全膝关节置换一体化加速康复的短期研究△

A short-term study of integrated enhanced recovery after surgery in total knee arthroplasty

摘要:

[目的]探讨类风湿性关节炎患者全膝关节置换(total knee arthroplasty, TKA)围术期应用“医护康”一体化加速康复外科 (enhanced recovery after surgery, ERAS) 方案的意义。[方法] 2019 年 11 月—2021 年 9 月对 84 例类风湿性关节炎患者行 TKA，采用随机数字表法分为两组。42 例采用 ERAS，另外 42 例采用常规处理。比较两组早期临床和检验指标。[结果] ERAS 组术后首次下床时间和住院时间均显著优于常规组 (P＜0.05)。ERAS 组术后 2、6 周和 6 个月的 HSS 评分优于常规组 (P＜0.05)，术后 2 周和 6 周的 VAS 评分优于常规组(P＜0.05)。检验方面，ERAS 组术后 1 和 3 d 的 D-D、FIB、ESR 和 CRP 均显著低于常规组 (P＜0.05)。[结论]“医护康”一体化 ERAS 方案运用于 RA 患者 TKA 围手术期，可以显著缓解围术期疼痛， 加快膝关节的功能恢复，改善临床凝血和炎症指标，缩短住院时间。

Abstract:

[Objective] To evaluate the significance of enhanced recovery after surgery (ERAS) applied by a team integrated with sur- geon, nurse and rehabilitator in perioperative period of total knee arthroplasty (TKA) for rheumatoid arthritis. [Methods] From November 2019 to September 2021, 84 patients received TKA for rheumatoid arthritis, and were divided into two groups by random number table method. The ERAS was used in 42 cases, while conventional treatment was used in the other 42 cases. The early clinical and laboratory da- ta were compared between the two groups. [Results] The ERAS group prove sifnificanlty superior to the conventional group in terms of the time of getting out of bed and hospital stay (P<0.001) . The ERAS group was significantly superior to the conventional group in terms of HSS scores at 2 weeks, 6 weeks and 6 months after surgery (P<0.05) , VAS scores at 2 and 6 weeks postoperatively (P<0.05) . In terms of blood testing, the ERAS group had significantly lower levels of D-D, FIB, ESR and CRP at 1 and 3 days postoperatively. [Conclusion] The integrated ERAS does significantly relieve perioperative pain, accelerate knee functional recovery, improve clinical coagulation and inflam- mation markers, and shorten hospitalization time in TKA for rheumatoid arthritis.