ERAS理念在老年脊柱手术患者围术期中的应用研究

Application of ERAS Concept in Perioperative Period of Elderly Patients Undergoing Spinal Surgery

目的:本研究立足于加速康复理念,通过制定综合性、连续性、全面性的脊柱外科手术围术期患者管理方案,探讨其应用效果。方法:通过组建MDT团队,制订加速康复方案,选取2019年6月—2022年5月赤峰市医院脊柱外科收治的244例老年脊柱手术患者为研究对象,按手术方式分为4组:腰椎后路短节段内固定减压术组对照组、腰椎后路短节段内固定减压术组ERAS组、经皮椎体成形术(PVP)/椎体后凸成形术(PKP)组对照组、PVP/PKP组ERAS组。探讨不同手术方式的老年脊柱患者围术期的管理效果。结果:腰椎后路短节段内固定减压术组ERAS组住院时间、首次下地时间均短于腰椎后路短节段内固定减压术组对照组,住院费用少于腰椎后路短节段内固定组对照组,组间差异有统计学意义(P<0.05);PVP/PKP组ERAS组住院时间、首次下地时间均短于PVP/PKP组对照组,组间差异有统计学意义(P<0.05)。腰椎后路短节段内固定减压术组ERAS组腹胀、便秘、感染、心脑血管疾病、深静脉血栓(VTE)发生率低于腰椎后路短节段内固定减压术组对照组,差异有统计学意义(P<0.05);PVP/PKP组ERAS组腹胀、便秘、VTE发生率均低于PVP/PKP组对照组,组间差异有统计学意义(P<0.05)。结论:在老年脊柱手术患者围术期中应用ERAS理念,可以加快患者康复速度,缩短平均住院时间,减少住院费用,降低患者围术期的各种并发症,提高患者围术期舒适度。

Objective:Based on the concept of accelerated rehabilitation,this study explored the application effect of a comprehensive,continuous and comprehensive perioperative management program for patients undergoing spinal surgery.Methods:By setting up the MDT team and formulating the accelerated rehabilitation program,244 elderly patients with spinal surgery admited to the spine Surgery Department of Chifeng Hospital from June 2019 to May 2022 were selected as the study objects,and divided into 4 groups according to the operation methods:Posterior lumbar short segment fixation decompression group control group,posterior lumbar short segment fixation decompression group ERAS group,percutaneous vertebroplasty(PVP)/kyphoplasty(PKP)group control group,PVP/PKP group ERAS group.To explore the effect of perioperative management in elderly spinal patients with different surgical methods.effect of perioperative management in elderly spinal patients with different surgical methods.Results:The length of hospital stay and the first trip in ERAS group were shorter than those in posterior short segment fixation decompression group,and the hospitalization cost was lower than that in posterior short segment fixation decompression group,the difference was statistically significant(P<0.05);the length of hospital stay and first trip time in ERAS in PVP/PKP group were shorter than those in PVP/PKP group,with statistical significance(P<O.05);the incidence of abdominal distension,constipation,infection,cardiovascular and cerebrovascular diseases and VTE in ERAS group was lower than that in control group,with statistical significance(P<0.05);the incidence of abdominal distension,constipation and VTE in ERAS in PVP/PKP group were lower than those in PVP/PKP group,with statistical significance(P<0.05).Conclusion:The application of ERAS concept in the perioperative period of elderly patients with spinal surgery can accelerate the recovery speed of patients,shorten the average length of hospital stay,reduce hospital costs,reduce various complications of patients during the perioperative period,and improve the comfort of patients during the perioperative period.