随机分为对照组和观察组,每组各50例。两组均实施骨科常规护理,观察组在此基础上采用麻仁丸和腹部按摩进行治疗... 目的探讨麻仁丸和腹部按摩在治疗髋关节置换术后老年便秘患者中的应用效果。方法选择行髋关节置换术后的老年便秘患者100例,随机分为对照组和观察组,每组各50例。两组均实施骨科常规护理,观察组在此基础上采用麻仁丸和腹部按摩进行治疗。比较两组患者的粪便形状、排便困难、腹胀和排便不尽感情况的差异。结果观察组患者的排便困难、腹胀和排便不尽感改善情况优于对照组,两组比较,差异具有统计学意义(均P<0.05)。结论采用麻仁丸和腹部按摩联合治疗髋关节置换术后老年便秘患者,在治疗便秘的同时,还可缓解老年患者术后胃肠道反应,值得临床应用推广。 展开更多
关键词 髋关节置换术 老年患者 便秘 麻仁丸 按摩
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