老年全髋关节置换术患者实施加速康复外科麻醉管理措施的临床研究

张嘉; 杨保仲; 管晓东

doi:10.16766/j.cnki.issn.1674-4152.002812

老年全髋关节置换术患者实施加速康复外科麻醉管理措施的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.002812

张嘉^{1, 2},
杨保仲^1, ,,
管晓东³

1.
山西医科大学麻醉学院, 山西太原 030600
2.
运城市中心医院麻醉科, 山西运城 044000
3.
运城市中心医院泌尿外科

基金项目:

山西省2020年“四个一批”科技兴医创新计划项目 2020TD22

详细信息

通讯作者:
杨保仲, E-mail: 362000311@qq.com

中图分类号: R687.4 R614.2
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- 文章访问数: 301
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- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2022-07-22
- 网络出版日期: 2023-04-07

Implementation of ERAS anaesthesia management measures in elderly patients undergoing total hip replacement

1.
College of Anesthesiology, Shanxi Medical University, Taiyuan, Shanxi 030600, China

摘要

摘要: 目的观察在老年全髋关节置换术围手术期实施加速康复外科(ERAS)麻醉管理相关措施的临床效果。方法选择2019年10月—2021年10月于运城市中心医院择期行全髋关节置换术的120例老年患者为研究对象，采用随机数字表法分为对照组(60例)和研究组(60例)。对照组在全身麻醉下行全髋关节置换术，研究组实施ERAS麻醉管理措施。记录手术及麻醉后恢复指标，比较术后VAS评分及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、去甲肾上腺素(NE)和皮质醇(Cor)等炎症及应激因子水平变化，统计术后48 h内补救镇痛次数及镇痛药物不良反应，观察住院期间并发症情况。结果研究组术中出血量[(1 022.86±26.74)mL]显著少于对照组[(1 350.41±28.29)mL, t=65.177，P＜0.001]，术后自主呼吸恢复时间、麻醉苏醒时间、拔管时间、术后首次排气时间、术后下床时间和住院时间均少于对照组(均P＜0.05)。研究组术后12、24、36 h和48 h的VAS评分均低于对照组(均P＜0.05)。术后24 h和48 h，研究组患者血清TNF-α、IL-6、NE和Cor均低于对照组(均P＜0.05)。研究组补救镇痛、镇痛药物不良反应和术后并发症发生率均低于对照组(均P＜0.05)。结论 ERAS麻醉管理模式可有效降低老年全髋关节置换术手术创伤，抑制应激及炎症反应，缓解疼痛反应，缩短康复周期，降低药物不良反应及并发症风险。
- 加速康复外科 /
- 全髋关节置换术 /
- 麻醉管理 /
- 术后康复 /
- 临床效果
Abstract: Objective This study aimed to observe the clinical effect of enhanced recovery after surgery (ERAS) anaesthesia management in the perioperative period of total hip arthroplasty in the elderly patients. Methods A total of 120 elderly patients who underwent elective total hip arthroplasty in Yuncheng Central Hospital from October 2019 to October 2021 were selected as the study subjects. They were randomly divided into the control group (60 cases) and study group (60 cases). The control group performed total hip arthroplasty under general anaesthesia, and the study group performed ERAS anaesthesia management measures. The control group received total hip arthroplasty under general anaesthesia, and the study group received ERAS anaesthesia management measures. The recovery indexes after operation and anaesthesia was recorded. The changes in VAS score and contents of serum inflammatory and stress factors such as tumor necrosis factor-α (TNF-α), inflammatory factors interleukin-6 (IL-6), norepinephrine (NE) and cortisol (Cor) were compared within 48 h after operation. The number of remedial analgesia and adverse reactions of analgesic drugs within 48 h after operation were counted, and the complications during hospitalisation were observed. Results The intraoperative bleeding volume in the study group [(1 022.86±26.74) mL] was less than that in control group [(1 350.41±28.29) mL, t=65.177, P < 0.001]. The recovery time of postoperative spontaneous breathing, anaesthesia awakening time, extubation time, postoperative first exhaust time, postoperative ambulation time and hospitalization time of the study group were shorter than those of the control group (all P < 0.05). The VAS scores of the study group were lower than those of the control group at 12, 24, 36 and 48 h after operation (all P < 0.05). At 24 and 48 h after operation, the content of serum TNF-α, IL-6, NE and Cor in the study group was lower than that in the control group (all P < 0.05). The rate of remedial analgesia, adverse reaction of analgesic drugs and postoperative complications in the study group was significantly lower than that in the control group (all P < 0.05). Conclusion ERAS anaesthesia management mode can effectively reduce the surgical trauma of total hip replacement in the elderly, inhibit stress and inflammatory reaction, alleviate postoperative pain reaction, shorten the rehabilitation cycle and reduce the risk of adverse drug reactions and complications.
- Enhanced recovery after surgery /
- Total hip arthroplasty /
- Anaesthesia management /
- Postoperative rehabilitation /
- Clinical effect

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表 1 2组全髋关节置换术患者手术及麻醉恢复指标比较(x ±s)

Table 1. Comparison of surgical and anesthetic recovery indexes between the two groups(x ±s)

组别	例数	术中出血量(mL)	自主呼吸恢复时间(min)	麻醉苏醒时间(min)	拔管时间(min)	术后首次排气时间(d)	术后首次下床时间(d)	住院时间(d)
研究组	60	1 022.86±26.74	8.59±0.79	12.28±0.93	16.54±1.22	1.98±0.36	3.82±0.59	5.41±0.63
对照组	60	1 350.41±28.29	10.48±0.97	14.17±1.15	18.73±1.40	2.74±0.41	6.37±0.76	7.61±0.81
t值		65.177	11.703	9.899	9.135	10.493	20.529	16.607
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 2 2组全髋关节置换术患者术后VAS评分比较(x ±s，分)

Table 2. Comparison of VAS scores in two groups at different time after operation(x + s, points)

组别	例数	术后12 h	术后24 h	术后36 h	术后48 h
研究组	60	3.42±0.59	2.74±0.54^a	1.89±0.47^ab	1.38±0.45^abc
对照组	60	4.61±0.67	3.82±0.62^a	2.56±0.53^ab	1.79±0.49^abc
t值		9.517	8.639	8.284	6.147
P值		＜0.001	＜0.001	＜0.001	＜0.001
注：与同组术后12 h比较，^aP＜0.05；与同组术后24 h比较，^bP＜0.05；与同组术后36 h比较，^cP＜0.05。

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表 3 2组全髋关节置换术患者术后血清炎症及应激因子水平比较(x ±s)

Table 3. Comparison of serum inflammatory and stress factor levels between two groups after operation(x ±s)

组别	例数	TNF-α(pg/mL)		IL-6(pg/mL)		NE(mg/mL)		Cor(mg/mL)
组别	例数	术后24 h	术后48 h	术后24 h	术后48 h	术后24 h	术后48 h	术后24 h	术后48 h
对照组	60	75.39±4.78	47.62±3.71	263.04±9.63	159.37±8.56	173.21±8.95	95.72±5.39	54.09±4.28	36.42±2.86
研究组	60	62.72±4.45	38.59±3.46	184.62±7.56	127.36±6.85	124.37±6.15	69.81±4.73	40.78±3.74	24.95±1.74
t值		15.028	13.788	49.615	23.029	34.838	27.987	18.139	26.539
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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