目的 探讨加速康复外科(enhanced recovery after surgery, ERAS)理念对骨科高龄单膝置换患者术后恢复效果的影响。方法 选取2016-03至2017-08医院骨科行单膝置换术治疗的120例高龄患者,按随机数字表法将入选患者分为对照组与观察组,每组60例,对照组进行常规的围术期管理,观察组在对照组的基础上采用股神经置管术后镇痛等ERAS理念进行围术期管理,比较两组术后1、6个月关节恢复情况、并发症及患者的满意度等相关指标。结果 观察组在术后1、6个月关节恢复程度均优于对照组,差异均有统计学意义(P<0.05);观察组术后24 h VAS评分、术后首次进食时间、拔尿管时间、住院时间与对照组比较,均有统计学意义;观察组术后谵妄等相关并发症的总发生率较对照组低,差异具有统计学意义(χ2=9.356,P=0.015);观察组术中补液量、术中出血量、鼻咽温度及术中芬太尼用量均优于对照组,差异有统计学意义(P<0.05)。结论 ERAS理念可以提高骨科高龄单膝置换患者术后恢复的应用效果显著,可促进患者术后关节恢复进程,减少患者住院时间和并发症发生率。
Abstract
Objective To explore the effect of enhanced recovery after surgery (ERAS) on postoperative recovery of elderly patients with single knee replacement.Methods One hundred and twenty elderly patients undergoing single knee replacement surgery in our department between March 2016 and August 2017 were randomly divided into the control group and observation group, with 60 cases in each. The control group was given routine nursing, while the observation group was additionally given ERAS nursing. The postoperative recovery, complications and patient satisfaction were observed and compared between the two groups.Results Joint recovery in the observation group at 1 month and 6 months after operation was better than that in the control group, and the difference was statistically significant. The VAS pain score of the observation group after 24 h was significantly lower than that of the control group. The patients in the observation group had their first diet, had their urinary catheters removed and were discharged earlier than those in the control group, and the difference was statistically significant. The incidence of postoperative complications in the observation group was lower than that in the control group, and the difference was statistically significant (χ2=9.356,P=0.015). The intraoperative fluid infusion volume, intraoperative blood loss, nasopharyngeal temperature and intraoperative fentanyl dosage in the observation group compared favorably with the control group, and the difference was statistically significant (P<0.05).Conclusion The application of ERAS to elderly patients with single knee replacement can promote their postoperative recovery, shorten their hospital stay and reduce the incidence of complications.
关键词
加速康复外科 /
单膝置换术 /
高龄患者 /
神经阻滞 /
股神经置管
Key words
enhanced recovery after surgery /
single knee replacement /
elderly patients /
nerve block /
femoral nerve catheterization
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基金
河北省衡水市科技计划项目(2017014036Z)
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