临床外科杂志 ›› 2018, Vol. 26 ›› Issue (12): 955-958.doi: 10.3969/j.issn.10056483.2018.12.020

• • 上一篇    下一篇

加速康复外科理念在人工全髋关节置换围手术期的临床应用

  

  1. 江苏省无锡市人民医院骨科
  • 出版日期:2018-12-20 发布日期:2018-12-20

The application of the concept of fast track surgery in the perioperative period of total hip arthroplasty

  • Online:2018-12-20 Published:2018-12-20

摘要: [摘要] 目的:探讨加速康复外科理念在人工全髋关节置换围手术期的临床应用。方法:行人工全髋关节置换术病人100例,根据围手术期干预方法不同分为观察组和对照组,每组各50例。对照组病人给予常规干预,观察组在对照组基础上采用加速康复干预模式。比较两组术中失血、输血情况,检测并比较两组病人手术前后髋关节状况、自理能力及血流变学水平,分析两组术后并发症发生情况及护理满意度。结果:与对照组比较,观察组病人护理满意度明显升高(P<0.05),术中总失血量、输血率、第1天血红蛋白降低值均显著降低(P<0.05),术后下床活动时间、术后住院时间显著缩短(P<0.05)。术后3个月两组病人日常活动能力与步态、关节活动、Harris总分均较术前显著升高,疼痛以及关节畸形得分较术前显著降低,视觉模拟评分量表(VAS)评分均较术前显著降低,Barthel指数均较术前显著升高,术后7天两组血浆中D二聚体水平均显著升高,两组间上述指标比较,差异有统计学意义(P<0.05)。术后7天观察组病人全血高切黏度、全血低切黏度、血沉以及血浆比黏度均较术前明显降低,低于对照组(P<0.05)。两组并发症发生率比较无明显差异(P>0.05)。结论:对行人工全髋关节置换术的病人给予加速康复外科干预模式,可提高病人髋关节功能和自理能力,加快血流速度,减轻疼痛。

关键词: 加速康复外科, 全髋关节置换术, 髋关节功能, 疼痛, 血流变学

Abstract: [Abstract] Objective:To investigate the application of the concept of fast track surgery in the perioperative period of total hip arthroplasty.Methods:100 cases of total hip arthroplasty in our hospital were retrospectively analyzed.The patients were divided into observation group and control group,50 cases in each group,according to the perioperative intervention measures.The control group received routine intervention,and the observation group adopted enhanced recovery after surgery intervention mode on the basis of the control group.The blood loss and blood transfusion were compared between the 2 groups.The hip joint function,pain and selfcare ability of the 2 groups were detected and compared before and 3 months after operation.The hemorrheology indexes of the 2 groups were detected and compared before and 7 d after operation.The incidence of postoperative complications and nursing satisfaction in the 2 groups were statistically analysed.Results:Compared with the control group,the nursing satisfaction of the observation group was significantly higher(P<0.05).The total blood loss,blood transfusion rate,the 1st d hemoglobin reduction of the observation group decreased significantly(P<0.05),the time of ambulation and the time of postoperative hospitalization of the observation group shortened significantly(P<0.05).The daily activity and gait,joint activity and Harris total scores of the 2 groups after 3 months operation were significantly higher than those before the operation,the scores of pain and joint deformity were significantly lower than those before operation,the score of Visual analogue scale(VAS)in the 2 groups after 3 months operation was significantly lower than that before the operation,the Barthel index was significantly higher than that before the operation,the plasma levels of Ddimer in 7d of the 2 group were significantly higher than those before the operation,there were significant differences between the two groups in the above indexes(P<0.05).The high viscosity of whole blood,low shear viscosity,blood sedimentation and plasma viscosity of the observation group after 7 d operation were significantly lower than those before the operation,and that were significantly lower than those in the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:The fast track surgery intervention model for patients with total hip arthroplasty can effectively improve hip joint function and selfcare ability,help to speed up the blood flow speed and reduce the pain of the body.

Key words: fast track surgery, total hip arthroplasty, hip joint function, pain, hemorheology

[1] 赵灏, 陈世宏, 黄旭平. 股骨近端防旋髓内钉治疗不稳定性老年股骨粗隆间骨折的临床分析[J]. 临床外科杂志, 2018, 26(12): 962-964.
[2] 刘二涛 徐皓 陈建梅等. 金属对金属大直径股骨头全髋关节置换术的临床应用及近期疗效观察 [J]. 临床外科杂志, 2013, 21(4): 294-296.
[3] 刘涛 徐皓 陈建梅. 全髋关节置换术治疗强直性脊柱炎髋关节强直 [J]. 临床外科杂志, 2013, 21(3): 221-223.
[4] 邱红根 杨振华 杨家英等 . Lichtenstein无张力修补术治疗腹股沟疝247例回顾性分析 [J]. 临床外科杂志, 2013, 21(2): 134-135.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 宫念樵. 器官捐献供肾质量评估[J]. 临床外科杂志, 2016, 24(10): 729 .
[2] 黄洪锋. 关注公民逝世后器官捐献肾移植受体围手术期感染的预防与处理[J]. 临床外科杂志, 2016, 24(10): 732 .
[3] 杨华;李新长;龙成美;等. 公民逝世后器官捐献供肾移植临床分析[J]. 临床外科杂志, 2016, 24(10): 747 .
[4] 张忠伟;刘扬;路明. 痔上黏膜环切术治疗直肠前突所致出口梗阻型便秘的疗效观察[J]. 临床外科杂志, 2016, 24(10): 774 .
[5] 陈绍站;许勇;李婧;等. 防旋股骨近端髓内针与股骨近端解剖锁定钢板治疗转子间骨折的疗效比较[J]. 临床外科杂志, 2016, 24(10): 787 .
[6] 周观金;彭昊;陈森. 全膝关节置换治疗膝关节炎术后早期镇痛的研究进展[J]. 临床外科杂志, 2016, 24(10): 804 .
[7] 贺长林;黎秋曦;刘锋;等. 腹腔镜阑尾切除术中转开腹及再手术的处理体会[J]. 临床外科杂志, 2016, 24(10): 802 .
[8] 金鑫;周鹏;赵文超;等. 肾脏混合性上皮间质肿瘤一例[J]. 临床外科杂志, 2016, 24(10): 785 .
[9] 涂儒鸿;黄昌明. 腹腔镜胃癌根治术淋巴结清扫技巧[J]. 临床外科杂志, 2016, 24(11): 809 .
[10] 曹志新. 基于膜解剖的胃癌D2手术[J]. 临床外科杂志, 2016, 24(11): 812 .