快速康复外科理念在全膝关节置换围术期的应用

目的 探讨快速康复外科理念(FTS)在全膝关节置换手术中的应用效果。方法 采用简单随机抽样的方法,选择2018年1月～2019年11月在我科行全膝关节置换手术160例患者,通过简单随数字表格方法分为干预组(n=80例)和对照组(n=80例),其中对照组患者予日常围手术期的护理措施,干预组的患者提供围手术期快速康复措施,比较两组的患膝关节活动角度、术后疼痛、膝关节HSS评分、住院天数、就医满意度。结果 干预组满意度(96.00%)明显低于对照组(91.38%),差异有统计学意义(P0.05);干预组疼痛VRS评分为(1.83±1.17)分,明显低于对照组的(3.70±1.35)分,差异有统计学意义(P0.05);干预组平均住院时间为(6.67±1.50)d,明显低于对照组的(9.83±2.48)d,差异有统计学意义(P0.05);术后1、3个月,干预组膝关节主动屈伸活动度分别为(106.4±10.7)°、(115.8±10.1)°,均明显高于对照组的(95.8±8.6)°、(101.8±9.7)°,差异有统计学意义(P0.05)。同时术后1、3个月,干预组HSS总评分为(69.7±5.0)分、(78.2±4.3)分,明显高于对照组的(59.5±6.7)分、(63.3±3.6)分,差异有统计学意义(P0.05)。结论 快速康复外科理念在全膝关节围手术期的应用,术前可增加患者信心,减少对于手术的恐惧,术后可缓解患者疼痛、焦虑等不适,增加膝关节主动活动度,促进患者生理心理的全面康复过程,提高了患者的就医体验满意度。

Application of fast track surgery concept in perioperative period of total knee arthroplasty

Objective To investigate the application effect of fast track surgery(FTS) concept on total knee arthroplasty.Methods A total of 160 patients who underwent total knee arthroplasty in our department from January 2018 to November 2019 were selected through simple random sampling method and divided into the intervention group(n=80) and the control group (n=80) through the simple random number table method.The patients in the control group were given routine perioperative nursing measures,while the patients in the intervention group were given perioperative FTS measures.The two groups were compared in terms of the range of motion (ROM) of affected knee joint,postoperative pain,the HSS scores of knee joint,hospitalization days and the satisfaction degree with medical treatment.Results The satisfaction degree of the intervention group(96.00%) was significantly higher than that of the control group(91.38%),and the difference was statistically significant(P<0.05).The VRS scores of the intervention group were(1.83±1.17),significantly lower than that of the control group(3.70±1.35),and the difference was statistically significant(P<0.05).The average hospitalization time of the intervention group was(6.67±1.50) d,significantly shorter than(9.83±2.48) d of the control group,and the difference was statistically significant (P<0.05).1 month and 3 months after operation,the active flexion and extension ranges of knee joint in the intervention group were respectively(106.4±10.7)° and(115.8±10.1)°,both significantly higher than(95.8±8.6)° and(101.8±9.7)° of the control group,and the differences were statistically significant(P<0.05).Meanwhile,the total HSS scores of the intervention group were respectively(69.7±5.0) and(78.2±4.3),significantly higher than(59.5±6.7) and(63.3±3.6) of the control group,and the differences were statistically significant(P<0.05).Conclusion The application of FTS concept in perioperative period of total knee arthroplasty can increase the patients''confidence and reduce their fear in operation before operation,and relieve the patients''discomfort feelings such as pain and anxiety,etc.,increase the active ROM of knee joint and promote the patients'' comprehensive rehabilitation process of physiology and psychology and improve the patients'' satisfaction with medical experience.