庞志敏 密芳 张伟 周艳花 王晨

[摘要] 目的 探討加速康复外科对中青年手外伤显微修复术后功能康复的影响。 方法 选择2018年1—6月我院手足外科的40例手外伤患者为对照组;2018年7—12月40例手外伤患者为观察组。对照组采取常规康复程序干预，观察组采用加速康复外科理念模式进行干预，观察两组患者焦虑情绪评分、手关节总主动活动度（TAM）、康复锻炼依从性及满意度情况。 结果 观察组焦虑情绪评分为（41.01±4.35）分，明显低于对照组的（54.96±3.47）分，观察组康复锻炼依从性为95.00%，明显高于对照组的80.00%，观察组TAM评分为（66.11±15.06）分，明显高于对照组的（57.52±10.47）分，观察组患者满意度评分为（78.54±13.31）分，明显高于对照组的（65.76±12.34）分，两组上述指标比较，差异均有统计学意义（P<0.05）。 结论 对中青年手外伤修复术后实施加速康复外科理念干预，能显著改善患者焦虑情绪，提高康复锻炼依从性，促进手功能恢复，提高患者对医疗服务的满意度。

[关键词] 加速康复外科;中青年;手外伤;功能康复;显微外科

[中图分类号] R473.6          [文献标识码] B          [文章编号] 1673-9701（2021）03-0180-04

Impacts of fast track surgery on functional rehabilitation of young and middle-aged patients with complex hand trauma after microsurgical repair

PANG Zhimin MI Fang ZHANG Wei ZHOU Yanhua WANG Chen

Department of Hand and Foot Surgery， Energy Zaozhuang Mining Group Central Hospital， Zaozhuang  277800， China

[Abstract] Objective To investigate the impacts of enhanced recovery after surgery on functional rehabilitation of young and middle-aged patients with complex hand trauma after microsurgical repair. Methods Patients with hand trauma in Hand and Foot Surgery Department of our hospital from January to June 2018 were selected as the control group（n=40）. Meanwhile， patients with hand trauma from July to December 2018 were selected as the observation group（n=40）. The control group was intervened by conventional rehabilitation program， while the observation group was intervened by the enhanced recovery after surgery. The anxiety score， the total active motion（TAM）， rehabilitation exercise compliance and satisfaction of the two groups of patients were observed. Results The anxiety score of the observation group was（41.01±4.35） points， which was significantly lower to（54.96±3.47） points of the control group. The compliance of rehabilitation exercise of the observation group was 95.00%， which was significantly higher to 80.00% of the control group. The TAM score of hand joint of the observation group was（66.11±15.06） points， which was significantly higher to（57.52±10.47） points of the control group. The patient satisfaction score of the observation group was（78.54±13.31） points， which was significantly higher to（65.76±12.34） points of the control group. There were significant differences in the above indexes between the two groups（P<0.05） Conclusion Implementation of the intervention of enhanced recovery after surgery in young and middle-aged patients after hand trauma repair can significantly relieve the anxiety， boost the compliance with rehabilitation exercises of young and middle-aged patients after hand trauma repair， thus promoting the recovery of hand function and raise their satisfaction with medical services.

[Key words] Enhanced recovery after surgery; The young and middle-aged; Hand trauma; Functional rehabilitation; Microsurgery

由于人们使用机械不当或操作失误等因素，手外伤是临床上常见的一种损伤，可导致血管、肌腱、神经及骨关节等多方面损伤[1]。显微外科修复术为手功能恢复创造了必要条件，但术后肿胀、疼痛、制动等又影响手功能的康复进程。有研究显示，手外伤术后1～3个月康复的早期介入可降低患者致残程度，有效促进手功能改善和提高其生活质量[2]，因此手外伤术后早期康复的有效实施尤为重要。加速康复外科（Enhanced recovery after surgery，ERAS）模式是指术前、术中及术后依据循证医学各种已证实有效的优化处理措施，减少手术患者生理和心理的创伤应急，加快患者术后早期康复、减少术后并发症等[3]。……