Lei Yiting, Huang Qiang, Zhang Shaoyun, Chen Guo, Cao Guorui, Pei Fuxing
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Nov 15;31(11):1295-1299. doi: 10.7507/1002-1892.201706012.
To evaluate the effectiveness and safety of restrictive fluid therapy combined with preoperative urination training during perioperative period in an enhanced recovery after surgery (ERAS) program for primary total hip arthroplasty (THA).
A retrospective study were conducted in 73 patients who underwent unilateral THA with liberal intravenous fluid therapy on the day of surgery between April 2015 and March 2016 (control group) and in 70 patients with restrictive fluid therapy and preoperative urination training between November 2016 and April 2017 (trial group). There was no significant difference in gender, age, weight, height, body mass index, primary disease, and complications between 2 groups ( >0.05). Perioperative related indexes were recorded and compared between 2 groups, including operation time; pre-, intra-, post-operative intravenous fluid volumes, overall intravenous fluid volume on the surgery day; postoperative urine volume per hour after surgery; blood volume; total blood loss during perioperative period; usage rates of diuretics and urine tube; the incidences of hypotension, nausea and vomiting, hyponatremia, and hypokalemia after surgery; postoperative length of stay; and the expressions of inflammatory factors [C reaction protein (CRP), interleukin-6 (IL-6)] before sugery and at 1st and 2nd days after surgery.
The pre-, intra-, post-operative intravenous fluid volumes and the overall intravenous fluid volume on the surgery day in trial group were significantly lower than those in control group ( <0.05). There was no significant difference in operation time, blood volume, total blood loss during perioperative period, and postoperative urine volume per hour after surgery between 2 groups ( >0.05). The usage rates of diuretics and urine tube in trial group were significantly lower than those in control group ( <0.05), while the differences in incidences of hypotension, nausea and vomiting, hyponatremia, and hypokalemia after surgery of 2 groups were insignificant ( >0.05). The level of inflammation factors (CRP, IL-6) at 1st and 2nd days was significant lower in trial group than in control group ( <0.05), with shorter postoperative length of stay ( =-5.529, =0.000).
It is safe and effective to adopt restrictive fluid therapy and preoperative urination training during perioperative period (intravenous fluid volume controls in about 1 200 mL on the day of surgery) following ERAS in primary THA. However, prospective studies with large-scale are still in demand for further confirming the conclusion.
评估在初次全髋关节置换术（THA）的术后加速康复（ERAS）计划中，围手术期采用限制性液体疗法联合术前排尿训练的有效性和安全性。
对2015年4月至2016年3月期间接受单侧THA且在手术当天采用自由静脉补液疗法的73例患者（对照组）以及2016年11月至2017年4月期间接受限制性液体疗法和术前排尿训练的70例患者（试验组）进行回顾性研究。两组患者在性别、年龄、体重、身高、体重指数、原发疾病及并发症方面差异无统计学意义（P>0.05）。记录并比较两组患者的围手术期相关指标，包括手术时间；术前、术中、术后静脉补液量，手术当天总静脉补液量；术后每小时尿量；血容量；围手术期总失血量；利尿剂和尿管使用率；术后低血压、恶心呕吐、低钠血症及低钾血症的发生率；术后住院时间；以及术前、术后第1天和第2天炎症因子[C反应蛋白（CRP）、白细胞介素-6（IL-6）]的表达情况。
试验组术前、术中、术后静脉补液量及手术当天总静脉补液量均显著低于对照组（P<0.05）。两组患者手术时间、血容量、围手术期总失血量及术后每小时尿量差异无统计学意义（P>0.05）。试验组利尿剂和尿管使用率显著低于对照组（P<0.05），而两组术后低血压、恶心呕吐、低钠血症及低钾血症的发生率差异无统计学意义（P>0.05）。试验组术后第1天和第2天炎症因子（CRP、IL-6）水平显著低于对照组（P<0.05），术后住院时间更短（t=-5.529，P=0.000）。
在初次THA的ERAS方案中，围手术期（手术当天静脉补液量控制在约1200 mL）采用限制性液体疗法和术前排尿训练是安全有效的。然而，仍需要大规模的前瞻性研究来进一步证实该结论。
