| 覃兆军,马广胜,向春艳,等.基于加速康复外科膝关节镜日间手术模式与传统住院模式的对比研究[J].安徽医药,2023,27(4):711-715. |
| 基于加速康复外科膝关节镜日间手术模式与传统住院模式的对比研究 |
| A comparative study of knee arthroscopy ambulatory surgery mode and traditional hospitalization mode based on enhanced recovery after surgery |
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| DOI：10.3969/j.issn.1009-6469.2023.04.017 |
| 中文关键词: 关节镜检查 加速康复外科 半月板 关节成形术 日间手术 膝关节 |
| 英文关键词: Arthroscopy Enhanced recovery after surgery Meniscus Arthroplasty Ambulatory surgery Knee joint |
| 基金项目:宜昌市医学拔尖人才培养工程(宜卫生计生函〔 2016〕114号)；宜昌市科技局医疗卫生科研项目( A20-2-026) |
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| 中文摘要: |
| 目的对比研究加速康复外科理念下日间手术模式与传统住院模式膝关节镜手术，为此类手术提供适宜诊疗模式。方法选择 2019年 1月至 2021年 1月三峡大学人民医院(宜昌市第一人民医院)拟行关节镜下单侧膝关节半月板切除术 /成形术病人 100例，根据住院模式不同分为日间手术模式组(观察组)和传统住院模式组(对照组)，每组 50例。两组均执行加速康复外科策略。检测两组病人术前 30 min及术后 2h血糖及胰岛素水平，计算胰岛素抵抗发生率；记录术后拔管、 3h、6h、12 h、24 h时静息及动态疼痛视觉模拟评分及下肢肌力分级；术后膝关节活动度恢复到 30°、60°、90°所需时间；术后首次进食时间、首次下床活动时间、住院时间、住院费用、伤口出血及感染发生率、术后镇痛补救率、恶心呕吐发生率、出院后 30 d内再入院率及再手术率、病人就医体验满意度。结果两组病人术前 30 min及术后 2h血糖、胰岛素水平及胰岛素抵抗发生率组间比较差异无统计学意义(P>0.05)；两组病人术后不同时点静息及动态视觉模拟评分、下肢肌力分级组间比较差异无统计学意义(P>0.05)；与对照组比较，观察组病人术后关节活动恢复到 30°、60°、90°所需时间更短［对照组:(3.5±1.8)h、(7.4±5.3)h、(16.8±7.6)h；观察组:(2.0±1.1)h、(4.2±2.2)h、(12.4±7.2)h］、术后首次进食时间［对照组:(5.7±0.9)h；观察组:(2.2±0.5)h］及术后首次下床活动时间更早［对照组:(10.1±6.1)h；观察组:(3.8±0.9)h］，住院时间更短［对照组:(8.5±2.7)d；观察组:(1.0±0.1)d］、费用更低［对照组:(14 350±3 612)元；观察组:(8 846±1 682)元］、就医体验满意度更高(对照组: 84%；观察组: 98%)(P<0.05)；两组病人术后伤口出血及感染发生率、术后镇痛补救率、恶心呕吐发生率、出院后 30 d内再入院率及再手术率组间比较差异无统计学意义(P>0.05)。结论在加速康复外科理念指导下，与传统住院模式相比，膝关节镜半月板切除术 /成形术更适合采用日间手术模式。 |
| 英文摘要: |
| Objective To provide the optimal treatment mode for knee arthroscopy through a comparative study of the ambulatorysurgery mode and traditional hospitalization surgery mode based on enhanced recovery after surgery.Methods From January 2019 to January 2021 in The People′s Hospital of China Three Gorges University(The First People′s Hospital of Yichang), according to the different hospitalization mode, 100 patients scheduled for elective unilateral knee arthroscopic meniscus resection or plastic surgery were divided into 2 groups (n = 50 each): ambulatory surgery mode group (the observation group) and traditional hospitalization mode group(the control group). Enhanced recovery after surgery protocol were implemented in both groups. The levels of blood sugar and insulinwere detected at 30 min before and 2 h after operation in the two groups, and the incidences of insulin resistance were also calculated.Rest and movement pain visual analogue scales, and the muscle strength grades were recorded after extubation, at 3 h, 6 h, 12 h, 24 hafter surgery, respectively. The time required for the postoperative knee joint mobility to recover to 30°, 60°, 90° were recorded. Thefirst time to take food and to get out of bed, length of stay, medical cost were recorded. Incidences of postopertative wound bleeding andinfection, postoperative analgesia rescue, postoperative nausea and vomitting, re-admission and re-operation within 30 d after discharge, and patient satisfaction were calculated.Results There were no significant differences in the level of blood sugar and insulinat 30 min before and 2 h after operation, the incidences of insulin resistance between the two groups. There were no significant differences in rest and movement pain visual analogue scales and the muscle strength grades at different time points after surgery betweenthe two groups. Compared with the control group, it took shorter time to recover knee joint movement of 30°, 60°, 90° after surgery [thecontrol group: (3.5±1.8) h, (7.4±5.3) h, (16.8±7.6) h; the observation group: (2.0±1.1) h, (4.2±2.2) h, (12.4±7.2) h], earlier time to takefood [the control group: (5.7±0.9) h;the observation group: (2.2±0.5) h], earlier time to get out of bed [the control group: (10.1±6.1) h;theobservation group: (3.8±0.9) h], shorter length of stay [the control group: (8.5±2.7) d; the observation group: (1.0±0.1) d], less medicalcost [the control group: (14 350±3 612)yuan;the observation group: (8 846±1 682)yuan] , higher patient satisfaction (the control group:84 %;the observation group: 98 %)in the observation group (P < 0.05). There were no statistical differences in the incidences of postopertative wound bleeding and infection, postoperative analgesia rescue, postoperative nausea and vomitting, re-admission and re-operation within 30 d after discharge between the two groups.Conclusion Based on the concept of enhanced recovery after surgery, the ambulatory surgery mode is more suitable for knee arthroscopic meniscectomy/plasty compared with the traditional hospitalization mode. |
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