术后加速康复（ERAS）缓解行经皮椎体后凸成形术治疗的骨质疏松性椎体压缩骨折患者的心理应激：一项观察性回顾性队列研究。

Enhanced recovery after surgery (ERAS) relieves psychological stress in patients with osteoporotic vertebral compression fracture undergoing percutaneous kyphoplasty: an observational retrospective cohort study.

机构信息

Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.

Department of Pain Management, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China.

出版信息

J Orthop Surg Res. 2023 Mar 20;18(1):218. doi: 10.1186/s13018-023-03703-x.

DOI:10.1186/s13018-023-03703-x

PMID:36935500

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10026471/

Abstract

STUDY DESIGN

This is an observational retrospective cohort study.

OBJECTIVE

The purpose of this study is to investigate the incidence rate of depression and anxiety and the changes in patients treated with percutaneous kyphoplasty (PKP) following ERAS protocol. The incidence of depression and anxiety is not uncommon in patients with osteoporotic vertebral compression fracture (OVCF), which affects the prognosis of surgery. Enhanced recovery after surgery (ERAS) protocols can improve the perioperative stress response of patients.

MATERIALS AND METHODS

Patients were treated conventionally in 2019 as the control group (CG) (n = 281), and patients were treated according to the ERAS protocol in 2020 as the intervention group (IG) (n = 251). All patients were evaluated for depression and anxiety using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 at admission, postoperative 1 week, 1 month and 3, 6, 12 months.

RESULTS

The degree of depression statistically decreased in the IG at follow-up periods (p < 0.001), and the degree of anxiety statistically decreased at 1 week (p < 0.001), 1 month (p < 0.001), 3 months (p = 0.017). Patients in the IG could soothe depression and anxiety disorders faster than patients in the CG and maintain psychological stability at the follow-up periods. The percentage of moderate or above depression in the IG was statistically fewer than in the CG at follow-up periods (p < 0.01). The odds ratio (OR) was respectively 0.410, 0.357, 0.294, 0.333, 0.327 from 1 week to 12 months. While the percentage of patients with moderate or above anxiety significantly decreased in the IG at 1 week (p < 0.001), OR = 0.528, 1 month (p = 0.037), OR = 0.309 and 12 months (p = 0.040), OR = 0.554, no differences between 3 months (p = 0.187) and 6 months (p = 0.133).

CONCLUSION

PKP following ERAS protocol to treat patients with OVCF had a better effect on relieving postoperative anxiety and depression than following conventional protocol.

摘要

研究设计

这是一项观察性回顾性队列研究。

目的

本研究旨在调查接受加速康复外科（ERAS）方案治疗的经皮椎体后凸成形术（PKP）患者的抑郁和焦虑发生率及变化。骨质疏松性椎体压缩性骨折（OVCF）患者中抑郁和焦虑的发生率并不少见，这会影响手术预后。ERAS 方案可以改善患者围手术期的应激反应。

材料与方法

2019 年，患者接受常规治疗作为对照组（CG）（n=281），2020 年，患者接受 ERAS 方案治疗作为干预组（IG）（n=251）。所有患者在入院时、术后 1 周、1 个月及 3、6、12 个月时使用患者健康问卷-9（PHQ-9）和广泛性焦虑障碍-7 量表评估抑郁和焦虑程度。

结果

IG 组在随访期间抑郁程度呈统计学下降（p<0.001），焦虑程度在术后 1 周（p<0.001）、1 个月（p<0.001）、3 个月（p=0.017）时呈统计学下降。IG 组患者比 CG 组患者更快地缓解抑郁和焦虑障碍，并在随访期间保持心理稳定。IG 组中中度或以上抑郁的比例在随访期间明显低于 CG 组（p<0.01）。1 周至 12 个月时，OR 分别为 0.410、0.357、0.294、0.333、0.327。而 IG 组中中度或以上焦虑的患者比例在术后 1 周（p<0.001）、OR=0.528、1 个月（p=0.037）、OR=0.309 和 12 个月（p=0.040）、OR=0.554 时明显下降，3 个月（p=0.187）和 6 个月（p=0.133）时无差异。