Study On The Application Of ERAS Combined TCM On RA Patients During The TKA Perioperative Period

Objective: To analyze the intervention effect of enhanced recovery after surgery(ERAS)combined traditional Chinese medicine(TCM)in patients with rheumatoid arthritis(RA)undergoing total knee arthroplasty(TKA)during perioperative period.Method: On the basis of literature review,retrospective analysis was performed on 220 cases of RA patients with TKA in Guang Hua hospital from 2016 to 2019.Patients who received ERAS combined TCM from January 2018 to December 2019 were selected as the observation group,patients from January 2016 to December 2017 were included in the control group.The control group received routine rehabilitation program,while the observation group received ERAS combined TCM(Including oral Chinese herbal decoction,acupuncture and massage,auricular acupoint pressing pills,transdermal electrical stimulation,rehabilitation exercise,etc).The total cost of hospitalization,western medicine,TCM,and the length of hospital stay were counted.Based on the results of retrospective studies,48 RA patients who underwent TKA in our hospital from January to December 2020 were prospectively studied and randomly divided into control group and observation group,with 24 patients in each group.A visual analogue scale(VAS)was used to assess pain intensity at different time point in the two groups,The VAS scores at 6,24,48,72 h after surgery and the use frequency of PCA three days after surgery were recorded.The active ROM at 24,48,72 h and 2 week after surgery were measured.American Special Surgery Hospital knee score(HSS)at 2 week,HSS and WOMAC score at 3month after surgery were recorded.The incidence of complications such as nausea、vomiting and deep vein thrombosis(DVT)were also counted.Result: Literature study showed that there were abundant TCM treatment methods for RA,and joint replacement was the ultimate treatment method for RA.Systematic research of the ERAS combined TCM was seldom applied in the perioperative period of TKA in RA patients.In the retrospective study,there was no significant difference in general data between the two groups(P>0.05).The total cost and western medicine cost of the observation group were lower than those of the control group(P<0.05);The cost of TCM in the observation group was higher than that in the control group(P<0.05);The hospitalization days of the observation group decreased by 1.25 days compared with the control group.In the prospective study,there was no significant difference in general data between the two groups(P>0.05).The VAS scores of the observation group at6,24,48,72 h after surgery were lower than those of the control group(P<0.05);The use frequency of PCA three days after surgery in the observation group was significantly less than that in the control group(P<0.05);The active ROM in the observation group at24,48,72 h and 2 week postoperatively was higher than that in the control group(P<0.05);The HSS scores of the observation group were higher than those of the control group at 2 weeks and 3 months after operation(P<0.05);WOMAC score of the observation group was lower than that of the control group at 3 months after operation(P<0.05);The incidence of nausea and vomiting in the observation group was lower than that in the control group(P<0.05),and there was no significant difference in the incidence of deep vein thrombosis between the two groups(P>0.05).Conclusion: ERAS combined TCM has a significant intervention effect in RA patients undergoing TKA during perioperative period,which can effectively reduce postoperative pain,improve ROM,achieve early functional exercise,reduce the incidence of complications,reduce hospital stay and hospitalization cost.