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Nursing Science 2025
ERAS理念下中医辨证施护对老年THA患者术后康复的临床效应评估
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Abstract:
目的：评估ERAS理念联合中医护理在老年全髋关节置换围术期中的临床效果。方法：本研究为前瞻性随机对照试验，纳入2024年10月~2025年3月接受初次单侧全髋置换术(THA)的84例老年股骨颈骨折病例。采用区组随机法双盲设计(1:1配比)，对照组(n = 42)行标准围术期管理，试验组(n = 42)实施ERAS-中医整合干预路径(ERAS核心措施 + 中医辨证施护模块)。通过多维疗效评估体系：① 生理指标(视觉模拟量表(VAS)动态监测疼痛强度)；② 功能恢复(Harris评分评估关节功能)；③ 心理状态(医院焦虑抑郁量表(HADS)检测负性情绪)；④ 患者护理满意度(基于本院康复医学团队研发的《围术期护理满意度量表》进行测评)，采用重复测量方差分析比较组间差异。结果：试验组术后3日及7日VAS评分显著优于对照组(P < 0.05)；术后7日及1月Harris评分改善更显著(P < 0.05)；术后7日HADS评分下降幅度更明显(P < 0.05)；试验组护理满意度达95.24%，显著高于对照组的80.95% (P < 0.05)。多维度疗效分析显示：① 疼痛控制维度：试验组术后关键节点(3d/7d) VAS评分低于对照组(P < 0.05)；② 功能恢复维度：术后7日及1月Harris评分改善更显著(P < 0.05)；③ 心理干预维度：HADS总分下降幅度更明显(P < 0.05)；④ 服务评价维度：护理满意度显著高于对照组(P < 0.05)。结论：ERAS理念与传统中医护理模式相结合，可有效改善整体髋关节置换手术期间，股骨颈骨折老人疼痛、焦虑的状况，促进髋关节功能恢复水平，使护理服务满意度明显提升，从而推动术后患者的康复进程。
Objective: To evaluate the clinical efficacy of integrating Enhanced Recovery After Surgery (ERAS) protocols with Traditional Chinese Medicine (TCM) nursing interventions in elderly patients undergoing total hip arthroplasty (THA) for femoral neck fractures during the perioperative period. Methods: This prospective randomized controlled trial (RCT) enrolled 84 elderly patients with unilateral femoral neck fractures who underwent primary THA between October 2024 and March 2025. Participants were allocated via block randomization with double-blind design (1:1 allocation ratio) into two groups: the control group (n = 42) received standard perioperative care, while the experimental group (n = 42) implemented an integrated ERAS-TCM pathway (ERAS core measures + TCM syndrome differentiation nursing modules). A multidimensional evaluation system was employed: ① physiological parameters (Visual Analog Scale, VAS, for dynamic pain assessment); ② functional recovery (Harris Hip Score for joint function); ③ psychological status (Hospital Anxiety and Depression Scale, HADS, for negative emotion detection); ④ patient satisfaction (assessed via the Perioperative Nursing Satisfaction Scale developed by our rehabilitation team). Repeated-measures ANOVA was utilized for intergroup comparisons. Results: The VAS score of the experimental group was significantly better than that of the control group at 3 and 7 days after surgery (P < 0.05), the Harris score at 7 days and 1 month after surgery was significantly improved (P < 0.05), the HADS score
| [1] | Liu, P., Zhang, Y., Sun, B., et al. (2021) Risk Factors for Femoral Neck Fracture in Elderly Population. Journal of Central South University. Medical Sciences, 46, 272-277. |
| [2] | Cui, S., Zhao, L., Yu, J., Ma, J. and Ma, X. (2025) A Criterion of Reduction Quality of Femoral Neck Fractures Based on Spatial Residual Displacements of Femoral Head. Orthopaedic Surgery, 17, 1503-1512. https://doi.org/10.1111/os.70027 |
| [3] | Saleem, A., Lin, C.C., Anil, U. and Rivero, S.M. (2024) Arthroplasty Treatment Options for Femoral Neck Fractures in the Elderly: A Network Meta-Analysis of Randomized Control Trials. Injury, 55, Article ID: 111875. https://doi.org/10.1016/j.injury.2024.111875 |
| [4] | Zelle, B.A., Salazar, L.M., Howard, S.L., Parikh, K. and Pape, H. (2022) Surgical Treatment Options for Femoral Neck Fractures in the Elderly. International Orthopaedics, 46, 1111-1122. https://doi.org/10.1007/s00264-022-05314-3 |
| [5] | Zhang, M., Gong, S. and Xie, R. (2024) Application of Enhanced Recovery after Surgery in Perioperative Nursing Care of Elderly Patients with Hip and Knee Arthroplasty: A Systematic Review and Meta-analysis. Medicine, 103, e37240. https://doi.org/10.1097/md.0000000000037240 |
| [6] | Liu, J., He, M., Song, R. and Li, J. (2025) The Association between Deep Vein Thrombosis at Admission and the Time from Injury to Admission in Hip Fractures. BMC Geriatrics, 25, Article No. 222. https://doi.org/10.1186/s12877-025-05875-z |
| [7] | Walter, N., Szymski, D., Kurtz, S.M., Lowenberg, D.W., Alt, V., Lau, E.C., et al. (2023) Epidemiology and Treatment of Proximal Femoral Fractures in the Elderly U.S. Population. Scientific Reports, 13, Article No. 12734. https://doi.org/10.1038/s41598-023-40087-8 |
| [8] | Zhou, X. (2024) Application of Multi-Disciplinary Team Nursing Model Enhances Recovery after Surgery for Total Hip Arthroplasty and Total Knee Arthroplasty. American Journal of Translational Research, 16, 3938-3949. https://doi.org/10.62347/bhgs1734 |
| [9] | Götz, J.S., Leiss, F., Maderbacher, G., Meyer, M., Reinhard, J., Zeman, F., et al. (2021) Implementing Fast-Track in Total Hip Arthroplasty: Rapid Mobilization with Low Need for Pain Medication and Low Pain Values: Retrospective Analysis of 102 Consecutive Patients. Zeitschrift für Rheumatologie, 81, 253-262. https://doi.org/10.1007/s00393-021-00978-5 |
| [10] | Ripollés-Melchor, J., Abad-Motos, A., Díez-Remesal, Y., Aseguinolaza-Pagola, M., Padin-Barreiro, L., Sánchez-Martín, R., et al. (2020) Association between Use of Enhanced Recovery after Surgery Protocol and Postoperative Complications in Total Hip and Knee Arthroplasty in the Postoperative Outcomes within Enhanced Recovery after Surgery Protocol in Elective Total Hip and Knee Arthroplasty Study (POWER2). JAMA Surgery, 155, e196024. https://doi.org/10.1001/jamasurg.2019.6024 |
| [11] | Zhang, Q., Chen, Y., Li, Y., Liu, R., Rai, S., Li, J., et al. (2023) Enhanced Recovery after Surgery in Patients after Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis. Postgraduate Medical Journal, 100, 159-173. https://doi.org/10.1093/postmj/qgad125 |
