基于加速康復外科的肩關節鏡下肩袖修補術日間手術研究

中圖分類號：R197.323;R687.4 文獻標識碼：B

MethodsA total of 4OO patients who underwent arthroscopic rotator cuff repairata tertiary hospital in Shanghai from January 2023 to May 2O24 were selectedand randomly divided into an experimental group and acontrol group，with 200 patients in each group.The control group folowed the traditional inpatient surgical process，while theexperimental group adopted a day surgery protocol based on enhanced recovery after surgery （ERAS）.ResultsThe average length of hospital stayintheexperimental group was1day，significantlyshorterthanthatinthecontrolgroup.Thetotal hospitalizationcosts and inpatient treatment expenses in the experimental group were significantlylower than thosein the control group.Theshoulderfunction recoveryand pain scoresatlmonth，3 months，and6 months postoperatively were superior in the experimental groupcompared with thecontrol group.Patient satisfaction was also higher inthe experimental group.There wereno statistically significant differences intheincidencerates of postoperativecomplications and adverse reactions between the two groups.ConclusionArthroscopic rotator cuf repair performed under aday surgery modelis safe and eficient.By establishing a qualitycontrol indicator systemandoptimizing processs，the qualityof medical services has been effectively improved，and the patient medical experience has been enhanced.

Key words Day Surgery;Grade IV Surgery;Arthroscopic Shoulder Surgery；Rotator Cuff Repair;Enhanced Recovery after Surgery

First-author'saddress Shanghai First People's Hospital，Shanghai，2Ol6Oo，China

展仍面臨諸多挑戰，如醫療質量與安全保障措施的落實、患者術后恢復的監控等[4]

隨著醫療技術的發展和醫療模式的創新，日間手術在我國得到了快速發展。日間手術具有高效、便捷、住院時間短、醫療費用低等特點[1]。近年來，我國政府積極推動公立醫院高質量發展，鼓勵醫療機構提高日間手術比例，以提升醫療服務效率[2]。然而，在日間手術的推廣過程中，四級手術比例偏低，成為日間手術推廣的瓶頸[3]。目前，四級手術在日間開

肩關節鏡下肩袖修補術于2019年被列人三級公立醫院績效考核四級手術目錄。隨著肩關節鏡微創技術的進步、加速康復外科（enhancedrecoveryaftersurgery，ERAS）理念的更新5和國內日間手術的發展，使得肩關節鏡下肩袖損傷手術在日間開展成為可能。然而，現有研究普遍缺乏日間手術模式下肩關節鏡下肩袖修補術的全面質量管理，存在多學科協作不夠和延伸服務薄弱等問題，且忽視了患者的主觀體驗[6-8]。本研究旨在探討基于ERAS的肩關節鏡下肩袖修補手術在日間開展的實踐，以探索肩關節鏡下肩袖修補術日間化管理的新路徑。

1 資料與方法

1.1一般資料

選取2023年1月—2024年5月上海某三甲醫院運動醫學科收治的400例肩關節鏡下肩袖修補術患者作為研究對象。研究對象納人標準：（1）患者滿足肩袖損傷診斷標準；（2）撕裂程度為小型（長度 lt;1cm 或中型（長度在 1cm～3cm ）；（3）患者為首次接受肩袖修補手術；（4）患者能夠積極參與康復訓練；（5）患者自愿參與本研究并簽署知情同意書。……