加速康复外科理念在高龄髋部骨折围术期的应用效果

目的探讨加速康复外科(ERAS)理念在高龄髋部骨折患者围术期应用的临床效果。方法回顾性分析2013年7月至2016年10月,上海中医药大学附属普陀医院接受手术的高龄(年龄≥75岁)髋部骨折患者149例,男62例,女87例,年龄(82±5)岁。分别采用加速康复外科组及传统处理模式组进行围手术期处理。分析两组患者术后住院时间、疼痛视觉模拟评分(VAS)评分、术后并发症发生情况、髋关节Harris评分并进行对比。结果149例患者均成功获得随访,随访时间(16.0±2.3)个月。男62例,女87例,平均年龄(82±5)岁。加速康复外科组患者术后住院时间为(7.2±1.2)d,少于传统处理模式组术后住院时间[(12.1±1.9)d,t=2.513,P<0.05]。术后24 h及48 h,加速康复外科组VAS评分与传统处理模式组比较,差异无统计学意义(t=1.761,t=1.598;均P>0.05)。术后12 h及72 h,加速康复外科组VAS评分为(2.5±1.3)分、(1.2±0.8)分,低于传统处理模式组[(3.9±1.6)分、(2.7±1.5)分,t=2.379,t=2.165;均P<0.05]。加速康复外科组术后精神异常以及恶心呕吐发生率(6.4%及9.0%)低于传统处理模式组(23.9%及29.6%,χ^(2)=9.079,χ^(2)=10.339;均P<0.05)。肺部感染、下肢深静脉血栓、脑血管意外、尿路感染、褥疮发生率差异无统计学意义(χ^(2)=1.665,χ^(2)=1.232,χ^(2)=0.444,χ^(2)=2.170及χ^(2)=1.091;均P>0.05)。术后1 w,加速康复外科组Harris评分为(63.2±4.8)分,高于传统处理模式组[(49.2±3.9)分,t=2.221,P<0.05],术后3、6及12个月,两组Harris评分差异无统计学意义(t=1.187,t=1.098,t=0.813,均P>0.05)。结论高龄髋部骨折患者围手术期应用加速康复外科理念安全有效,可以减少术后精神异常以及恶心呕吐发生率,加速患者术后早期髋关节功能恢复,缩短术后住院时间,值得临床推广应用。

Enhanced recovery after surgery for elderly patients with hip fracture during the perioperative period

ObjectiveTo evaluate the clinical effects of enhanced recovery after surgery (ERAS) forelderly patients with hip fracture during the perioperative period. Methods149 elderly patients (≥75 years old) with hip fracture who underwentsurgery were analyzed retrospectivelyfrom July 2013 to October 2016 in Putuo Hospital affiliated to Shanghai University of Chinese Medicine. There were 62 males and 87 females with mean age of 82±5 years. All patients were divided into ERAS group (78 cases) and conventional care group (71 cases) during the perioperative period. The length of postoperative hospital stay, Visualanalogyscore (VAS), postoperative complications and Harris hip score of the two groups were analyzed and compared. ResultsAll 149 patients werefollowed up with an average of 1 (6.0±2.3) months. The length of postoperative hospital stay was (7.2±1.2) day in ERAS group and (12.1±1.9) day in conventional care group, (t=2.513, P<0.05). Therewasno significant difference in VAS score between the two groups at 24 h and 48 h after surgery (t=1.761, t=1.598, P>0.05). VAS score of ERAS group at 12 h and 72 h after surgery (2.5±1.3 and 1.2±0.8) was significantly lower than that of conventional care group (3.9±1.6 and 2.7±1.5)(t=2.379, t=2.165, P<0.05)]. Postoperative complication rates of mental disorder andincidence of nausea and vomiting in ERAS group (6.4% and 9.0% respectively) were significantly lower than conventional care group (23.9% and 29.6%) (χ²=9.079, χ²=10.339, P<0.05). There were no significant differences in the rates of pneumonia, DVT, cerebrovascular accident, urinary tract infection and bedsore between two groups (χ²=1.665, χ²=1.232, χ²=0.444, χ²=2.170, χ²=1.091, P>0.05). Harris hip score of ERAS group (63.2±4.8) was significantly higher than than conventional care group (49.2±3.9) (t=2.221, P<0.05) at 1 week after surgery. There was no significant difference in Harris hip score between the two groups at 3 months, 6 months and 12 months after surgery (t=1.187, t=1.098, t=0.813, P>0.05). ConclusionsThe application of ERAS program for elderly patients with hip fracture during the perioperative period can reduce the complication rates of mental disorder and the incidence of nausea and vomiting, accelerate the recovery of the early postoperative hip function and shorten the length of postoperative hospital stay.