快速康复外科在产科手术中的安全性及可行性

Safety and feasibility of fast track surgery in obstetric surgery

目的:探讨快速康复外科(fast track surgery,FTS)在产科手术中的安全性及可行性。方法:收集择期剖宫产孕妇493例,随机分为快速康复组150例,对照组343例(包括止痛药组39例,止痛药+杜密克组29例,镇痛泵组71例,未用止痛药及杜密克镇痛泵组204例),比较术后排气时间、排尿时间、排便时间、并发症、子宫复旧、疼痛评分和住院时间。结果:快速康复组较对照组术后疼痛轻、子宫复旧好、胃肠功能及膀胱功能恢复快、术后住院时间短(P<0.05或P<0.01),术后并发症及Hb下降值无明显差异(P>0.05);在对照组中,止痛药+杜密克组排气排便更快(P<0.05)。结论:FTS方案可减轻患者术后疼痛、加快术后胃肠道功能及子宫复旧,降低术后住院时间、便秘发生率,同时并不增加尿潴留、腹胀发生率以及出血量。

Objective: To explore the safety and feasibility of rapid rehabilitation surgery in obstetric surgery. Methods: 493 pregnant women undergoing elective cesarean section were randomly divided into fast rehabilitation group (150 cases) and control group (343 cases, including analgesic group, analgesic plus Duphalac group, analgesic pump group, analgesic pump group without analgesic and Duphalac). The time of exhaust, urination, defecation, complications, uterine involution, pain score and length of stay were compared after operation. Results: Compared with the control group, the rapid rehabilitation group had less pain, better uterine involution, faster recovery of gastrointestinal and bladder functions, shorter length of stay ( P < 0.05 or P < 0.01);no significant differences in postoperative complications and the decrease of Hb value were found(P >0.05);in the control group, the analgesic + Duphalac group had faster exhaust and defecation. Conclusion: Rapid rehabilitation surgery can relieve postoperative pain, accelerate gastrointestinal function and uterine involution, reduce length of stay and incidence of constipation, which does not increase the incidence of urinary retention, abdominal distension and bleeding.