ERAS围术期护理在斜外侧椎间融合术治疗腰椎滑脱症中的效果观察

Application effects of enhanced recovery after surgery perioperative nursing in treatment of lumbar spondylolisthesis by oblique lateral interbody fusion

目的探讨加速康复外科(ERAS)围术期护理在斜外侧椎间融合术(OLIF)治疗腰椎滑脱症中的应用效果。方法采用目的抽样法,将2017年3月至2018年1月脊柱外科接受OLIF治疗的68例腰椎滑脱症患者作为对照组,2018年2月至2019年5月收治的70例腰椎滑脱症患者作为观察组。在此基础上,对照组实施常规围术期护理干预,观察组在对照组基础上实施ERAS围术期护理干预。比较2组术后2周内并发症发生情况,术后24、48、72 h视觉模拟评分法(VAS)评分,术前及术后1、3个月Oswestry功能障碍指数问卷表(ODI)评分及日本骨科协会评估治疗(JOA)评分,并于术后3个月随访时评定腰椎功能恢复效果。结果术后24、48 h,观察组VAS评分均显著低于对照组(P<0.05);但2组术后72 h的VAS评分差异无统计学意义(P>0.05)。术后1、3个月,2组ODI评分均显著低于术前,JOA评分均显著高于术前,且观察组ODI评分均显著低于对照组,JOA评分均显著高于对照组(P<0.05)。观察组术后2周内并发症发生率显著低于对照组(P<0.05)。观察组术后3个月随访时腰椎功能优良率显著高于对照组(P<0.05)。结论将ERAS围术期护理应用于腰椎滑脱症OLIF治疗中,有利于减轻术后早期疼痛,降低术后并发症发生率,促进患者术后尽快康复,显著改善腰椎功能,提高其临床疗效,值得临床广泛推广。

Objective To investigate the application effects of enhanced recovery after surgery(ERAS)perioperative nursing in treatment of lumbar spondylolisthesis by oblique lateral interbody fusion(OLIF).Methods Using purpose sampling method,68 patients with lumbar spondylolisthesis who were treated in our hospital from March 2017 to January 2018 were enrolled as control group,and the other 70 patients with lumbar spondylolisthesis who were treated in our hospital from February 2018 to May 2019 were enrolled as observation group.The patients in both groups were treated by OLIF,on that basis,the patients in control group were given routine perioperative nursing intervention,however,the patients in observation group,on the basis of control group,were given ERAS perioperative nursing intervention.The incidence of complications within two weeks,visual analogue scales(VAS)at 24h,48h and 72 hours after surgery,Oswestry disability index(ODI)scores and Japanese orthopaedic association scores(JOA)before surgery,and at 1m and 3m after surgery were observed and compared between the two groups.Moreover the effects of lumbar function recovery at 3-month follow up after surgery were observed and compared between the two groups.Results The VAS scores at 24h,48h after surgery in observation group were significantly lower than those in control group(P<0.05),but there were no significant differences at 72 hours after surgery between the two groups(P>0.05).The ODI scores at 1m and 3m after surgery in both groups were significantly lower than those before surgery,however,the JOA scores were significantly higher than those before surgery,moreover,which in observation group were significantly lower than those control group,and JOA scores were significantly higher than those in control group(P<0.05).In addition the incidence rate of complications within two weeks after operation in observation group was significantly lower than that in control group(P<0.05).The excellent/good rate of lumbar function in observation group was 88.57%,which was significantly higher than that(69.12%)in control group(P<0.05).Conclusion The application of ERAS perioperative nursing in treatment of lumbar spondylolisthesis after OLIF is beneficial to reduce the early postoperative pain,reduce the incidence of postoperative complications,promote the recovery of patients as soon as possible,which can significantly improve the lumbar function of patients,improve the clinical effects,thus,it is worth popularizing widely in clinical practice.