加速康复外科理念在功能性内镜鼻窦手术围手术期护理的初步应用

Preliminary application of enhanced recovery after surgery in the perioperative nursing in functional endoscopic sinus surgery

目的初步探讨加速康复外科理念(ERAS)在功能性内镜鼻窦手术(FESS)围手术期护理中的作用。方法将在2017年10月1日~2017年12月31日行全麻功能性鼻内镜鼻窦手术的48例患者按入院日期的单、双分配到ERAS组(n=17)及常规手术组(n=31)。将住院费用、术后疼痛程度、术后睡眠情况、术后活动意愿及术后进食质量进行组间对比。结果两组的住院费用差异无统计学意义(P=0.16)。ERAS组在术后当天即摆脱了疼痛的困扰,活动意愿及进食质量也显著高于常规手术组(P<0.001)。常规手术组的疼痛程度需在术后第2天方能达到ERAS组相似的水平(P=0.14),活动意愿及进食质量也需在术后第1天才能达到ERAS组相似的水平(P=0.23,P=0.15)。睡眠质量在术后当天虽然未见显著的组间差异(P=0.25),但ERAS组的睡眠时间显著长于常规手术组(P=0.002)。结论在住院费用无显著增加的前提下,ERAS有望帮助FESS患者获得更大的术后舒适度。

Objective To explore the role of enhanced recovery after surgery（ ERAS） in perioperative nursing of functional endoscopic sinus surgery（ FESS）. Methods From October 1,2017 to December 31,2017,48 patients who underwent general anesthesia functional endoscopic sinus surgery in our department were assigned to the ERAS group（ n = 17） and the conventional surgery group（ n = 31） according to the admission date. The hospitalization costs,the degree of postoperative pain,postoperative sleep,postoperative motivation,and postoperative feeding quality were compared between groups. Results There was no significant difference in hospitalization costs between the two groups（ P = 0.16）. In the ERAS group,the pain was relieved on the day after surgery,and the willingness to move and the quality of eating were also significantly higher than those in the conventional surgery group（ P〈0.001）. The pain level of the conventional surgery group should reach the similar level in the ERAS group on the 2 nd day after surgery（ P = 0.14）. The willingness to move and the quality of eating also need to reach the similar level in the ERAS group on the 1 st postoperative day（ P = 0.23,P = 0.15）. Sleep quality did not showsignificant intergroup differences on the day after surgery（ P= 0.25）,but the sleep time in the ERAS group was significantly longer than in the conventional surgery group（ P = 0.002）.Conclusion ERAS is expected to help patients with FESS achieve greater postoperative comfort without a significant increase in hospitalization costs.