摘要
目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念在全膝关节置换术(total knee arthroplasty,TKA)疼痛管理中的应用效果。方法 2016年6月—7月基于ERAS理念组建医护一体化的疼痛管理小组,在对医护进行系统培训后开展疼痛管理。根据两样本均数比较所需样本含量公式和纳入排除标准,将2016年3月—5月入院的60例TKA患者作为对照组(干预前),2016年8月—10月入院的60例TKA患者作为试验组(干预后)。对照组实施常规疼痛管理。试验组在常规疼痛管理基础上,围绕术前实施预防性镇痛,疼痛健康教育路径化,建立医护标准化疼痛沟通模式;术中优化麻醉方案;术后多模式镇痛,按时和按需镇痛相结合,主动评估和干预;出院时采取延续性镇痛方案等。比较两组患者术后疼痛评分、膝关节功能、平均住院日和住院费用(不含材料费)等。结果两组患者入院时、术后6 h疼痛数字评价量表(Numeric Rating Scale,NRS)评分比较,差异均无统计学意义(P>0.05),试验组患者术后24、48、72 h的疼痛NRS评分显著低于对照组,差异有统计学意义(P<0.05)。两组患者入院时的美国特种外科医院(Hospital for Special Surgery,HSS)膝关节评分比较,差异无统计学意义(P>0.05);试验组患者术后3 d、术后1周、术后1个月的HSS评分显著高于对照组,差异有统计学意义(P<0.05)。试验组平均住院日和平均住院费用均低于对照组,差异均有统计学意义(P<0.05)。结论基于ERAS理念的疼痛管理,有助于缓解TKA患者术后疼痛,促进早期功能康复,缩减平均住院日和住院费用。
Objective To explore the application of enhanced recovery after surgery （ERAS） in pain management after knee arthroplasty （TKA）. Methods Doctor-nurse pain management team was established based on ERAS between June and July 2016, and the pain management was carried out after training the doctors and nurses. According to the formula of two-sample mean comparison and inclusion and exclusion criteria, 60 TKA patients admitted to the hospital from March to May 2016 were assigned into the control group （before intervention） and 60 TKA patients admitted from August to October 2016 were assigned into the trial group （after intervention）. The patients in the control group received routine pain management. In the trial group, preventive analgesia was performed, pain health education paths were built and ISBAR communication mode was made preoperatively; anesthesia protocols were optimized intraoperatively; muhimodal analgesia based on time-demand was used postoperatively; continuing analgesia program was provided at the discharge. The pain score, Hospital for Special Surgery （HSS） knee score, average length of stay （ALOS） and average hospitalization cost （excluding materials） were compared between the two groups. Results The pain scores between the two groups at the admission and 6 hours after surgery were not statistically different （P〉0.05）, and the pain scores in the trial group 24, 48, 72 hours after surgery were significantly lower than those in the control group （P〈0.05）. The HSS scores between the two groups at the admission were not statistically different （P〉0.05）, and the HSS scores in the trial group 3 days, 1 week, and 1 month after surgery were significantly higher than those in the control group （P〈0.05）. And ALOS and average hospitalization cost （excluding materials） in the trial group were significantly lower than those in the control group （P〈0.05）. Conclusion The application of ERAS in pain management after TKA can effectively alleviate the post
出处
《华西医学》
CAS
2017年第9期1328-1332,共5页
West China Medical Journal
基金
湖南省自然科学基金项目(2017JJ2374)
2017年度中南大学研究生自主探索创新项目(2017zzts925)
关键词
加速康复外科
全膝关节置换
疼痛
膝关节功能
Enhanced recovery after surgery
Total knee arthroplasty
Pain
Knee joint function
