目的 通过回顾性分析接受单髁关节置换术(UKA)患者日间手术模式和常规住院模式围手术期管理及早期转归,探讨关节置换日间手术模式的可行性。方法 选取解放军总医院第四医学中心2023-05至2024-09在全身麻醉下接受UKA日间手术患者为日间手术组,依据患者性别、年龄等信息,按照1∶3的比例匹配同时段住院全麻UKA患者为常规手术组。记录患者基本情况,比较两组围手术期麻醉管理、住院时长、住院费用、术后并发症及再入院率等信息。结果 共纳入224例(日间手术组56例,常规手术组168例),两组患者基本情况、ASA分级及术前合并症比较,差异无统计学意义(P>0.05);术中患者平均动脉压、心率、麻醉药物消耗量、出入量及手术时间,组间比较亦无统计学差异(P>0.05);与常规手术组相比,日间手术组患者术前收肌管阻滞率明显较高(71.4% vs. 36.9%,P＜ 0.05);术后患者静息及运动VAS评分、不良反应及再入院率,无统计学差异(P>0.05);日间手术组患者平均住院时间为(2.36±1.51)d,常规手术组则为(7.14±2.07)d,差异有统计学意义(P＜ 0.05);患者住院费用[(3.01±0.76)万元 vs. (3.85±1.21)万元]比较,差异亦有统计学意义(P＜ 0.05)。结论 采用喉罩全身麻醉结合术前收肌管阻滞UKA患者的日间手术模式安全可行。
Abstract
Objective To investigate the feasibility of the day surgery model of joint replacement by retrospectively analyzing the perioperative management and early regression of patients undergoing unicompartmental knee arthroplasty(UKA) in the day surgery model and the conventional inpatient model. Methods Patients receiving UKA day surgery under general anesthesia in the Fourth Medical Center of PLA General Hospital from May 2023 to September 2024 were selected as the day surgery group. Based on the patients' gender, age and other information, they were matched with concurrent hospitalized general anesthesia UKA patients according to 1:3 as the conventional surgery group. The basic condition of the patients, perioperative anesthesia management, length of stay, hospitalization cost, postoperative complications, and readmission rate were compared between the two groups. Results A total of 224 cases were included (56 cases in the day surgery group and 168 cases in the conventional surgery group). There were no statistically significant differences in the basic condition of the patients, ASA classification, or preoperative comorbidities between the groups (P>0.05); there were also no statistically significant differences in the intraoperative patients' mean arterial pressure, heart rate, anesthesia drug consumption, intraoperative fluid balance, or operative time between the groups (P>0.05); the patients in the day surgery group had significantly higher rates of preoperative retractile myotubular compared with the conventional surgery group, the preoperative retractor tube block rate was significantly higher in the day surgery group (71.4% vs. 36.9%, P＜0.05); there were no statistically significant differences in the postoperative patients' resting and exercise VAS scores, adverse reactions, or readmission rates (P>0.05); and the average hospital stay was (2.36±1.51)d in the day surgery group compared with (7.14±2.07)d in the conventional surgery group, with statistically significant difference (P＜0.05). There was statistically significant difference in the hospitalization cost [(30 100±7600)yuan vs.(38 500±12 100)yuan, P＜0.05)]. Conclusions The use of laryngeal mask general anesthesia combined with preoperative retractor tube block in patients undergoing unicompartmental arthroplasty is a safe and feasible mode of day surgery.
关键词
日间手术 /
单髁关节置换术 /
围手术期管理 /
可行性
Key words
day surgery /
unicompartmental knee arthroplasty /
perioperative management /
feasibility
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