快速康复外科理念在全膝关节置换术围手术期的应用

目的 评价快速康复外科理念下的多模式镇痛对全膝关节置换术围手术期疼痛和功能恢复的影响。 方法 选取2018年1—12月苏州大学附属第二医院行全膝关节置换术患者200例,将单月手术患者100例设为对照组,行常规围手术期护理;双月手术患者100例设为观察组,行基于快速康复外科理念的多模式镇痛护理,包括术前宣教及疼痛评估、术后疼痛评估、药物镇痛及观察、早期进食、早期锻炼等措施。具有康复专业知识的护士于床边指导协助并采集数据,比较2组患者术后不同时段的疼痛程度、首次单独直腿抬高时间、下床活动时间、关节屈曲度及膝关节功能评分(HSS评分)。 结果 观察组术后回室时、6 h、12 h、24 h和48 h疼痛程度明显小于对照组,首次单独直腿抬高平均时间、下床活动平均时间观察组分别为26.5(22.5,36.0)h和38.0(24.0,49.0)h,早于对照组的49.0(31.0,58.0)h和75.0(48.0,87.0)h。观察组术后第3天、第5天关节屈曲度分别为83.0(65.0,98.0)°和92.0(83.0,107.0)°,明显高于对照组的70.0(45.0,95.0)°和81.0(64.0,102.0)°。观察组术后1、3个月HSS评分分别为86.0(73.0,91.0)分和75.0(68.0,82.0)分,明显高于对照组术后1、3月评分67.5(60.5,71.0)分和74.0(66.5,80.0)分。 结论 基于快速康复外科理念的多模式镇痛可以明显降低全膝关节置换术患者术后疼痛程度,提升功能恢复的效果。 

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

Objective To evaluate the effect of multi-modal analgesic on pain and functional exercise results of patients undergone Total Knee Arthroplasty (TKA) based on the fast track surgery (FTS). Methods Two hundred patients who undergone TKA from January to December 2018 were selected in Department of Joint Surgery. Patients included in odd-numbered months were assigned as the controlled group for routine perioperative nursing and patients included in double-numbered months were assigned to the observation group for multi-modal analgesia based on FTS, including preoperative propaganda and pain assessment, post-operative pain assessment, drug analgesia and observation, early eating, early exercise and other measures. Professional rehabilitation nurses guided and assisted by bedside and collected data. The pain degree (VAS score), the first time of straight-leg raising, the time of getting out of bed, ranges of joint flexion and HSS score were compared between the two groups. Results The VAS scores of the observation group at the time of returning to the room, 6 hours, 12 hours, 24 hours and 48 hours after operation were significantly lower than that of the controlled group. For the first time, the average time of straight leg elevation and the average time of getting out of bed activity in the observation group were 26.5(22.5,36.0)h and 38.0(24.0,49.0)h, respectively, earlier than those in the control group 49.0(31.0,58.0)h and 75.0(48.0,87.0)h. On the 3rd and 5th day after operation, the joint flexion degrees of the observation group were 83.0(65.0,98.0) degrees and 92.0(83.0,107.0) degrees, respectively, which were significantly higher than those of the control group 70.0(45.0,95.0) degrees and 81.0(64.0,102.0) degrees. The HSS scores of the observation group in 1 and 3 months after operation were 86.0(73.0,91.0) and 75.0(68.0,82.0), respectively, which were significantly higher than those of the control group in 1 and 3 months after operation 67.5(60.5,71.0) and 74.0(66.5,80.0). Conclusion Multi-modal analgesic nursing based on the concept of FTS can significantly reduce the degree of pain after total knee arthroplasty and improve the effect of functional exercise.