Objective: 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).
Methods: 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 ( P>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.
Results: 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 ( P<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 ( P>0.05). The usage rates of diuretics and urine tube in trial group were significantly lower than those in control group ( P<0.05), while the differences in incidences of hypotension, nausea and vomiting, hyponatremia, and hypokalemia after surgery of 2 groups were insignificant ( P>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 ( P<0.05), with shorter postoperative length of stay ( t=-5.529, P=0.000).
Conclusion: 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.
目的: 评价基于加速康复外科（enhanced recovery after surgery，ERAS）理念，人工全髋关节置换术（total hip arthroplasty，THA）围术期限制性输液联合术前排尿训练的安全性及有效性。.
方法: 回顾分析 2016 年 11 月—2017 年 4 月，初次单侧 THA 术前行排尿训练及手术当日限制性输液患者 70 例（试验组）临床资料；以 2015 年 4 月—2016 年 3 月手术当日自由性输液患者 73 例作为对照组。两组患者年龄、性别、体质量、身高、体质量指数、疾病类型以及术前合并症比较，差异均无统计学意义（ P>0.05）。比较两组手术时间，术前、术中及术后输液量，手术当日总输液量，术后当日小时尿量，血容量，围术期总失血量；术后利尿剂及尿管使用情况；术后低血压、恶心呕吐、低钠血症、低钾血症等不良事件发生情况；术后住院时间；术前及术后第 1、2 天 C 反应蛋白（C reactive protein，CRP）和 IL-6 水平。.
结果: 试验组患者术前、术中、术后输液量以及手术当日总输液量均明显低于对照组（ P<0.05）；两组手术时间、血容量、围术期总失血量以及术后当日小时尿量比较，差异无统计学意义（ P>0.05）。试验组术后利尿剂及尿管使用率均明显低于对照组（ P<0.05），两组术后低血压、恶心呕吐、低钠血症、低钾血症发生率比较差异无统计学意义（ P>0.05）。试验组术后住院时间明显短于对照组（ t=–5.529， P=0.000）。试验组术后第 1、2 天 CRP 和 IL-6 水平均低于对照组（ P<0.05）。.
结论: 基于 ERAS 理念，THA 围术期限制性输液（手术当日输液量控制在 1 200 mL 左右）联合术前排尿训练是安全有效的，但该结论仍需要大样本的前瞻性随机对照研究来验证。.
Keywords: Enhanced recovery after surgery; restrictive fluid therapy; total hip arthroplasty; urination training.