慢性鼻窦炎伴鼻息肉院前干预在术后加速康复中的应用价值

Application of pre-hospital intervention for chronic rhinosinusitis with nasal polyps in EARS

目的探讨慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)院前干预措施在其术后加速康复(enhanced recovery after surgery,ERAS)中的应用价值。方法选取符合纳入和排除标准的128例CRSwNP患者,随机分为干预组(60例)和对照组(68例)。干预组根据门诊健康评估、多学科协作(multidisciplinary team,MDT)及个体差异采用针对性预康复处理,对照组门诊评估后在院完善常规术前准备,围术期两组均实施常规ERAS方案。依据焦虑抑郁量表(hospital anxiety and depression scale,HADS)、医学结局研究睡眠量表(medical outcomes study sleep scale,MOS-SS)、视觉模拟量表(visual analogue scale,VAS),对比干预组患者心理干预前后的情绪状态、两组患者术后睡眠质量及不适症状程度。比较两组患者术中出血量、手术时间、术前在院等待时间、住院总时间及术后并发症发生率。结果干预组患者心理干预前后HADS评分为(6.10±1.39)分、(3.18±0.79)分,干预组和对照组术后MOS-SS评分为(47.77±2.98)分、(37.69±2.27)分,差异均有统计学意义(P<0.05);干预组术后鼻痛、口干、吞咽障碍、呼吸障碍的VAS评分均低于对照组,差异均有统计学意义(P<0.05);干预组术中出血量、手术时间、术前在院等待时间、住院总时间均少于对照组,差异均有统计学意义(P<0.05)。结论个体化的院前干预措施,可以为CRSwNP手术创造良好的机体条件,减少患者围术期的生理和心理应激,改善就医体验,促进术后康复,进一步完善CRSwNP的ERAS方案。

Objective To investigate the effect of pre-hospital intervention in chronic rhinosinusitis with nasal polyps(CRSwNP)in enhanced recovery after surgery(ERAS).Methods A total of 128 patients with CRSwNP meeting the inclusion criteria were selected and randomly divided into the intervention group(n=60)and the control group(n=68).The intervention group adopted targeted pre-rehabilitation treatment according to outpatient health assessment,multidisciplinary team(MDT)and individual differences,and the control group completed routine preoperative preparation in hospital after outpatient assessment.Routine ERAS protocol was implemented in both groups during perioperative period.According to the hospital anxiety and depression scale(HADS),medical outcomes study sleep scale(MOS-SS)and visual analogue scale(VAS),the emotional state before and after the psychological intervention of the patients in the intervention group,the postoperative sleep quality and the degree of discomfort symptoms of the two groups were compared.Intraoperative blood loss,operation time,waiting time in hospital before operation,total length of stay and incidence of postoperative complications were compared between the two groups.Results The HADS scores of the patients in the intervention group before and after the psychological intervention were 6.10±1.39 and 3.18±0.79 s,and the MOS-SS scores of the intervention group and the control group were 47.77±2.98 and 37.69±2.27 with statistically significant differences(P<0.05).VAS scores of postoperative nasal pain,dry mouth,dysphagia and respiratory disorders in the intervention group were lower than those in the control group(P<0.05).In the intervention group,intraoperative blood loss,operation time,preoperative waiting time in hospital and total hospitalization time were all less than those in the control group(P<0.05).Conclusions Individualized pre-hospital intervention could create a good physiological condition for CRSwNP surgery,reduce patients’perioperative physiological and psychological stress,improve medical experience,promote postoperative recovery and further improve the ERAS protocol for CRSwNP.