加速康复外科在妇科腹腔镜手术中应用的可行性和安全性分析

The feasibility and safety of enhanced recovery after surgery in gynecological laparoscopic surgery

目的探讨加速康复外科（enhanced recovery after surgery,ERAS）用于妇科腹腔镜手术患者的可行性和安全性。方法将2017年7月至2017年12月于本院妇科行腹腔镜手术的患者104例,按照随机数字表分为ERAS组（采用ERAS处理）和对照组（采用传统方法处理）,每组各52例,比较两组患者术前血糖、术前乏力腹泻、手术时间、术中出血量、术后排气时间、平均住院日、再入院率及术后并发症等指标。结果 ERAS组患者术前饥饿感发生率（28.85%,15/52）、术前睡眠不良发生率（30.77%,16/52）、术前乏力、腹泻等不适发生率（5.77%,3/52）均明显低于对照组（P 〈0.05）。ERAS组患者术后24 h内肛门排气（71.15%,37/52）、术后6 h内下床（48.08%,25/52）、术后6 h疼痛评分≤3分（69.23%,36/52）、术后饥饿感（15.38%,8/52）、术后恶心呕吐发生率（28.85%,15/52）和平均住院日[（6.52±3.18）d]均明显低于对照组（P 〈0.05）。两组患者手术时间、术中出血量、术后尿潴留、术后感染、肠梗阻等发生率比较,差异均无统计学意义（P〉0.05）。两组术后均无血栓及再入院患者。结论采用ERAS理念对妇科腹腔镜手术患者进行围手术期处理,能够减轻患者术前不适,促进患者术后恢复,且并不增加术后并发症的发生。

Objective To explore the feasibility and safety of enhanced recovery after surgery（ERAS） in gynecologic laparoscopic surgery. Methods A randomized controlled study was conducted from July 2017 to December 2017 in our hospital, including 104 patients who underwent gynecological laparoscopic surgery. 52 cases underwent perioperative treatment with the concept of ERAS（ERAS group）, and 52 cases underwent the traditional perioperative treatment（control group）. The difference of preoperative blood glucose, preoperative fatigue, diarrhea, operation time, intraoperative blood loss, postoperative exhaust time, average hospital stay, readmission rate and postoperative complications were compared between the two groups preoperatively. Results The incidence of preoperative hunger（28.85%, 15/52）, preoperative sleep dyspnea（30.77%, 16/52）, preoperative fatigue, diarrhea and other discomfort（5.77%, 3/52） in the ERAS group were significantly lower than those in the control group（P〈0.05）. In the ERAS group, postoperative exhaust within 24 h（71.15%, 37/52）, postoperative ambulation within 6 h（48.08%, 25/52）, postoperative pain score ≤ 3 within 6 h（69.23%, 36/52）, postoperative hunger（15.38%, 8/52）, the incidence of postoperative nausea and vomiting（28.85%, 15/52） and average hospitalization days [（6.52＋3.18） d] were significantly lower than the control group（P〈0.05）. The incidence of operation time, intraoperative blood loss, postoperative urinary retention, postoperative infection and intestinal obstruction were not statistically significant between the two groups（P〈0.05）. Conclusion The perioperative treatment of patients undergoing gynecological laparoscopic surgery with the concept of ERAS can alleviate preoperative discomfort and promote postoperative recovery without increasing postoperative complications