加速康复理念在单孔胸腔镜肺癌根治术的应用

Application of enhanced recovery after surgery in single port thoracoscopic radical resection of lung cancer

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念在单孔胸腔镜肺癌根治术围手术期的临床疗效。方法选择2015年2月至2017年5月陕西中医药大学附属医院胸心外科收治的肺癌患者48例,手术方式均为单孔胸腔镜肺癌根治术,患者依据围手术期处理方式不同分为对照组27例、ERAS组21例。分析比较两组的术后疼痛评分、手术时间、术中补液量、胸管拔除时间、住院时间、炎症指标、D-二聚体检测、术后并发症等。结果 ERAS组的术后24、36、72 h疼痛视觉模拟评分法(visual analogue scale,VAS)分别为(3.22±0.97)分、(3.08±0.71)分、(3.93±0.67)分,明显低于对照组的(4.96±0.75)分、(5.15±0.46)分、(5.41±0.25)分,差异有统计学意义(P<0.01);术中ERAS组限制性补液,液体输入量明显少于对照组,术后胸管拔除时间、住院时间短于对照组,差异均有统计学意义(P<0.05);两组的手术时间比较无差异。ERAS组的术后1、4 d白细胞计数和CRP水平均低于对照组,ERAS组的术后D-二聚体低于对照组(P<0.05)。ERAS组并发症总发生率为14.29%,明显低于对照组并发症总发生率48.15%,差异有统计学意义(P<0.05)。结论单孔胸腔镜肺癌根治术围术期应用ERAS理念作为指导,处理方式的改变和优化,减少并发症,加快术后康复。

ObjectiveTo explore the concept of enhanced recovery after surgery （ERAS） in single hole assisted thoracoscopic lung cancer radical surgery clinical perioperative period. MethodsFrom Feb. 2015 to May 2017 the Affiliated Hospital of Shaanxi University of Chinese Medicine department of thoracic surgery treated 48 cases of patients with lung cancer, surgery for hole thoracoscopic lung resection on the basis of perioperative treatment, were divided into control group of 27 cases and 21 cases in ERAS group. The two groups were analyzed and compared the postoperative pain score, operative time, intraoperative fluid volume, chest tube removal time, hospitalization time, inflammation index, D two poly detection, postoperative complications. ResultsAfter the operation of group ERAS 24 h, 36 h ,72 h, VAS pain score （3.22 ±0.97）, （3.08 ±0.71）, （3.93±0.67） was significantly lower than the control group （4.96±0.75）, （5.15±0.46）, （5.41±0.25）, the difference was statistically significant （P〈0.01） ERAS; group limited fluid resuscitation during operation, the liquid input is significantly less than the control group, postoperative extubation time, hospitalization time is shorter than the control group, the differences were statistically significant （P〈0.05）; there is no difference between the two groups in operation time. Day 1,4 ERAS group of white blood cell count and CRP levels after operation were lower than the control group, ERAS group after two D dimer was lower than that of control group （P〈0.05） in.ERAS group. The total incidence rate was 14.29%, significantly lower than the control group the overall complication rate of 48.15%, there are differences （P〈0.05）. ConclusionsThe perioperative application the concept of rapid rehabilitation surgery as a guide hole thoracoscopic lung cancer radical change, and optimize the processing mode, reduce the complications and accelerate the rehabilitation after operation.