Study on the impact of multidisciplinary co-management model based on ERAS concept on ultra-early ambulation in elderly patients with intertrochanteric femoral fractures
基于ERAS理念下多学科共管模式对老年股骨粗隆间骨折患者超早期下床活动的影响研究

摘要

目的 探讨基于 ERAS 理念下多学科共管模式在老年股骨粗隆间骨折患者中实施超早期下床活动的效果。方法 采用随机对照实验设计，选取2023年4月至2025年6月我院收治的老年股骨粗隆间骨折患者，采用随机数字表达分为实验组与对照组各50例，实验组实施基于加速康复外科（Enhanced Recovery After Surgery）理念的多学科共管模式，组建由骨科医师、麻醉师、康复师、营养师等构成的多学科团队，制定个体化围术期管理方案，包括术前营养支持、优化麻醉方案、多模式镇痛、阶梯式康复训练等综合干预；对照组接受传统围术期护理。比较两组患者日常生活能力（ADL）、疼痛评分（VAS）、谵妄发生率（Nu-DESC）、压力性损伤风险（Braden）及术后首次下床时间等指标。结果 实验组患者日常生活能力得分55（50，56.25），对照组患者日常生活能力得分40（35，40），Z=-8.783，P＜0.001，差异具有统计学意义；实验组患者疼痛评分2（2，4），对照组患者疼痛评分4（4，6），Z=-5.64，P＜0.001，差异具有统计学意义；实验组患者谵妄发生3例，对照组谵妄发生10例，χ2=4.332，P=0.037，差异具有统计学意义；实验组压力性损伤得分17.5（16.75，18），对照组压力性损伤得分12.5（11，14），Z=-7.754，P＜0.001，差异具有统计学意义；实验组下床时间2.5（2，3），对照组下床时间5.5（4，7）Z=-8.176，P＜0.001，差异具有统计学意义。结论 加速康复外科(Enhanced Recovery After Surgery)理念下多学科共管模式提高了患者的日常生活能力，减轻疼痛，降低力性损伤风险及谵妄发生率，使老年股骨粗隆间骨折患者实现超早期下床活动。

Abstract

Objective To explore the effect of a multidisciplinary co-management model based on the Enhanced Recovery After Surgery (ERAS) concept on ultra-early ambulation in elderly patients with intertrochanteric femoral fractures.
Methods A randomized controlled trial design was adopted. A total of 100 elderly patients with intertrochanteric femoral fractures admitted to our hospital from April 2023 to June 2025 were selected and divided into an experimental group and a control group (50 cases each) using the random number table method. The experimental group implemented a multidisciplinary co-management model guided by ERAS principles, forming a multidisciplinary team comprising orthopedic surgeons, anesthesiologists, rehabilitation therapists, nutritionists, and others to develop individualized perioperative management protocols. These protocols included preoperative nutritional support, optimized anesthesia regimens, multimodal analgesia, and stepwise rehabilitation training, among other comprehensive interventions. The control group received traditional perioperative care. Outcomes including Activities of Daily Living (ADL) scores, Visual Analogue Scale (VAS) pain scores, incidence of delirium (Neelon and Champagne Confusion Scale [Nu-DESC]), pressure injury risk (Braden Scale), and time to first postoperative ambulation were compared between the two groups.
Results The experimental group had ADL scores of 55 (50, 56.25), while the control group scored 40 (35, 40) (Z = -8.783, P < 0.001, statistically significant). VAS pain scores were 2 (2, 4) in the experimental group versus 4 (4, 6) in the control group (Z = -5.64, P < 0.001, statistically significant). Delirium occurred in 3 cases in the experimental group and 10 in the control group (χ² = 4.332, P = 0.037, statistically significant). Braden scores for pressure injury risk were 17.5 (16.75, 18) in the experimental group and 12.5 (11, 14) in the control group (Z = -7.754, P < 0.001, statistically significant). Time to first postoperative ambulation was 2.5 (2, 3) days in the experimental group versus 5.5 (4, 7) days in the control group (Z = -8.176, P < 0.001, statistically significant).
Conclusion   The multidisciplinary co-management model under the ERAS concept improved patients' activities of daily living, reduced pain, lowered the risk of pressure injuries and delirium incidence, and enabled elderly patients with intertrochanteric femoral fractures to achieve ultra-early ambulation.