【正文】 ) Society remendations[J]. Clin Nutr, 2012,31(6):817830. R,4 ERAS在關(guān)節(jié)置換中的應(yīng)用目前ERAS在膝、髖關(guān)節(jié)置換的病例中已取得成功，根據(jù)對(duì)丹麥National Patient Registry項(xiàng)目所有醫(yī)院報(bào)告分析，2000年7 200例行單側(cè)THA/TKA術(shù)患者平均住院時(shí)間為10~11 d，于2009年應(yīng)用ERAS對(duì)13 800例行單側(cè)THA/TKA的術(shù)后患者進(jìn)行規(guī)范化治療，住院時(shí)間減少至4 d[27]。所以術(shù)后鎮(zhèn)痛治療，應(yīng)以足量、有效、早期應(yīng)用為基本原則。Alexander等[11]就髖關(guān)節(jié)置換患者術(shù)中保溫問題進(jìn)行了研究， ℃，術(shù)中失血量顯著減少。術(shù)后12個(gè)月內(nèi)仍有7%~20%的病死率，而大于75歲的老人髖部創(chuàng)傷病死率在40%[2]。 enhanced recovery after surgery術(shù)后快速康復(fù)(enhanced recovery after surgery，ERAS)是指采用有循證醫(yī)學(xué)證據(jù)的圍手術(shù)期處理的一系列優(yōu)化措施，減少手術(shù)患者的生理及心理創(chuàng)傷應(yīng)激，更全面地重視微創(chuàng)理念，達(dá)到術(shù)后快速康復(fù)的目的[1]。大量的研究表明，由傷后所激發(fā)的疼痛造成神經(jīng)高敏性的間期延長(zhǎng)，與手術(shù)切口造成的二次疼痛密切相關(guān)，因此圍手術(shù)期給予延期多模式鎮(zhèn)痛治療是非常必要的，適當(dāng)?shù)乃幬锝M合、濃度及持續(xù)時(shí)間對(duì)解決術(shù)后急慢性疼痛是最有效的[9]。如果不能充分解決術(shù)后疼痛的問題，患者會(huì)對(duì)麻醉及手術(shù)的效果感到失望，術(shù)后并發(fā)癥及病死率明顯提高。術(shù)后，患者的蓄積鈉排泄能力顯著降低。a O, Birkenberg B. Aggressive warming reduces blood loss during hip arthroplasty [J]. Anesth Analg, 2000, 91(4):978984. JW, Solomkin JS, Edwards MJ. Updated remendations for control of surgical site infections[J].Ann Surg, 2011, 253(6):10821093.13. Gambatesa M, D39。et al. Early盡管ERAS模式已被證明能夠提高術(shù)后的療效，縮短住院時(shí)間，但是由于其從圍手術(shù)期營(yíng)養(yǎng)、術(shù)后處理方面對(duì)傳統(tǒng)外科手術(shù)有了根本性的轉(zhuǎn)變，所以在臨床推廣上較為緩慢[28]。1997年，希臘人口普查中，有92 400例老年患者出現(xiàn)髖部骨折，在2002年時(shí)， d[21]。 術(shù)前皮膚準(zhǔn)備、引流及麻醉 在手術(shù)當(dāng)天完成皮膚準(zhǔn)備。1 老年髖部骨折術(shù)后康復(fù)及死亡的因素 髖部骨折首先是疼痛刺激，然后是較長(zhǎng)時(shí)間的臥床，骨折后的應(yīng)激反應(yīng)導(dǎo)致器官功能障礙，老年患者臥床后出現(xiàn)胃腸蠕動(dòng)減慢，低氧血癥、睡眠障礙、疲勞等。【關(guān)鍵詞】 髖骨折；老年人；綜述；術(shù)后快速康復(fù)；ERASUsing the concept of enhanced recovery after surgery to treat senile hip fracturesHUANG Haijing, XIN Jingyi, JIN HongbinTianjin Orthopedic Hospital, Tianjin 300211, China[Abstract] It need to stay in bed for a long time and has a higher prevalence of plications and mortality in hip fracture in the elderly. Considering the factors of patients in the intraoperative death and postoperative rehabilitation, we use the concept of Enhanced Recovery After Surgery (ERAS) to take appropriate treatment measures in the preoperative, intraoperative and postoperative time. It’s good for the patients to get the rapid rehabilitation and to reduce the incidence of plications and mortality. It includes preoperative fasting and prevention of pain, intr