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

Clinical Efficacy Evaluation of TCM Syndrome Differentiation-Based Nursing Under ERAS Protocol on Postoperative Rehabilitation in Elderly Patients Undergoing Total Hip Arthroplasty

摘要: 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。

Abstract: 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 decreased significantly at 7 days after surgery (P < 0.05), and the nursing satisfaction of the experimental group was 95.24%, which was significantly higher than that of the control group (80.95%) (P < 0.05). Multi-dimensional efficacy analysis showed that: (1) the dimension of pain control: the VAS score of the experimental group at the key node (3 d/7 d) after surgery was lower than that of the control group (P < 0.05); (2) the dimension of functional recovery: the Harris score improved more significantly at 7 days and 1 month after surgery (P < 0.05); (3) the dimension of psychological intervention: the total score of HAD decreased significantly (P < 0.05); (4) the dimension of service evaluation: nursing satisfaction was significantly higher than that of the control group (P < 0.05). Conclusion: The combination of ERAS concept and traditional Chinese medicine nursing mode can effectively improve the pain and anxiety of the elderly with femoral neck fracture during the overall hip replacement surgery, promote the recovery level of hip joint function, and significantly improve the satisfaction of nursing services, so as to promote the rehabilitation process of postoperative patients.