实施加速康复外科麻醉管理对甲状腺手术应激水平的影响

Effect of anesthesia management in enhanced recovery after surgery on stress level in thyroid surgery

目的比较加速康复外科(enhanced recovery after surgery,ERAS)与传统围术期的麻醉管理对甲状腺手术围术期应激水平的影响。方法选择2016年5~8月择期行甲状腺手术的患者62例,男13例,女49例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为ERAS组(n=29)和对照组(C组,n=33)。ERAS组按照ERAS围术期流程操作,记录苏醒期和术后第1天VAS疼痛评分以及术后镇痛满意度评分,记录术前、术后当日和术后1d的C反应蛋白(CRP)、血皮质醇、IL-6、IL-8和TNF-α浓度。记录术后并发症的发生情况。结果苏醒期ERAS组VAS疼痛评分明显低于C组[(0.42±0.83)分vs(0.95±1.16)分,P<0.05],术后1dERAS组VAS疼痛评分明显低于C组[(1.90±1.21)分vs(2.73±1.40)分,P<0.05]。ERAS组术后第1天镇痛满意度评分明显高于C组(P<0.05)。术后当日和术后1dERAS组CRP浓度明显低于C组;C组CRP浓度明显高于术前(P<0.05)。两组术后咽痛、声嘶和饮水呛咳等并发症的发生率差异无统计学意义。结论 ERAS围术期操作系统在甲状腺手术中的应用安全、可靠,有效提高患者的满意度,提升舒适化围术期体验,同时减轻术后疼痛,促进患者快速康复。

Objective To compare the effect of anesthesia management between enhanced recovery after surgery（ERAS）protocol and traditional protocol on stress level of thyroid surgery.Methods Sixty-two patients receiving thyroid surgery from May 2016 to August 2016,13 males and49females,aged 18-65 years,of ASA physical status Ⅰ or Ⅱ,were randomly divided into group ERAS（n=29）and traditional group（group C,n=33）.Each group had its own anesthesia management protocol.Operation method,operation duration,the level of pain during emergence and on the first postoperative day,the occurrence rate of complications and the satisfaction evaluation of pain and nausea and vomiting after the operation day were recorded.C-reactive protein（CRP）,serum cortisol,interleukin-6（IL-6）,interleukin-8（IL-8）and tumor necrosis factor（TNF-α）before and after the operation day were evaluated.Results The visual analogue scale（VAS）pain score in group ERAS was lower than that in group C during emergence[（0.42±0.83）points vs（0.95±1.16）points]and on the first postoperative day[（1.90±1.21）points vs（2.73±1.40）points]（P〈0.05）.Group ERAS was more satisfied with pain relief at first day after the surgery than that of group C（P〈0.05）.The level of CRP in group ERAS was lower than that in group C on the operative day and the first postoperative day（P〈0.05）.In group C,the level of CRP on the operative day and the first postoperative day were much higher than those before the surgery（P〈0.05）.The occurrence rate of complications between the two groups had no statistical difference.Conclusion The perioperative ERAS anesthesia management of thyroid surgery is safe and effective in pain management,patient satisfaction and accelerated recovery.