应用术后快速康复理念治疗老年髋部骨折.docVIP

应用术后快速康复理念治疗老年髋部骨折? ?作者单位：天津市天津医院创伤骨科（邮编300211） *审校者 黄海晶 辛景义＊ 金鸿宾 【摘要】 老年髋部骨折的卧床时间长，具有较高的合并症发生率及病死率。应用术后快速康复（ERAS）这一理念，针对影响患者术中死亡及术后康复的因素，在术前、术中及术后采取相应的治疗措施，利于患者的快速康复，大大降低并发症的发生及死亡率。ERAS包括术前禁食、预防性镇痛，术中体温控制、麻醉、手术径路的选择及术后限制静脉补液量、营养支持、无痛下进行早期活动等多个方面，本文就其理念应用的安全性、可靠性及临床疗效进行综述。 【关键词】 HYPERLINK javascript:doLinkSearch(,true,,zh,%E9%AB%8B%E9%AA%A8%E6%8A%98,%E4%B8%BB%E9%A2%98%E8%AF%8D); 髋骨折；老年人；综述；术后快速康复；ERAS Using the concept of enhanced recovery after surgery to treat senile hip fractures HUANG Haijing, XIN Jingyi, JIN Hongbin Tianjin Orthopedic Hospital, Tianjin 300211, China [Abstract] It need to stay in bed for a long time and has a higher prevalence of complications and mortality in hip fracture in the elderly. Considering the factors of patients in the intraoperative death and postoperative rehabilitation, we use the concept of Enhanced Recovery After Surgery (ERAS) to take appropriate treatment measures in the preoperative, intraoperative and postoperative time. It’s good for the patients to get the rapid rehabilitation and to reduce the incidence of complications and mortality. It includes preoperative fasting and prevention of pain, intraoperative temperature control, anesthesia and surgical approach, postoperative limitation of the amount of intravenous rehydration, nutritional support and painless early motion. This article intends to give a review of the security , reliability and efficacy of application of the concept. [Key words] hip fractures; aged；review; ERAS; enhanced recovery after surgery 术后快速康复(enhanced recovery after surgery，ERAS)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，减少手术患者的生理及心理创伤应激，更全面地重视微创理念，达到术后快速康复的目的[1]。这一理念对于老年需要快速康复者尤为适用。髋部骨折70%发生在75岁以上的老人，常有压褥、便秘、肠梗阻、肺感染、尿路感染、伤口感染等合并症的发生。术后12个月内仍有7%~20%的病死率，而大于75岁的老人髋部创伤病死率在40%[2]。ERAS的应用能够大幅度的降低老年髋部骨折并发症及病死率的发生，是国内外广泛研究和应用的热点。本文旨在讨论ERAS对老年髋部骨折的临床效果及研究现状，为进一步开展其应用奠定基础。 1 老年髋部骨折术后康复及死亡的因素 髋部骨折首先是疼痛刺激，然后是较长时间的卧床，骨折后的应激反应导致器官功能障碍，老年患者卧床后出现胃肠蠕动减慢，低氧血症、睡眠障碍、疲劳等。刘智等[3]总结出老年髋部骨折术前合并内科疾病者占88.2%，主要包括呼吸系统、心血管系统、糖尿病及严重消化系