摘要
目的探讨加速康复策略(ERAS)在肥胖患者全髋关节置换术的临床应用。方法选取于2013年6月至2016年5月于揭阳市人民医院骨外一科行全髋关节置换术的肥胖患者共58例,其中采用常规围手术期处理的共32例(A组),采用加速康复策略的肥胖患者26例(B组),比较两组患者术前和的术后血红蛋白(HGB)和白蛋白(ALB)、胃肠动力恢复时间、术后疼痛评分、恶心呕吐程度,术后首次下地进行锻炼时间和术后住院时间、并发症和术前术后3 d、1周和2周的髋关节Harris评分。分别采用t检验和卡方检验(或Fisher确切检验)通过SPSS 24.0软件进行统计分析。结果入院前两组患者的HGB和ALB比较差异无统计学意义(HGB:t=0.388,ALB:t=0.216,P>0.05),术前B组的HGB和ALB显著高于A组(HGB:t=5.512,ALB:t=3.025,P<0.05),而术后24 h、7 d中B组的HGB和ALB高于A组,差异具有统计学意义(24 h:HGB:t=7.246,ALB:t=5.538,P<0.05;7 d:HGB:t=2.331,ALB:t=2.296,P<0.05);B组的肠鸣音恢复时间(t=5.453)、肛门排气时间(t=4.897)、肛门排便时间(t=3.912)显著少于A组(P<0.05),术后24 h的B组的视觉模拟评分(VAS)评分显著低于A组(t=2.639,P<0.05),B组首次下地锻炼时间显著低于A组(t=7.939,P<0.05),B组术后住院时间显著低于A组(t=3.658,P<0.05),B组总并发症发生率显著低于A组(P<0.05)。结论 ERAS可以促进肥胖患者行THA的早期胃肠道功能恢复,减少首次下地锻炼和住院时间,减少术后相关并发症的发生。
Objective To study the application of enhanced recovery after surgery（ ERAS）strategy in obese patients who undergo total hip arthroplasty. Methods A total of 58 obese patients undergone total hip arthroplasty,including the conventional perioperative management group（ group A）and the accelerate rehabilitation strategy group（ group B）,were selected from June 2013 to May 2016 in our hospital. The comparisons of the two groups included preoperative and postoperative hemoglobin（ HGB） and albumin（ ALB）,gastrointestinal recovery time,postoperative pain score,the degree of nausea and vomiting,postoperative time for the first exercise,postoperative hospital stay-length and complications,the preoperative Harris hip score and the scores at the postoperative 3rdday,one week and two weeks. Chisquare test and t test were applied for statistical analysis by SPSS 14. 0. Results The HGB and ALB of the two groups at the time of admission showed no statistical difference（ HGB： t = 0. 388,ALB： t = 0. 216,P 0. 05）. The preoperative levels of HGB and ALB in group B were significantly higher than those of group A（ HGB： t = 5. 512,ALB： t = 3. 025,P 0. 05）. At the time of postoperative 24 h and the 7thday,HGB and ALB levels in group B were significant higher than those of group A（ 24 h： HGB： t = 7. 246,A LB： t = 5. 538,P 0. 05; 7 d： HGB： t = 2. 331,ALB： t = 2. 296,P 0. 05）. Group B had less bowel sound recovery time（ t = 5. 453）,anus exhaust time（ t = 4. 897）,and anus bowel movement time（ t =3. 912） than group A（ P 0. 05）. The postoperative visual analogue score of group B was significantly less than that of group A 24 h postoperation for（ t = 2. 639,P 0. 05）. The postoperative time for the first exercise in group B was significantly shorter than that of group A（ t = 7. 939,P 0. 05）. The postoperative hospital stay-length of group B was significantly shorter than that of group A（ t = 3. 658,P 0. 05）. The total complication rate of group B was significantly lower than that of group A（ P 0. 05）. Conclusion ERAS strategy can promote the early recovery of gastrointestinal function in the obese patients of THA,shorten the first exercise time and length of hospital stay,and reduce postoperative related complications.
出处
《中华关节外科杂志（电子版）》
CAS
2017年第4期23-28,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
康复
肥胖症
关节成形术
置换
髋
住院时间
手术后期间
Recovery of function
Obesity
Arthroplasty
replacement
hip
Length of stay
Postoperative period
