膝关节置换围手术期的快速康复措施

发布时间：2018-06-18 16:01

本文选题：关节成形术 + 置换　；参考：《中国组织工程研究》2017年03期

【摘要】：背景:快速康复外科即加强术后康复,是指采用有循证医学证据的围手术期处理的一系列优化措施,以减少降低手术患者的生理及心理创伤刺激,从而加速患者康复。近年来,随着手术、麻醉技术的提高,其已成为骨科领域的研究热点,尤其是关节外科,并在临床当中得到了广泛的应用。目的:综述近年来国内外膝关节置换过程中应用优化措施的临床研究。方法:第一作者应用计算机检索1997年1月至2016年9月Pub Med数据库、相关期刊论文相关文章,英文检索词“Joint replacement,enhanced recovery after surgery,multi-mode analgesia,diet management,steroid hormones”;中文检索词“关节置换,快速康复,多模式镇疼,饮食管理,类固醇激素”。共检索到81篇相关文献,另外纳入1部专著。结果与结论:(1)膝关节置换的围手术期由外科医生、麻醉科医生、护理人员、营养师等共同参与通过进行术前健康教育、缩短术前禁食、禁水时间,术前超前镇疼,不放置导尿管;术中采用全身麻醉及适当的收肌管阻滞镇疼、规范氨甲环酸使用;术后多模式镇疼,麻醉恢复后尽早功能锻炼,早期进水,预防恶心呕吐等快速康复方案显示关节置换后患者的住院时间已从4-12 d减少至1-3 d,并且术后并发症发生率以及再入院率等方面均无显著提高;(2)研究还表明,快速康复方案可适用于绝大多数膝关节置换患者,其中包括高龄、术前合并心肺疾病、2型糖尿病以及术前吸烟、饮酒等患者。
[Abstract]:Background: rapid rehabilitation surgery is to strengthen postoperative rehabilitation, refers to the use of evidence-based medical evidence perioperative management of a series of optimization measures to reduce the physiological and psychological trauma of patients with surgery stimulation, so as to accelerate the rehabilitation of patients. In recent years, with the improvement of surgery and anesthesia technology, it has become a research hotspot in orthopaedics, especially in joint surgery, and has been widely used in clinic. Objective: to summarize the clinical research on the application of optimization measures in knee arthroplasty at home and abroad in recent years. Methods: the first author searched the Pub Med database by computer from January 1997 to September 2016, and related articles in the full text database of Chinese periodicals, using the English key word "Joint replacement enhanced recovery after surrey multi-mode algebra hormones", and the Chinese key word "Joint replacement, rapid recovery". Multi-mode pain, diet management, steroid hormones. A total of 81 related documents were retrieved and 1 monograph was included. Results and conclusion the perioperative period of knee arthroplasty involved surgeons, anesthesiologists, nursing staff and dieticians in the perioperative period of knee arthroplasty. Do not place catheter; use general anesthesia and appropriate adductor tube block to relieve pain during operation, standardize the use of carbamoic acid; relieve pain in multiple modes after operation, exercise as early as possible after anaesthesia recovery, and enter water early, Rapid rehabilitation programs such as the prevention of nausea and vomiting showed that the hospitalization time of the patients after joint replacement had been reduced from 4-12 days to 1-3 days, and the incidence of postoperative complications and readmission rates were not significantly increased. Rapid rehabilitation regimen can be used in the majority of knee replacement patients, including elderly patients, preoperative patients with cardiopulmonary disease type 2 diabetes, preoperative smoking, drinking and so on.
【作者单位】：中国医学科学院北京协和医学院北京协和医院骨科;国家癌症中心/中国医学科学院北京协和医学院肿瘤医院乳腺外科;
【分类号】：R394.2

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