【摘要】：目的探索加速康復(fù)外科(ERAS)策略在肥胖患者全膝關(guān)節(jié)置換術(shù)的應(yīng)用方式及臨床效果。方法選取行單側(cè)全膝關(guān)節(jié)置換術(shù)的肥胖患者共76例,其中采用常規(guī)圍手術(shù)期處理的共43例(常規(guī)組),采用ERAS的肥胖患者共33例(ERAS組)。對(duì)比分析(1)兩組患者手術(shù)前、術(shù)后3、7、14 d的膝關(guān)節(jié)HSS評(píng)分及活動(dòng)度(ROM);(2)手術(shù)前后的血紅蛋白(Hb)和白蛋白(Alb)、胃腸動(dòng)力恢復(fù)時(shí)間和惡心嘔吐程度;(3)術(shù)后疼痛程度、術(shù)后住院時(shí)間以及術(shù)后并發(fā)癥。結(jié)果兩組患者入院時(shí)的Hb和Alb比較差異無統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)前ERAS組的Hb和Alb顯著高于常規(guī)組,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。而術(shù)后1、7 d時(shí)ERAS組Hb和Alb均顯著高于常規(guī)組(P0.01)。ERAS組的術(shù)后胃腸道功能恢復(fù)時(shí)間,包括腸鳴音恢復(fù)時(shí)間、肛門排氣時(shí)間、肛門排便時(shí)間均顯著少于常規(guī)組(P0.05)。ERAS組惡心程度為Ⅰ級(jí)和Ⅱ級(jí)的比例顯著高于常規(guī)組(P0.05)。術(shù)后各時(shí)間的VAS評(píng)分比較,ERAS組顯著低于常規(guī)組(P0.01),HSS評(píng)分ERAS組顯著高于常規(guī)組(P0.05),術(shù)后14 d ERAS組膝關(guān)節(jié)ROM顯著高于常規(guī)組(P0.01),ERAS組并發(fā)癥的發(fā)生率顯著低于常規(guī)組(P0.05)。結(jié)論ERAS加快肥胖患者全膝關(guān)節(jié)置換術(shù)術(shù)后早期胃腸道功能恢復(fù),減少術(shù)后疼痛和相關(guān)并發(fā)癥的發(fā)生,加快了膝關(guān)節(jié)功能的康復(fù)速度。
[Abstract]:Objective to explore the application and clinical effect of accelerated rehabilitation surgery (ERAS) strategy in total knee arthroplasty in obese patients. Methods A total of 76 obese patients undergoing unilateral total knee arthroplasty were selected, 43 of whom were treated with routine perioperative treatment (routine group) and 33 with ERAS (ERAS group). (1) the HSS score and (ROM); (_ 2 of knee joint before and after operation were compared between the two groups. The recovery time of gastrointestinal motility of hemoglobin (Hb) and albumin (Alb), before and after operation and the degree of nausea and vomiting were compared. (3) postoperative pain, postoperative hospital stay and postoperative complications. Results there was no significant difference in Hb and Alb between the two groups at admission (P0.05). The Hb and Alb of preoperative ERAS group were significantly higher than that of routine group (P0.01). On the 7th day after operation, Hb and Alb in ERAS group were significantly higher than those in routine group (P0.01). ERAS group). The anal defecation time was significantly lower than that in the routine group (P0.05). The proportion of nausea grade 鈪，

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