妇科手术中快速康复外科理念的麻醉管理的应用效果研究

Study on the application effect of anesthesia management in the concept of rapid rehabilitation surgery in gynecological surgery

目的:本研究立足妇科手术患者旨在探讨分析妇科手术中快速康复外科理念的麻醉管理的效果。方法:选取2015年1月至2018年5月172例在妇产科行妇科手术的患者,其中开腹手术86例,腹腔镜手术86例,分别分为观察组43例和对照组43例,对照组实施传统麻醉管理计划,实验组实施妇科手术快速康复外科手术麻醉管理,比较观察组、对照组患者术后肛门通气时间、肛门排便时间、住院时间及住院费用,术前、术后1、4 d胰岛素抵抗指数(homeostasis model assessment-IR,HOMA-IR指数)、C反应蛋白(C-reactionprotein,CRP)、白细胞介素6(inter-leukin-6,IL-6)、肿瘤坏死因子(tumor necrosis factor-α,TNF-α)血清前白蛋白(prealbumin,PA)、白蛋白(albumin,ALB),术后并发症发生情况。结果:观察组患者术后肛门通气时间、肛门排便时间、住院时间较对照组显著缩短,住院费用较对照组显著减少(P<0.05),术前1 d观察组、对照组患者HOMA-IR指数、CRP、IL-6、TNF-α、PA、ALB指标水平差异无统计学意义(P>0.05),术后1、4 d观察组患者HOMA-IR指数、CRP、IL-6、TNF-α指标水平较对照组均显著降低,而PA、ALB指标水平较对照组显著提高(P<0.05),观察组患者术后并发症发生率较对照组显著降低(P<0.05)。结论:无论是开腹手术还是腹腔镜手术,实施妇科手术快速康复外科手术麻醉管理均能够改善胰岛素抵抗,降低炎性因子水平,提高营养性指标水平,加速患者术后康复,建议在临床上推广。

Objective:To study the effect of anesthesia management in the concept of rapid rehabilitation surgery in gynecological surgery.Methods:From January 2015 to May 2018,172 patients,who underwent gynecological surgery including 86 cases of open surgery and 86 cases of laparoscopic surgery,were divided into the observation group and the control group respectively,43 patients in each group.The control group underwent the traditional anesthesia management plan,while the observation group underwent the anesthesia management in the concept of rapid rehabilitation surgery in gynecological surgery,with the postoperative anal ventilation time,anal defecation time,hospitalization time and hospitalization cost compared,and Insulin resistance index(HOMA-IR index),C-reactive protein(CRP),inter-leukin-6(IL-6),tumor necrosis factor(TNF-α),serum prealbumin(PA),albumin(ALB)and postoperative complications)measured before and 1 d and 4 d after surgery.Results:Postoperative anal ventilation time,anal defecation time,and hospitalization time in the observation group were significantly shorter than those in the control group,and the hospitalization cost in the observation group was significantly lower than that in the control group(P<0.05).There were no significant differences in HOMA-IR index,CRP,IL-6,TNF-α,PA and ALB levels between the two groups 1d before operation(P>0.05).HOMA-IR index,CRP,IL-6 and the levels of TNF-αin the observation group were significantly lower than those in the control group 1 and 4 days after operation,while the levels of PA and ALB in the observation group were significantly higher than those of the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05).Conclusion:Whether it is open surgery or laparoscopic surgery,the implementation of the anesthesia management in the concept of rapid rehabilitation surgery in gynecological surgery can improve insulin resistance,reduce the level of inflammatory factors,improve the level of nutritional indicators and accelerate the postoperative rehabilitation of patients,worthy of clinical popularization.