加速康复外科在结核性脓胸电视胸腔镜手术围术期的应用

Application of enhanced recovery after surgery in perioperative period of video-assisted thoracoscopic surgery for tuberculous empyema

目的探究加速康复外科(ERAS)理念在结核性脓胸电视胸腔镜手术围术期的应用价值。方法选取我院收治的116例结核性脓胸患者进行回顾性研究,依据围术期干预方式不同分为对照组(58例,行常规围术期干预)和观察组(58例,行基于ERAS的围术期干预)。比较2组患者围术期相关指标、术后数字疼痛评分法(NPRS)评分、术后并发症发生情况、术后恢复情况及手术前后白细胞介素-6(IL-6)、C反应蛋白(CRP)、用力肺活量(FVC)、每分钟最大通气量(MVV)及第一秒用力呼气容积(FEV_(1))。结果2组患者围术期相关指标比较差异无统计学意义(P>0.05)。观察组术后24 h、48 h的NPRS评分均低于对照组(P<0.05)。2组患者术前、术后72 h血清IL-6、CRP水平比较差异无统计学意义(P>0.05),观察组术后24 h血清IL-6、CRP水平均低于对照组(P<0.05)。观察组术后并发症发生率低于对照组(P<0.05)。观察组术后下床活动时间、肠鸣音恢复时间、拔管时间及住院时间均短于对照组(P<0.05)。2组患者术前、术后3个月FEV_(1)、FVC、MVV比较差异无统计学意义(P>0.05)。结论基于ERAS理念的电视胸腔镜手术治疗结核性脓胸,可明显减轻患者应激反应及术后疼痛程度,降低术后并发症发生率,促进患者康复。

Objective To investigate the application value of enhanced recovery after surgery(ERAS)concept in the perioperative period of video-assisted thoracoscopic surgery for tuberculous empyema.Methods A total of 116 patients with tuberculous empyema admitted to our hospital were selected for retrospective study.They were divided into the control group(58 patients with conventional perioperative intervention)and the observation group(58 patients with ERAS-based perioperative intervention)according to the perioperative intervention methods.The perioperative related indicators,postoperative numeric pain rating scale(NPRS),incidence of postoperative complications,postoperative recovery and interleukin-6(IL-6),C-reactive protein(CRP),forced vital capacity(FVC),maximum ventilation volume(MVV)per minute and forced expiratory volume in one second(FEV_(1))before and after surgery were compared between the two groups.Results There was no statistically significant difference in the perioperative related indexes between the two groups(P>0.05).The NPRS scores 24 hours and 48 hours after surgery in the observation group were lower than those in the control group(P<0.05).There was no statistically significant difference in the serum IL-6 and CRP levels before surgery and 72 hours after surgery between the two groups(P>0.05),and the serum IL-6 and CRP levels 24 hours after surgery in the observation group were lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).The time of getting out of bed,recovery time of bowel sounds,extubation time and hospitalization time in the observation group were shorter than those in the control group(P<0.05).There was no statistically significant difference in FEV_(1),FVC,and MVV before surgery and 3 months after surgery between the two groups(P>0.05).Conclusion Video-assisted thoracoscopic surgery based on ERAS concept in the treatment of tuberculous empyema can significantly relieve stress response and postoperative pain of patients,reduce the incidence of postoperative complications,and promote the recovery of patients.