Effect of preoperative and postoperative intervention of ERAS on rehabilitation effect and quality of life in elderly patients after total knee arthroplasty
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摘要:
目的 探讨加速康复外科(ERAS)术前术后干预对老年全膝关节置换术后康复效果和生活质量的影响。 方法 选择蚌埠医学院第一附属医院2019年7月—2020年12月收治的行全膝关节置换术的老年患者42例作为研究对象，按照随机数字表法分为2组，每组21例，研究组给予ERAS干预，对照组常规治疗，观察2组患者康复效果和生活质量改善情况。 结果 术后12 h、48 h研究组患者VAS评分[(4.38±1.12)分，(2.71±1.09)分]明显少于对照组[(6.24±1.47)分，(5.87±2.10)分, 均P < 0.05]。术后2组患者膝关节活动度(ROM)逐渐增加，术后2周、1个月研究组患者ROM[(96.62±7.31)°，(117.83±4.29)°]明显高于对照组[(83.28±6.74)°，(108.27±5.28)°，均P < 0.05]。术后2组患者膝关节纽约特种外科医院(HSS)评分逐渐增加，术后1个月、6个月研究组评分[(65.84±7.73)分，(86.74±7.48)分]明显高于对照组[(55.28±6.13)分，(75.33±6.13)分, 均P < 0.05]。术后2周研究组患者物质生活、躯体功能、心理功能、社会功能和生活质量总评分均明显高于对照组(均P < 0.05)。研究组满意度为95.24%，明显高于对照组(61.90%，P < 0.05)。 结论 对全膝关节置换术老年患者实施ERAS干预，能够明显缩短住院时间，降低并发症发生率，有利于关节功能恢复。 Abstract:Objective To investigate the effect of preoperative and postoperative intervention of enhanced recovery after surgery (ERAS) on rehabilitation effect and quality of life in elderly patients after total knee arthroplasty (TKA). Methods Forty-two elderly patients who underwent TKA in the First Affiliated Hospital of Bengbu Medical College from July 2019 to December 2020 were divided into two groups according to random number table. The study group received intervention of ERAS, and the control group received routine nursing. The rehabilitation effect and quality of life of the two groups were observed. Results The VAS pain scores of the study group [(4.38±1.12) points, (2.71±1.09) points] were significantly lower than those of the control group [(6.24±1.47) points, (5.87±2.10) points] at 12 and 48 hours after operation (all P < 0.05). The range of motion (ROM) of the two groups increased gradually after operation, and the ROM of the study group [(96.62±7.31)°, (117.83±4.29)°] were significantly higher than that of the control group [(83.28±6.74)°, (108.27±5.28)°] at 2 weeks and 1 month after operation (all P < 0.05). The score of hospital for special surgery knee score (HSS) of patients in the two groups increased gradually after surgery, and the score of the study group [(65.84±7.73) points, (86.74±7.48) points] were significantly higher than that of the control group [(55.28±6.13) points, (75.33±6.13) points] at 1 month and 6 months after surgery (all P < 0.05). Two weeks after operation, the total scores of material life, physical function, psychological function, social function and quality of life in the study group were significantly higher than those in the control group (all P < 0.05). The satisfaction of the study group was 95.24%, which was significantly higher than that of the control group (61.90%, P < 0.05). Conclusion ERAS intervention in elderly patients after TKA can significantly shorten hospitalization time, reduce the incidence of complications, and promote the recovery of knee function. -
