术前戒烟对全髋关节置换术后并发症影响的随机对照试验

目的探讨术前戒烟对全髋关节置换术后并发症的影响。方法对择期全髋关节置换术吸烟患者,采用区组随机法分为戒烟组和对照组。戒烟组患者于手术前4周接受戒烟,给予患者戒烟辅导和尼古丁替代疗法,使患者戒烟或吸烟量减少至少50%;对照组患者接受标准治疗,很少或根本未接受到吸烟的风险信息或戒烟辅导。两组患者均按医院常规接受腰硬联合麻醉或全麻。采用双盲法记录两组患者心、肺、肾和神经并发症的例数,住院天数和住ICU天数。采用SPSS 13.0软件进行统计分析。结果共纳入120例患者,每组各60例,均为男性,年龄65~82岁,体重42~75 kg,ASAⅠ~Ⅲ级。最终戒烟组56例、对照组57例患者完成研究。结果显示:戒烟组术后并发症发生率(12/56 vs.39/57,P=0.000)、术后伤口相关并发症发生率(3/56 vs.21/57,P=0.000)、切口感染发生率(1/56 vs.13/57,P=0.001)、需二次手术者(1/56 vs.9/57,P=0.022)和伤口清创者(1/56 vs.8/57,P=0.040)均明显少于对照组。此外,戒烟组患者骨外科中位住院天数也明显少于对照组(14天vs.26天,P=0.000)。结论手术前4周戒烟可有效减少全髋关节置换术后并发症的发生率。

Effect of Preoperative Smoking Intervention on Postoperative Complications of Total Hip Replacement

ObjectiveTo investigate the effect of preoperative smoking intervention on the incidence of postoperative complication in patients undergoing total hip replacement. MethodsPatients undergoing elective total hip replacement were randomly （block randomization） assigned to either smoking intervention group or control group 4 weeks before scheduled hip replacement. Smoking intervention group received counseling and nicotine replacement therapy and achieved smoking cessation or at least 50% smoking reduction while the control group received standard care with little or no information about the risk of smoking or smoking cessation counselling. Anesthesia was done in accordance with the practice of our hospital with either general anesthesia or combined spinal-epidural anesthesia （CSEA）. An assessor who was masked to the intervention recorded the incidence of cardiopulmonary, renal, neurological, or surgical complications and duration of hospital admittance and treatment in intensive care unit （ICU） of two groups of patients. ResultsA total of 120 patients were finally included （60 cases were in each group, all male, ASA Ⅰ-Ⅲ, aged 65-82 years, weighting 42-75 kg）. A total of 56 patients in the smoking intervention group and 57 in the control group were analyzed finally. The results showed that, the smoking intervention group was lower than the control group in the incidences of post-operative complications （12/56 vs. 39/57, P=0.000）, postoperative wound-related complications （3/56 vs. 21/57, P=0.000）, incision infection （1/56 vs. 13/57, P=0.001）, and the requirement of secondary surgery （1/56 vs. 9/57, P=0.022） and wound debridement （1/56 vs. 8/57, P=0.040）. The median length of stay in the smoking intervention group was significantly less than that of the control group （14 days vs. 26 days, P=0.000）. ConclusionAn effective smoking intervention 4 weeks before surgery reduces incidence of postoperative complications.