ERAS理念对PFNA治疗老年股骨转子间骨折术后谵妄和预后的影响

目的 探讨加速康复外科(ERAS)理念指导下股骨近端防旋髓内钉(PFNA)固定手术治疗老年股骨转子间骨折,对术后谵妄的发生及治疗效果的影响.方法 选择2018年1月至2020年1月在沈阳医学院附属中心医院就诊并行PFNA固定手术治疗的64例老年股骨转子间骨折患者.采用随机数字表法,分为试验组与对照组,每组32例.试验组围手术期间采用ERAS理念指导,对照组采用传统理念指导.比较两组患者谵妄发生率、疼痛评分、并发症发生率、卧床时间、住院费用、住院时间及术后1年Harris评分的差异.结果 试验组患者术后1周谵妄发生率为12.50％,术后1周VAS评分为(3.09±0.93)分,术后并发症发生率为12.50％,均低于对照组,差异有统计学意义(P<0.05).试验组患者平均卧床时间为(2.59±0.67)d,平均住院时间为(9.97±1.94)d,平均住院费用为(0.74±0.06)万元,均低于对照组,差异有统计学意义(P<0.05).试验组患者术后1年Harris评分优良率为84.38％,高于对照组,差异有统计学意义(P<0.05).结论 ERAS理念应用于PFNA治疗的老年股骨转子间骨折,可以显著降低术后谵妄及并发症的发生率,减轻患者疼痛,减少住院时间及医疗成本,提高治疗效果,值得在临床推广使用.

Effects of ERAS on postoperative delirium and outcomes in elderly patients undergoing intertrochanteric femoral fracture treated by PFNA

Objective To investigate the effects of enhanced recovery after surgery (ERAS) on postoperative delirium and outcomes in elderly patients with intertrochanteric femoral fracture treated by proximal femoral nail anti-rotation (PFNA). Methods A total of 64 intertrochanteric femoral fracture patients treated with PFNA internal fixation from January 2018 to January 2020 at the Central Hospital of Shenyang Medical College were selected. Random number table method applied, the patients were divided into trial group and control group, with 32 cases in each group. The trial group received ERAS pathway and the control group received traditional care pathway. The differences in the incidence of delirium, pain score, the incidence of postoperative complication, bedtime, hospitalization time, hospitalization charge and Harris score one year after surgery were compared between the two groups. Results The total incidence of delirium in the trial group was 12.50%, the VAS score was (3.09±0.93) one week after surgery, and the incidence of postoperative complication was 12.50%, which were all lower than those in the control group, and the difference was statistically significant (P<0.05). The average bedtime of patients in the trial group was (2.59±0.67) days, the average hospitalization time was (9.97±1.94) days, and the average hospitalization charge was (0.74±0.06) million, which were all lower than those of the control group, and the difference was statistically significant (P<0.05). The excellent and good rate of Harris score in the trial group was 84.38% one year after operation, which was higher than that in the control group, and the difference was statistically significant(P<0.05). Conclusions The application of ERAS in elderly patients undergoing intertrochanteric femoral fracture treated with PFNA could significantly reduce the incidence of postoperative delirium and complications, pain, hospitalization time and hospitalization charge, and improve the treatment outcomes, which is worthy of clinical promotion.