表 1 2组全膝关节置换术患者围手术期处理治疗措施
Table 1. Perioperative management of total knee arthroplasty patients in 2 groups
治疗措施 对照组 研究组 术前宣教 告知患者及家属麻醉风险、手术风险及可能的并发症 利用宣传册给患者及家属讲解手术过程、术后康复步骤，缓解患者紧张焦虑情绪，积极进行心理指导 术前准备 术前常规检查，控制血压和血糖；术前8 h禁食、4 h禁饮 除常规术前准备外，还进行术前营养支持、术后功能锻炼及助行器使用指导；对术前明显紧张的患者，疏导其紧张情绪，必要时予镇静药物 术中保温 术中控制手术室温为22~24 ℃ 术中予充气式保温毯保温；术中输血、输液予适当加温；术中巡回护士调节室温，控制在22~24 ℃ 术中镇痛 无 术中予罗哌卡因和氟比罗芬混合，在关节转换周围局部浸润麻醉镇痛 术后24 h功能锻炼 无 予患者持续被动运动器进行被动运动训练、间歇充气加压治疗、患者早期起身坐床和站立练习 术后1~3 d 拔除引流管，借助助行器下地行走练习 趾关节抗阻力练习，踝泵及下肢进行主动屈伸练习，借助助行器下地行走练习 
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表 2 2组全膝关节置换术患者VAS评分比较(x±s，分)
Table 2. Comparison of VAS scores between two groups of total knee arthroplasty patients(x±s, points)
组别 例数 术后12 h 术后48 h 术后1个月 F值 P值 研究组 21 4.38±1.12 2.71±1.09a 1.65±0.72a 22.981 ＜0.001 对照组 21 6.24±1.47 5.87±2.10 1.82±0.74ab 157.108 ＜0.001 t值 4.612 6.120 0.755 P值 ＜0.001 ＜0.001 0.455 注：与同组术后12 h比较，aP < 0.05；与同组术后48 h比较，bP < 0.05;重复测量方差分析结果显示交互作用F=42.558、P < 0.001，组间效应F=213.388、P < 0.001, 不同时间效应F=111.147、P < 0.001。
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表 3 2组全膝关节置换术患者ROM和HSS评分比较(x±s)
Table 3. Comparison of ROM and HSS scores between two groups of total knee arthroplasty patients(x±s)
组别 例数 ROM(°) F值 P值 HSS评分(分) F值 P值 术后2周 术后1个月 术后6个月 术后2周 术后1个月 术后6个月 研究组 21 96.62±7.31 117.83±4.29a 119.68±3.32a 194.424 ＜0.001 43.76±6.39 65.84±7.73c 86.74±7.48cd 245.151 ＜0.001 对照组 21 83.28±6.74 108.27±5.28a 118.49±3.19ab 296.231 ＜0.001 47.11±7.02 55.28±6.13c 75.33±6.13cd 138.228 ＜0.001 t值 6.148 6.440 1.184 1.617 4.905 5.407 P值 ＜0.001 ＜0.001 0.243 0.114 ＜0.001 ＜0.001 注：与同组术后2周比较，aP < 0.05, 与同组术后1个月比较，bP < 0.05；与同组术后2周比较，cP < 0.05, 与同组术后1个月比较，dP < 0.05。ROM重复测量方差分析显示交互作用F=1 955.676、P < 0.001，组别效应F=1 573.075、P < 0.001, 时间效应F=218.937、P < 0.001;HSS评分重复测量方差分析显示交互作用F=839.240、P < 0.001，组别效应F=1 529.176、P < 0.001, 时间效应F=189.232、P < 0.001。
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表 4 2组全膝关节置换术患者术后2周生活质量评分比较(x±s，分)
Table 4. Quality of life scores 2 weeks after total knee arthroplasty in 2 groups(x±s, points)
组别 例数 物质生活 躯体功能 心理功能 社会功能 总分 研究组 21 51.82±9.82 59.44±5.34 63.81±6.56 64.48±4.25 68.69±4.76 对照组 21 45.14±9.29 54.26±5.25 57.39±5.78 60.17±3.84 60.52±4.84 t值 2.276 3.170 3.365 3.448 5.515 P值 0.028 0.003 0.002 0.001 ＜0.001
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表 5 2组全膝关节置换术患者住院时间、满意度和并发症情况比较
Table 5. Two groups of patients with total knee arthroplasty, length of hospital stay, satisfaction and complications
组别 例数 住院时间(x±s，d) 满意度[例(%)] 并发症[例(%)] 研究组 21 6.83±1.24 20(95.24) 1(4.76) 对照组 21 12.09±2.61 13(61.90) 7(33.33) 统计量 8.342a 5.091b 3.860b P值 ＜0.001 0.024 0.045 注：a为t值，b为χ2值。
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