快速通道单髁膝关节置换术后的直立不耐受：发生率和血液动力学——一项前瞻性观察队列研究。
Postoperative orthostatic intolerance following fast-track unicompartmental knee arthroplasty: incidence and hemodynamics-a prospective observational cohort study.
机构信息
Department of Anesthesiology and Intensive Care, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark.
Section of Surgical Pathophysiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
出版信息
J Orthop Surg Res. 2024 Apr 1;19(1):214. doi: 10.1186/s13018-024-04639-6.
BACKGROUND
Early postoperative mobilization is essential for early functional recovery but can be inhibited by postoperative orthostatic intolerance (OI). Postoperative OI is common after major surgery, such as total knee arthroplasty (TKA). However, limited data are available after less extensive surgery, such as unicompartmental knee arthroplasty (UKA). We, therefore, investigated the incidence of OI as well as cardiovascular and tissue oxygenation responses during early mobilization after UKA.
METHODS
This prospective single-centre observational study included 32 patients undergoing primary UKA. Incidence of OI and cardiovascular and tissue oxygenation responses during mobilization were evaluated preoperatively, at 6 and 24 h after surgery. Perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain during mobilization and opioid usage were recorded.
RESULTS
During mobilization at 6 h after surgery, 4 (14%, 95%CI 4-33%) patients experienced OI; however, no patients terminated the mobilization procedure prematurely. Dizziness and feeling of heat were the most common symptoms. OI was associated with attenuated systolic and mean arterial blood pressure responses in the sitting position (all p < 0.05). At 24 h after surgery, 24 (75%) patients had already been discharged, including three of the four patients with early OI. Only five patients were available for measurements, two of whom experienced OI; one terminated the mobilization procedure due to intolerable symptoms. We observed no statistically significant differences in perioperative fluid balance, bleeding, surgery duration, postoperative hemoglobin, pain, or opioid usage between orthostatic intolerant and tolerant patients.
CONCLUSIONS
The incidence of orthostatic intolerance after fast-track unicompartmental knee arthroplasty is low (~ 15%) and is associated with decreased orthostatic pressure responses. Compared to the previously described orthostatic intolerance incidence of ~ 40% following total knee arthroplasty, early orthostatic intolerance is uncommon after unicompartmental knee arthroplasty, suggesting a procedure-specific component.
TRIAL REGISTRATION
Prospectively registered at ClinicalTrials.gov; registration number: NCT04195360, registration date: 13.12.2019.
背景
早期术后活动对于早期功能恢复至关重要，但术后直立不耐受（OI）可能会抑制术后活动。在全膝关节置换术（TKA）等大手术后，术后 OI 很常见。然而，在较小范围的手术后，如单髁膝关节置换术（UKA），相关数据有限。因此，我们研究了 UKA 后早期活动期间 OI 的发生率以及心血管和组织氧合反应。
方法
这是一项前瞻性单中心观察性研究，纳入了 32 例接受初次 UKA 的患者。在术前、术后 6 小时和 24 小时评估了 OI 的发生率以及活动期间的心血管和组织氧合反应。记录围手术期液体平衡、出血、手术时间、术后血红蛋白、活动时疼痛和阿片类药物使用情况。
结果
在术后 6 小时的活动期间，4 名（14%，95%CI 4-33%）患者出现 OI；但没有患者提前终止活动程序。头晕和发热感是最常见的症状。OI 与坐姿时收缩压和平均动脉血压反应减弱相关（均 p<0.05）。术后 24 小时，24 名（75%）患者已出院，其中包括 4 名早期 OI 患者中的 3 名。仅有 5 名患者可进行测量，其中 2 名患者出现 OI；1 名患者因无法忍受的症状而终止了活动。在直立不耐受和耐受的患者之间，围手术期液体平衡、出血、手术时间、术后血红蛋白、疼痛或阿片类药物使用方面没有统计学上的显著差异。
结论
快速通道单髁膝关节置换术后直立不耐受的发生率较低（约 15%），且与直立位压力反应降低有关。与先前描述的全膝关节置换术后约 40%的直立不耐受发生率相比，单髁膝关节置换术后早期直立不耐受并不常见，这表明存在特定于手术的因素。
试验注册
前瞻性在 ClinicalTrials.gov 注册；注册号：NCT04195360，注册日期：2019 年 12 月 13 日。
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