马晋?钟浩博?樊仕才

【摘要】目的 探討加速康复外科（ERAS）临床路径在创伤骨科患者围术期中的应用效果。方法 选择行手术治疗的100例老年髋部骨折、中青年桡骨远端骨折及踝关节骨折患者为研究对象，根据围术期是否行ERAS将患者分为非ERAS组与ERAS组，每组各50例。比较2组患者手术情况、术后恢复情况、VAS评分和并发症发生情况。结果 2组术中出血量、手术时间比较差异均无统计学意义（P均> 0.05）。与非ERAS组相比，ERAS组的首次进食时间和下床活动时间较早，住院时间较短，非手术住院费用明显减少（P均< 0.001）。术后第24 h、48 h，ERAS组患者VAS评分均低于非ERAS组（P均< 0.001），2组术后72 h VAS评分比较差异无统计学意义（P > 0.05）。ERS组的术后并发症总发生率低于非ERAS组（P < 0.001）。结论 ERAS应用于创伤骨科手术患者围术期管理中，能够缓解患者术后初期疼痛感，减少并发症发生，有助缩短康复进程，减轻患者的经济负担。

【关键词】创伤骨科;加速康复外科;临床路径;围术期管理

Application of the clinical pathway of enhanced recovery after surgery （ERAS） in trauma and orthopedics Ma Jin， Zhong Haobo， Fan Shicai. Department of Orthopedics， the First Peoples Hospital of Huizhou City， Huizhou 516003， China

Corresponding author， Fan Shicai， E-mail： 69568870@ qq. com

【Abstract】Objective To evaluate the effect of the clinical pathway of enhanced recovery after surgery （ERAS） in the perioperative management of orthopedic trauma patients. Methods A total of 100 elderly patients with hip fracture， young-and middle-aged patients with distal radius fracture and ankle joint fracture were recruited in this study. All 100 patients were evenly divided into the ERAS and non-ERAS groups according to whether ERAS was performed during perioperative period. Surgical condition， postoperative recovery， VAS score and incidence of postoperative complications were statistically compared between two groups. Results Intraoperative blood loss and operation time did not significantly differ between two groups （both P > 0.05）. Compared with the non-ERAS group， the first feeding time and out-of-bed activity time were significantly earlier， the length of hospital stay was remarkably shorter and the nonsurgical hospitalization expense was considerably less in the ERAS group （all P < 0.001）. At 24- and 48-h after operation， the VAS scores in the ERAS group were significantly lower than that in the non-ERAS group （both P < 0.001）， whereas the VAS score at postoperative 72 h did not significantly differ between two groups （P > 0.05）. The incidence of postoperative complications in the ERAS group was significantly lower than that in the non-ERAS group （P < 0.001）. Conclusions Application of the clinical pathway of ERAS in the perioperative management of patients undergoing orthopedic trauma surgery can significantly relieve postoperative pain， lower the incidence of complications， shorten the rehabilitation process， and reduce the economic burden of patients.

【Key words】Orthopaedic trauma;Enhanced recovery after surgery;Clinical pathway;

Perioperative management

加速康复外科（ERAS）理念为近年新兴的一种围术期管理理念，主要是以循证医学为依据，应用多模式医疗手段改良围术期管理流程，以减少患者心理、生理应激反应，促使患者快速康复[1]。当前，ERAS理念广泛应用于关节外科、消化外科、妇科、胸外科等外科手术，也有研究证实其能够减少患者术后并发症发生、缩短住院时间。创伤骨科收治的患者通常年龄跨度较大，疾病类型多种多样，且病情复杂，故更应该重视围术期的康复管理[2]。但目前创伤骨科尚无公认的ERAS方案。为此，本研究回顾性分析近年行手术治疗的100例老年髋部骨折、中青年桡骨远端骨折及踝关节骨折患者的临床资料，探讨ERAS临床路径在创伤骨科患者围术期中的应用效果，具体过程和结果报道如下。

对象与方法

一、研究对象

选择2018年9月至2019年3月在惠州市第一人民医院骨科行手术治疗的老年髋部骨折、中青年桡骨远端骨折及踝关节骨折患者为研究对象。病例……