摘要目的 探讨术后加速康复(enhanced recovery after surgery，ERAS)模式在初次全膝关节置换术(total knee arthroplasty，TKA)中应用的效果及安全性，揭示ERAS模式下延长TKA术后住院时间(length of stay，LOS)的危险因素。方法 回顾性收集2018年7月至10月在北京积水潭医院回龙观院区矫形骨科病房接受初次TKA的患者共182例，男37例，女145例；年龄22~86岁，平均(65.2±7.7)岁。分析该患者人群术后LOS、术后1个月内并发症及术后1个月内再住院率等指标，分析年龄、性别、身体质量指数(body mass index，BMI)、病因、美国麻醉医师协会(American society of anesthesiologists，ASA)分级、术前白蛋白、术前及术后血色素、术者等因素对TKA术后LOS的影响。结果 ERAS模式下初次TKA患者平均术后LOS(2.8±0.9) d，其中术后LOS≤48 h的病例82例(45.1%)。术后1个月内7例(3.8%)出现并发症，包括2例(1.1%)症状性下肢深静脉血栓，2例(1.1%)严重内科并发症(1例胃出血和1例肺炎)，3例(1.6%)伤口浅表感染。术后1个月内再住院患者3例(1.6%)，其中2例因严重内科并发症，1例因伤口浅表感染。术后LOS＞48 h比≤48 h的患者ASA分级更高(P＝0.030)，类风湿关节炎比骨关节炎的比例低(P＝0.030)，术者也是术后LOS的影响因素(P＝0.040)。结论 ERAS诊治模式在初次TKA患者中的应用是安全、有效的。患者术前的内科情况是影响术后LOS的重要影响因素，需要围手术期对内科情况进行优化来促进患者术后的早期康复。
Abstract：Objective To investigate effectiveness and safety of enhanced recovery after surgery (ERAS) in primary total knee arthroplasty (TKA) and to analyze risk factors of prolongation of length of stay (LOS) after TKA.Methods A total of 182 primary TKA cases receiving ERAS from July to October in 2018 in Department of Orthopaedics in Beijing Jishuitan Hospital Huilongguan Branch were retrospectively selected.The mean age of them was (65.2±7.7) years (Range，22 to 86 years) which included 37 male and 145 female patients.LOS after TKA，complications within 1 month and 1month readmission rate of this case series were evaluated.Risk factors including age，gender，body mass index (BMI)，etiology，American society of anesthesiologists (ASA) grade，pre operative albumin level，pre and post operative hemoglobin level and surgeon were analyzed for prolongation of LOS after TKA.Results The mean LOS after TKA under ERAS mode was (2.8±0.9) days，and the LOS after TKA in 82 cases (45.1%) was no more than 48 hours.Seven cases (3.8%) suffered complications within 1 month after TKA，including 2 cases of symptomatic deep venous thrombosis of lower limb (1.1%)，2 cases of severe medical complications (1.1%，1 case of gastrointestinal bleeding and 1 case of pneumonia)，and 3 cases of superficial wound infection (1.6%).Three cases were readmitted within 1 month (1.6%，2 cases for severe medical complications and 1 case for superficial wound infection).The mean ASA grade of LOS＞48 h group was higher than LOS≤48 h group (P＝0.030)，while the ratio of rheumatoid arthritis to osteoarthritis was less (P＝0.030).The surgeon is another influencing factor for LOS after TKA (P＝0.040).Conclusion The application of ERAS on primary TKA is safe and helpful.Preoperative optimization of medical condition is important for achieving reduced LOS，improved outcome，and early recovery.
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