快速康复外科管理用于子宫切除术围手术期中的效果观察

Clinical effect of enhanced recovery after surgery management in patients with vaginal hysterectomy

目的探讨快速康复外科管理用于经阴道子宫切除术围手术期管理的效果及临床意义。方法回顾性分析因子宫肌瘤、子宫腺肌病、中盆腔缺陷、宫颈病变及子宫内膜病变等行经阴道子宫切除术患者73例的临床资料，根据围手术期管理方法不同分成两组，观察组35例，采用快速康复外科技术进行围手术期管理，对照组38例，采用常规围手术期管理。比较两组围手术期管理相关指标，包括手术时间、手术出血量、术后首次进食时间、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等。结果两组平均年龄、体质量指数、腹部手术史、疾病构成差异均无统计学意义（均P〉0.05）。观察组与对照组术后首次进食时间[（7.6±1.3）h比（12.6±3.2）h]、术后排气时间[（15.5±4.6）h比（20.2±6.5）h]、留置尿管时间[（20.1±4.9）h比（28.4±6.8）h]、下地活动时间[（19.2±3.5）h比（24.2±7.9）h]、住院时间[（4.5±0.7）d比（5.8±1.2）d]及住院费用[（6 545.2±430.7）元比（7 953.8±653.3）元]差异均有统计学意义（t＝8.069、3.538、5.938、3.582、5.590、10.777，均P〈0.05）；两组手术时间[（45.3±20.8）min比（39.9±17.4）min]和手术出血量[（69.4±32.2）mL比（57.0±24.5）mL]差异均无统计学意义（t＝1.206、1.860，均P〉0.05）。结论将快速康复外科管理引入经阴道子宫切除术患者的围手术期管理中，能够加快患者术后康复进程，减少住院时间和患者经济负担，具有重要临床意义。

ObjectiveTo analyze the effect of enhanced recovery after surgery program（ERAS） in perioperative management of vaginal hysterectomy.MethodsThe clinical data of 73 patients who underwent transvaginal hysterectomy for uterine fibroids, adenomyosis, middle pelvic defects, cervical lesions and endometrial lesions were retrospectively analyzed.All patients were divided into two groups according to the perioperative management method.The observation group （35 cases） received the enhanced recovery program, while the control group （38 cases） received the routine perioperative management.The general data and perioperative management indicators of the two groups were recorded and compared.ResultsThere were no statistically significant differences between the two groups in mean age, body mass index, abdominal surgery history and diagnosis constitution（all P〉0.05）. The first feeding time[（7.6±1.3）h vs.（12.6±3.2）h], postoperative exhaust time[（15.5±4.6）h vs.（20.2±6.5）h], indwelling catheter time[（20.1±4.9）h vs.（28.4±6.8）h], mobilization time[（19.2±3.5）h vs.（24.2±7.9）h], the length of hospital stay[（4.5±0.7）d vs.（5.8±1.2）d]and hospitalization expense[（6 545.2±430.7）CNY vs.（7 953.8±653.3）CNY]of the observation group were less than those of the control group, the differences were statistically significant（t=8.069, 3.538, 5.938, 3.582, 5.590, 10.777, all P〈0.05）. There were no statistically significant differences between the two groups in the operation time[（45.3±20.8）min vs.（39.9±17.4）min]and the amount of bleeding[（69.4±32.2）mL vs.（57.0±24.5）mL]（t=0.231, 0.067, all P〉0.05）.ConclusionThe ERAS program perioperative management can speed up the postoperative recovery process, reduce the length of hospital stay and the financial burden of patients who underwent transvaginal hysterectomy.