ERAS中多模式镇痛在髋关节置换的应用

Journal: Basic Medical Theory Research DOI: 10.12238/bmtr.v4i4.5448

高璐1, 李秀华2, 苗苗1, 王永成1

1. 华北理工大学
2. 唐山工人医院

Abstract

加速康复外科(Enhanced recovery after surgery,ERAS)理念最早是由Kehlet[1]于2011年提出的,并被应用于胃肠外科[2]。主要措施包括:进一步优化的麻醉方法的选择、围术期多模式镇痛、微创手术的开展、目标导向容量治疗策略和避免术中低体温发生等。可显著减轻患者围术期疼痛,减少麻醉术后应激反应,使得康复速度加快,会大大缩短患者的住院时间,降低医疗花费,促进患者身体心理康复[2]。股骨颈骨折是常见的骨折急诊疾病之一,在临床实践中,常对股骨颈骨折患者进行髋关节置换术来重建髋关节,可以有效改善临床症状,缓解疼痛[3]。研究表明,快速康复手术对骨科大手术后的康复有积极作用。然而,很少有研究者考察加速康复手术对髋关节置换术患者身心康复的影响[4]。本研究旨在探讨加速康复外科理念下多模式镇痛在髋关节置换术中的应用价值。

Keywords

加速康复外科;多模式镇痛;髋关节置换术

References

[1] Kehlet H. Fast-track surgery-an update on physiologi cal care principles to enhance recovery. Langenbecks Arcl Su rg 2011;396:585-90.
[2] Zhong M, Liu D, Tang H, Zheng Y, Bai Y, Liang Q, Yang X. Impacts of the perioperative fast track surgery concept on the physical and psychological rehabilitation of total hip arthroplasty: A prospective cohort study of 348 patients. Medicine (Baltimore). 2021 Aug 13;100(32):e26869.
[3] 杨路德,吴晓波,解品亮,等.快速康复外科在老年股骨转子间骨折围术期的运用效果[J].中华创伤杂志,2018,34(10):939-944.
[4] Zhong M, Liu D, Tang H, Zheng Y, Bai Y, Liang Q, Yang X.Impacts of the perioperative fast track surgery concept on the physical and psychological rehabilitation of total hip arthroplasty: A prospective cohort study of 348 patients.Medicine (Baltimore). 2021 Aug 13;100(32):e26869.
[5] Erivan R, Villatte G, Dartus J, Reina N, Descamps S,Boisgard S. Progres-sion and projection for hip surgery in France, 2008–2070: Epidemiologic study with trend and pro jection analysis. Orthop Traumatol Surg Res.2019;105(7):1227-35.
[6] Yanyan B, Kaiyuan C, Xiao C, Xisheng W. Reports and analysis of amount of hip and knee arthroplasty in China from 2011 to 2019. Chin J Orthop.2020;40(21):1453-60.
[7] Shan L, Shan B, Graham D, Saxena A. Total hip replacem ent: a system-atic review and meta-analysis on mid-term quality of life.OsteoarthritisCartilage. 2014;22:389-406.
[8] Gabbert T, Filson R, Bodden J, Coppola C. Summary: NAO N's Best Practice Guideline, Total Hip Replacement (Arthroplas ty). Orthop Nurs. 2019 Jan/Feb;38(1):4-5.
[9] Meng Y, Deng B, Liang X, Li J, Li L, Ou J, Yu S, Tan X, Chen Y, Zhang M. Effectiveness of self-efficacy-enhancing interventions on rehabilitation following total hip replace ment: a randomized controlled trial with six-month follow-up. J Orthop Surg Res. 2022 Apr 10;17(1):225.
[10] Götz JS, Leiss F, Maderbacher G, Meyer M, Reinhard J, Zeman F, Grifka J, Greimel F. Implementing fast-track in total hip arthroplasty: rapid mobilization with low need for pain medication and low pain values : Retrospective analysis of 102 consecutive patients. Z Rheumatol. 2022 Apr;81(3):253-262.
[11] Kenney MO, Smith WR. Moving Toward a Multimodal Analgesic Regimen for Acute Sickle Cell Pain with Non-Opioid Analgesic Adjuncts: A Narrative Review. J Pain Res. 2022 Mar 31;15:879-894.
[12] Olmos AV, Steen S, Boscardin CK, Chang JM, Manahan G, Little AR, Lee MC, Liu LL. Increasing the use of multimodal analgesia during adult surgery in a tertiary academic anaes thesia department. BMJ Open Qual. 2021 Jul;10(3):e001320.
[13] Steyaert A, Lavand'homme P. Prevention and treatmen t of chronic postsurgical pain: a narrative review. Drugs 2018;78:339-54.
[14] Beverly A, Kaye AD, Ljungqvist O, et al. Essential elements of multimodal analgesia in enhanced recovery after surgery (ERAS) guidelines. Anesthesiol Clin 2017;35:e115-43.
[15] Wang F, Ma W, Huang Z. Analgesia effects of IPACK block added to multimodal analgesia regiments after total knee replacement: A systematic review of the literature and meta-analysis of 5 randomized controlled trials. Medicine(Baltimore). 2021 Jun 4;100(22):e25884.
[16] Baharuddin KA, Rahman NH, Wahab SF, et al. Intraveno us parecoxib sodium as an analgesic alternative to morphine in acute trauma pain in the emergency department. Int J Emerg Med,2014.7(1):2.
[17] 李艳,王白云,谭尹娜.基于快速康复外科理论的多模式镇痛在腹腔镜结直肠癌根治术中的实施效果[J].中国老年学杂志,2019,39(18):4492-4494.
[18] National Guideline C. Evidence review for inpatient hip and knee postoperative rehabilitation: Joint replacement (primary): hip, knee and shoulder: Evidence review P. London: National Institute for Health and Care Excellence (UK). Copyright © NICE 2020.; 2020.
[19] Kim SI,Ha KY,Oh IS.Preemptive multimo odal analgesia for postoper-ative pain management after lumbar fusion surgery:a randomized con-trolled trial[J]. Eur Spine J,2016; 25(5) :1614-9.
[20] Li H, Liu Y, Li Q, et al. Effects of a fast track surgery nursing program in perioperative care of older patients with a hip fracture. Eur Geriatr Med 2020;11:519-25.

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