围术期加速康复外科策略在腹腔镜膀胱癌根治术麻醉管理中的应用

Application of strategy of enhanced postoperative recovery in the anesthesia management of laparoscopic radical cystectomy

目的探讨围术期加速康复外科(enhanced recovery after surgery, ERAS)在腹腔镜膀胱癌根治术患者麻醉管理中的应用效果及对患者术后疼痛及恢复质量的改善作用。方法 2016年6月至2018年3月行腹腔镜根治性膀胱切除术治疗患者70例,男57例,女13例,年龄18~75岁,ASAⅠ或Ⅱ级,随机分为两组:ERAS组(E组,n=31)和对照组(C组,n=39)。ERAS组基本要素包括:术前积极宣教、取消常规肠道准备、术前2h摄入含糖饮料、术中体温监测、优化液体管理、避免或减少放置引流、多模式镇痛、术后早期进食及下床活动等。记录术后2、6、12、24 h VAS评分及PCIA有效按压次数以及术后引流管拔管时间、胃管拔除时间、首次排气时间、首次下地时间、首次普食时间和术后住院时间。结果与C组比较,E组术中瑞芬太尼用量明显减少(P<0.01),术后2、6、12和24 h VAS评分明显降低,术后24 h内有效按压次数明显减少(P<0.05);E组术后引流管拔管时间、胃管拔除时间、首次排气时间、首次下地时间和首次普食时间明显缩短(P<0.05);E组术后恶心呕吐发生率明显降低(P<0.05)。两组术后住院时间差异无统计学意义。结论在行腹腔镜膀胱癌根治术的患者围术期麻醉管理中实施ERAS策略可以明显改善术后恢复质量。

Objective To explore the application of strategy of enhanced postoperative recovery(ERAS)in the anesthesia management of laparoscopic radical cystectomy(LRC) and the improvement of postoperative pain and recovery quality. Methods Seventy LRC patients from June 2016 to March 2018, 57 males, 13 females, aged 18-75 years, falling into ASA physical status Ⅰ or Ⅱ,were randomly divided into the ERAS group(group E, n=31) and conventional recovery after surgery group(group C, n=39). Pain was evaluated by recording the VAS scores at 2, 6, 12 and 24 h after surgery and the effective compressions of PCIA at different time points after surgery. The first exhaust time, the first normal diet time, the first ambulation time, gastric tube removal time and urinary catheter removal time were used to assess the quality of postoperative recovery. Results Compared with group C, the amount of remifentanil used in the group E and VAS score at 2, 6, 12 and 24 h after surgery were significantly decreased(P<0.01), The numbers of effective compressions of PCIA in the group E were obviously reduced(P<0.05). The first exhaust time, the first normal diet time, the first ambulation time, the gastric tube extraction time, and the drainage tube extraction time in the group E were obviously less than that in the group C(P<0.05);The incidence of postoperative nausea and vomiting was significantly lower in group E than that in the group C(P<0.05). There were no significant differences in chill, intestinal obstruction, lung infection and lower limb venous thrombosis between the two groups. Conclusion The application of ERAS strategy in the anesthesia management of patients undergoing LRC can significantly improve the quality of postoperative recovery.