加速康复外科理念在腹腔镜全子宫切除术围手术期的应用价值

Application value of enhanced recovery after surgery in perioperative period of laparoscopic hysterectomy

目的探讨加速康复外科（ERAS）理念和措施在腹腔镜下全子宫切除术患者围手术期的安全性及临床应用效果。方法选取2017年1—12月郑州大学第一附属医院妇科因子宫良性疾病行腹腔镜下全子宫切除术的患者200例,采用区组随机化分组将患者随机分成ERAS组和对照组,每组分别为100例,ERAS组和对照组分别采用加速康复外科和传统的围手术期处理原则,比较两组患者的手术时间、术中出血量、术后首次肛门排气时间、术后镇痛效果、术后并发症、术后住院时间、住院费用及患者满意度情况。结果 ERAS组的手术用时为（63.43±9.18）h,术中出血量为（36.31±17.06）ml,对照组分别为（65.22±8.82）h和（34.96±16.60）ml,两组比较,差异均无统计学意义（P〉0.05）;ERAS组患者术后首次肛门排气时间为（12.13±2.22）h,术后镇痛效果评分为（3.57±1.54）分,术后住院时间为（4.03±0.82）d,住院费用为（12 865.74±861.03）元,对照组分别为（23.31±4.97）h、（5.89±1.29）分、（5.95±1.03）d、（15 970.16±612.43）元,两组各指标比较,差异均有统计学意义（P 〈0.05）;ERAS组术后并发症发生率（5.0%,5/100）与对照组（8.0%,8/100）比较,差异无统计学意义（P〉0.05）。结论加速康复外科理念在腹腔镜下全子宫切除术围手术期的应用,缩短了患者住院日,减少了患者住院费用,提高了患者的满意度,且未增加术后并发症发生率,具有安全性。

Objective To investigate the safety and clinical effect of enhanced recovery after surgery（ERAS） during perioperative period of laparoscopic hysterectomy. Methods A total of 200 patients underwent laparoscopic hysterectomy for the gynecological benign disease of in the First Affiliated Hospital of Zhengzhou University from January to December 2017 were randomly divided into two groups： ERAS group and control group. Each group consisted of 100 patients. The ERAS group and the control group were treated with enhanced recovery after surgery and traditional perioperative management respectively. The operation time, intraoperative blood loss, first postoperative anal exhaust time, postoperative analgesia effect, postoperative complications, postoperative hospital stay, hospitalization expenses and patient satisfaction were compared between the two groups. Results The operation time of the ERAS group was（63.43±9.18） h, and the intraoperative blood loss was（36.31±17.06） ml, and the control group was（65.22±8.82） h and（34.96±16.60） ml, respectively. There was no significant difference between the two groups（P〈0.05）. In ERAS group, the first anal exhaust time was（12.13±2.22） h, the postoperative analgesia was（3.57±1.54） score, and the postoperative hospital stay was（4.03±0.82） days, the hospitalization cost was（12 865.74±861.03） yuan, and the control group was（23.31±4.97） h（5.89±1.29） score,（5.95±1.03） d,（15970.16±612.43） yuan respectively. There were significant differences between the two groups（P〈0.05）. The incidence of postoperative complications in the ERAS group（5.0%, 5/100） was not statistically significant compared with the control group（8.0%, 8/100）（P〈0.05） Conclusions The application of enhanced recovery after surgery in the perioperative period of laparoscopic hysterectomy has shorten the patient＇s hospital stay, reduced the hospitalization cost, improved the patient＇s satisfaction, and did not improve the postoperative complication rate,which can be used safely.