加速康复对初次全膝置换血栓形成的影响△

Effect of enhanced recovery after surgery on thrombosis in primary total knee replacement

摘要:

[目的] 探讨围术期加速康复（enhanced recovery after surgery, ERAS） 管理对初次全膝关节置换术（total knee arthro-plasty, TKA） 患者术后下肢深静脉血栓（deep vein thrombosis, DVT） 发生的影响。[方法] 回顾性分析本院关节外科2016 年7月—2018 年6 月行初次TKA 且有术前术后下肢血管彩超检查的307 例患者，根据医患沟通结果，分为ERAS 组88 例，常规组219 例。对比两组患者临床结果、凝血指标、超声检查结果。[结果] ERAS 组手术时间[(107.0±19.4) min vs (134.9±20.7) min, P＜0.001]、术后下地时间[(27.8±11.5) d vs (70.6±11.0) d, P＜0.001]、住院期间症状血栓[例, 无/小腿/全下肢/心肺: (86/2/0/0) vs (196/15/8/0), P=0.046]、确诊血栓事件发生率（9.1% vs 19.6%, P=0.025） 显著优于常规组。凝血指标方面，ERAS 组患者术后D-D [(3.2±1.7) mg/L vs (3.8±1.7) mg/L, P=0.008]、FIB [(4.9±1.9) g/L vs (5.6±2.3) g/L, P=0.011] 均显著低于常规组。超声检查住院期间ERAS 组患者血栓分布情况[无/肌间/小静脉/大静脉/肺动脉: (80/2/6/0/0) vs (176/10/20/13/0), P=0.045] 显著优于常规组。[结论] 围术期ERAS 管理能有效减少初次TKA 患者术后DVT 的发生，有助于血栓的预防

Abstract:

[Objective] To investigate the effects of enhanced recovery after surgery (ERAS) management on deep vein thrombosis(DVT) in total knee arthroplasty (TKA). [Methods] A retrospective study was done on 307 patients who received primary TKA and under-went preoperative and postoperative lower limb vascular ultrasonography in our hospital from July 2016 to June 2018. According to the doc-tor-patient discussion, 88 cases were divided into ERAS group, while other 219 cases were in the routine group. The clinical results, coagu-lation test and ultrasound consequence of the two groups were compared. [Results] The ERAS groups proved significantly superior to theroutine group in terms of operative time [(107.0±19.4) min vs (134.9±20.7) min, P＜0.001] and postoperative ambulation time [(27.8±11.5)days vs (70.6±11.0) days, P＜0.001], occurrence of symptomatic thrombosis during hospitalization [non/calf/whole lower limb/cardiopulmo-nary, (86/2/0/0) vs (196/15/8/0), P=0.046], and the incidence of confirmed thrombotic events (9.1% vs 19.6%, P=0.025). With regard to co-agulation assay, ERAS group were significantly lower than the routine group in postoperative D-D [(3.2±1.7) mg/L vs (3.8±1.7) mg/L, P=0.008] and FIB [(4.9±1.9) g/L vs (5.6±2.3) g/L, P=0.011]. Regarding to ultrasound, the ERAS was also significantly better than the routinegroup in distribution of thrombus [none/ intermuscular/ small vein/ large vein/ pulmonary artery, (80/2/6/0/0) vs (176/10/20/13/0), P=0.045]during hospitalization. [Conclusion] Perioperative ERAS management can effectively reduce the occurrence of DVT in primary TKA andcontribute to the prevention of thrombosis.