目的:尽管加速康复外科(enhanced recovery after surgery,ERAS)理念在外科围手术期患者中普遍应用,但膝关节置换患者的术前管理仍有待进一步加强.本研究探讨基于ERAS理念的院前预康复在老年膝关节置换患者中的应用效果.方法:选取2022年12月至2023年12月在江苏省苏北人民医院入院服务中心登记入住骨关节科行膝关节置换的老年患者90例,随机分为对照组(n=45)和观察组(n=45).对照组患者入院后按照围手术期护理常规进行护理,观察组患者进行基于ERAS理念的院前预康复干预.比较患者干预前、出院前1 d、出院后2周、出院后3个月时膝关节最大屈曲角度(range of motion,ROM)、美国纽约特种外科医院(Hospital for Special Surgery,HSS)评分、下肢肌力、日常生活能力量表(Activity of Daily Living,ADL)评分、住院时间、住院费用以及术后并发症发生率和患者满意度.结果:观察组出院前1 d、出院后2周、出院后3个月的ROM评分、HSS评分、下肢肌力、ADL评分和满意度均显著高于对照组(均P<0.05),住院时间、住院费用及并发症发生率均明显低于对照组(均P<0.05).结论:基于ERAS理念的院前预康复在老年膝关节置换患者中的应用效果良好,可有效提高患者术后膝关节功能,提升生活质量,降低患者住院时间、住院费用和并发症发生率,提高患者满意度.
Application of preoperative prehabilitation based on the enhanced recovery after surgery concept in elderly patients undergoing knee replacement
Objective:Although the concept of enhanced recovery after surgery(ERAS)is widely applied in perioperative care for surgical patients,preoperative management for knee replacement patients who need further improvement.This study aims to explore the effect of preoperative prehabilitation based on the ERAS concept in elderly patients undergoing knee replacement.Methods:A total of 90 elderly patients admitted to the Department of Orthopedic of Northern Jiangsu People's Hospital for knee replacement from December 2022 to December 2023 were randomly assigned to a control group(n=45)and an observation group(n=45).The control group received standard perioperative care after admission,while the observation group underwent preoperative prehabilitation intervention based on ERAS principles.We compared the knee joint maximum range of motion(ROM),Hospital for Special Surgery(HSS)score,lower limb muscle strength,Activities of Daily Living(ADL)score,hospital stay,hospital costs,postoperative complication rate,and patient satisfaction before intervention,one day before discharge,2 weeks,and 3 months post-discharge.Results:The observation group had significantly higher ROM scores,HSS scores,lower limb muscle strength,ADL scores,and satisfaction levels than the control group at one day before discharge,2 weeks,and 3 months post-discharge(all P<0.05).Hospital stay,hospital costs,and complication rates were significantly lower in the observation group than those in the control group(all P<0.05).Conclusion:Preoperative prehabilitation based on the ERAS concept has positive effects on elderly knee replacement patients,effectively improving postoperative knee joint function,enhancing quality of life,reducing hospital stay,hospital costs,and complication rates,and increasing patient satisfaction.
enhanced recovery after surgeryprehabilitationelderly patientknee replacement