加速康复管理在腹腔镜全子宫切除术患者中的应用研究

Application Research of Perianesthesia Enhanced Recovery after Surgery Program in Patients of Laparoscopic Total Hysterectomy

目的:总结加速康复外科(enhanced recovery after surgery,ERAS)理念在腹腔镜全子宫切除术患者围麻醉期管理中的应用效果,探讨其临床意义。方法:回顾性分析中国人民解放军总医院妇产科2016年1月—2017年1月诊治的腹腔镜全子宫切除术患者87例,根据康复管理方法分为观察组(42例,采用围麻醉期加速康复管理方法)和对照组(45例,采用常规康复管理方法)。2组患者年龄、体质量指数(BMI)、腹部手术史、手术时间、术中出血量和疾病构成情况比较,差异无统计学意义(均P>0.05)。记录2组患者康复相关指标和就医满意度。结果:观察组术后排气时间、留置尿管时间、下地活动时间、住院时间和住院费用均少于对照组,差异有统计学意义(均P<0.05)。2组患者并发症发生率比较差异无统计学意义(P>0.05)。观察组就医满意度高于对照组,差异有统计学意义(90.5%vs.73.3%,χ~2=4.254,P=0.039)。结论:对于腹腔镜全子宫切除术患者实施围麻醉期加速康复管理能够加快术后康复进程,同时提升就医满意度,具有重要意义。

Objective:To investigate the effect of enhanced recovery after surgery(ERAS) program used in patients undergoing laparoscopic hysterectomy. Methods:A retrospective analysis of 87 cases of laparoscopic total hysterectomy in China PLA General Hospital from January 2016 to January 2017 was selected. All patients were divided into two groups according to the recovery management. The observation group(42 cases) received the enhanced recovery after surgery program during the anesthesia period, and the control group(45 cases) received routine recovery management. There was no significant difference between the two groups in age, body mass index(BMI), history of abdominal surgery, operation time, intraoperative blood loss and disease constitution(P>0.05). The indexes of postoperative recovery and the medical satisfaction between the two groups were observed and recorded. Results:The postoperative exhaust time, indwelling catheter time, mobilization time,average length of stay and average hospitalization expenses of the observation group were less than those of the control group, the difference was statistically significant(P<0.05). There were no significant differences in the incidence of complications between the two groups(P >0.05). The medical satisfaction of the observation group was higher than that of the control group, the difference was statistically significant(90.5% vs. 73.3%, χ~2=4.254, P =0.039). Conclusions:For patients undergoing laparoscopic hysterectomy, enhanced recovery program can accelerate postoperative recovery and improve medical satisfaction.