止血带联合鸡尾酒对全膝关节置换的术后快速康复过程的影响

目的探讨止血带联合鸡尾酒在全膝关节置换的术后快速康复过程中的影响。方法选择全膝关节置换术手术200例患者,按照是否半程使用止血带联合鸡尾酒法分为观察组和对照组,各100例。比较两组患者围手术期情况、以及术后疼痛视觉模拟评分法(VAS)评分、膝关节特种外科医院(HSS)评分和下肢活动度(ROM)测量值,以及股四头肌肌力、大腿肿胀率指标变化。结果观察组术中可见失血量高于对照组,止血带时长低于对照组,差异均有统计学意义(t分别=16.29、-17.23,P均<0.05)。两组在总失血量、手术时长、术后住院天数、术后康复满意度以及并发症的比较,差异均无统计学意义(t分别=1.74、1.89、1.84、1.08,χ~2=1.85,P均>0.05)。与术前比较,两组患者术后3 d的VAS评分较术前降低,HSS评分、ROM值较术前增高(t分别=-19.20、-23.05、29.39、13.90、13.61、23.05,P均<0.05)。术后3 d,观察组患者VAS评分低于对照组,HSS评分和ROM值均高于对照组(t分别=-4.55、18.26、18.25,P均<0.05)。观察组术后3 d的股四头肌力高于对照组,大腿肿胀率低于对照组(t分别=14.65、-16.21,P均<0.05)。结论在全膝关节置换术患者的快速康复过程中,半程用止血带联合鸡尾酒有明显的促进作用,能缩短患者预后恢复时间,提高满意程度。

Effect of tourniquet combined with cocktail in the rapid recovery after total knee arthroplasty

Objective To investigate the effect of tourniquet combined with cocktail in the rapid recovery after total knee arthroplasty.Methods A total of 200 patients undergoing total knee arthroplasty were selected and divided into observation group and control group with 100 cases in each according to whether to use tourniquet and cocktail method or not.The perioperative conditions,postoperative visual analogue scale(VAS)score,knee HSS function score and lower limb range of motion(ROM),quadriceps muscle strength,and thigh swelling rate were compared.Results The intraoperative blood loss of the observation group was more than that of the control group,and the tourniquet duration was shorter than that of the control group(t=16.29,-17.23,P<0.05).There was no statistically significant difference between the two groups in total blood loss,operation time,postoperative hospital stay,postoperative rehabilitation satisfaction,and complications(t=1.74,1.89,1.84,1.08,χ2=1.85,P>0.05).Compared with preoperation,the VAS scores at 3 days after operation of the two groups were lower,while HSS scores and ROM values were higher(t=-19.20,-23.05,29.39,13.90,13.61,23.05,P<0.05).Three days after operation,the VAS score of the observation group was lower than that of the control group,and the Hss score and ROM value were higher than those of the control group(t=-4.55,18.26,18.25,P<0.05).Three days after operation,the quadriceps muscle strength of the observation group was higher than that of the control group,and the thigh swelling rate was lower than that of the control group(t=14.65,-16.21,P<0.05).Conclusion During the rapid recovery of total knee arthroplasty,tourniquet combined with cocktail has a significant promoting effect,which can shorten the patient's prognostic recovery time and improve the degree of satisfaction.