加速康复外科理念对体外循环心脏术后病人康复及创伤后应激反应的干预效果

Intervention effects of enhanced recovery after surgery for postoperative rehabilitation and post-traumatic stress response in patients after cardiac surgery under cardiopulmonary bypass

目的探讨加速康复外科(ERAS)理念对体外循环(CPB)心脏手术病人术后康复及创伤后应激障碍(PTSD)的干预效果。方法选取2018年6月至2019年12月期间在本院心外科接受CPB心脏手术的320例病人,根据时间先后顺序分为对照组与观察组,每组160例。对照组按心外科常规护理,观察组基于ERAS理念施护。对比两组病人术后康复指标及并发症发生情况,采用40项恢复质量评分量表(qoR-40)评价恢复质量,PTSD检查表平民版(PCL-C)评价PTSD。结果观察组的术中出血量、血浆用量、术后麻醉苏醒时间、首次排便时间、拔管时间、住院时间及术后并发症发生率均低于对照组(P<0.05)。术后48 h,观察组的qoR-40评分高于对照组(P<0.05)。术后1周、1个月及3个月,观察组的PCL-C评分低于对照组(P<0.05),观察组PTSD症状阳性率及三大症状检出率均低于对照组(P<0.05)。结论ERAS理念干预有利于减轻CPB心脏手术后病人的创伤应激反应程度,促进术后康复,提高康复质量,预防或减少PTSD的发生。

ObjectiveTo explore the effects of enhanced recovery after surgery(ERAS)for postoperative rehabilitation and post-traumatic stress disorder(PTSD)in patients with cardiac surgery under cardiopulmonary bypass(CPB).MethodsFrom June2018 to December 2019,320 patients who underwent CPB cardiac surgery were divided into control group and observation group according to chronological order,with 160 cases in each group.The control group received routine cardiac surgery care,while the observation group received ERAS intervention.The postoperative rehabilitation indexes and complications of the two groups were compared,the quality of recovery was evaluated by the 40-item recovery quality score scale(qoR-40),and the PTSD was evaluated by The PTSD Cheeklist-CivilianVersion(PCL-C).ResultsThe intraoperative blood loss,plasma dosage,postoperative anesthesia recovery time,first bowel movement time,extubation time,hospital stay and postoperative complication rate of the observation group were lower than those of the control group(P<0.05).At 48 hours after surgery,the qoR-40 score of the observation group was higher than that of the control group(P<0.05).At 1 week,1 month,and 3 months after surgery,the PCL-C scores of the observation group were lower than that of the control group(P<0.05).The positive rate of PTSD symptoms and the detection rate of three major symptoms in the observation group were lower than those in the control group(P<0.05).ConclusionERAS conceptual intervention was helpful to reduce the degree of trauma stress response in patients with CPB cardiac surgery,which could promote postoperative rehabilitation,improve the quality of rehabilitation,reduce and prevent the occurrence of PTSD.