加速康复策略的麻醉管理在胃食管反流病手术治疗中应用的效果评价

Effect of enhanced recovery after surgery applicated in patients undergoing gasroesophageal reflux disease operation

目的探讨加速康复策略对采用腹腔镜手术治疗的胃食管反流病患者术后胃肠功能恢复、疼痛及应激反应因子的影响。方法选择2017年9月至2018年6月在新疆自治区人民医院进行腹腔镜手术的胃食管反流病患者62例。按照随机数字表法分为加速康复组与对照组2组,每组各31例。加速康复组患者围手术期应用加速康复策略进行麻醉管理,对照组患者行传统麻醉处理措施。观察并记录2组患者胃肠功能恢复时间(包括肠鸣音恢复时间、肛门排气时间)、术后疼痛视觉模拟评分(VAS)、术后应激性指标[包括C-反应蛋白(CRP)、皮质醇水平及白细胞(WBC)计数]、下床活动时间、术后住院时间、患者满意度及术后并发症等,并采用t检验进行比较。结果加速康复组患者肛门排气时间、肠鸣音恢复时间、下床活动时间均短于对照组患者,且差异均有统计学意义(t=14.95、16.39、14.94,P均<0.001)。但2组患者术后住院时间、满意度评分差异均无统计学意义。加速康复组患者术后疼痛VAS评分低于对照组患者,且差异有统计学意义(t=5.942,P<0.001)。加速康复组患者术后CRP水平、WBC计数均较术前升高,而皮质醇水平较术前降低,但差异均无统计学意义。对照组患者术后CRP水平、WBC计数均较术前升高,但差异均无统计学意义;皮质醇水平也较术前升高,但差异有统计学意义(t=13.15,P=0.048)。术前2组患者CRP、皮质醇水平及手术前后WBC计数差异均无统计学意义,术后加速康复组CRP、皮质醇水平均低于对照组患者,且差异均有统计学意义(t=0.60,P=0.001;t=4.640,P<0.001)。2组患者术后均无严重并发症发生。结论在胃食管反流病患者腹腔镜手术围手术期应用加速康复策略进行麻醉管理可以明显促进胃肠功能恢复,缓解术后疼痛,降低术后炎性反应,且安全性高。

Objective To explore the effect of accelerated rehabilitation strategy on gastrointestinal function recovery,pain and stress response factors in patiens with gasroesophageal reflux disease(GERD)treated by laparoscopic sugery.Methods Totally 62 cases of patients with GERD were selected for laparoscopic surgery from Septemper 2017 to June 2018 in the Xinjiang Uygur Automous Region People’s Hospital.According to the stochastic numerical table method,all patients were divided into 2 groups,the accelerated rehabilitation group and the control group,with 31 cases in each group.The accelerated rehabilitation group was treated with enhanced recovery strategy in the perioperative period;the control group was treated with traditional anesthesia.The recovery time of gastrointestinal function(including bowel recovery time,anus exhaust time),postoperative pain visual simulation score(VAS),postoperative stress index[incuding C-reaction protein(CRP),cortisol level and white blood cell(WBC)count],postoperative activity time,hospital stay time,patients satisfaction,postoperative complication etc were recorded,and compared with t test.Results The time of anus exhaust,the bowel recovery time,postoperative activity time were shorter than those in control group,and the differences were statistically significant(t=14.95,16.39,14.94,all P<0.001).However,there was no statistically significant difference in hospital stay time and patients satisfaction scores.The scores postoperative pain VAS score was lower in the accelerated rehabilitation group than in control group,the difference was statistically significant(t=5.942,P<0.001).In the control group,postoperative CRP level,WBC count were both higher than those before surgery,but the differences were not statistically significant.Cortisol level was also higher than that before surgery,but the difference was statistically significant(t=13.15,P=0.048).There were no statistically significant difference in CRP,cortisol level and WBC count before and after surgery between the two groups.CRP,cortisol level in the postoperative accelerated rehabilitation group were lower than those in the control group,and the difference were statistically significant(t=0.60,P=0.001;t=4.640,P<0.001).No serious complication occurred in the two groups.Conclusion In laparoscopic GERD operation at perioperative period,the application of accelerated rehabilitation strategy for anesthesia management can significantly promote the recovery of gastrointestinal function,alleviate postoperative pain,decrease the postoperative inflammatory response,and has higher security.