加速康复外科在早期非小细胞肺癌围术期管理的应用评价

Value of enhanced recovery after surgery in peri-operative management of early-stage non-small cell lung cancer

目的探讨加速康复外科理念(ERAS)在早期非小细胞肺癌(NSCLC)根治术围手术期管理的优势及临床价值。方法收集2017年1月至2019年5月接受手术治疗的98例早期NSCLC患者的临床资料进行回顾性研究。以采用ERAS理念进行围手术期处理的49例为ERAS组,采用传统围手术期理念处理的49例为对照组;对比两组患者的术前一般资料及相关临床指标,包括疼痛数字评分法(NRS)评分。结果两组患者的术前一般资料、手术持续时间、清扫淋巴结个数、术中出血量、术后胸腔引流量、并发症发生率等情况均无明显差异(P均>0.05);但ERAS组术后24 h NRS评分[(2.6±0.6)分vs(4.2±0.8)分,P<0.01]、48 h NRS评分[(1.4±0.5)分vs(3.3±0.6)分,P<0.01]、72 h NRS评分[(0.9±0.4)分vs(1.9±0.5)分,P<0.01]、术后胸腔引流管拔除时间[(2.5±0.5)d vs(3.0±0.5)d,P<0.01]、术后住院时间[(6.0±1.5)d vs(7.5±3.0)d,P<0.01]均明显优于对照组。两组患者围手术期无死亡病例。所有患者术后随访1~3个月;1个月内无因发生并发症而再次住院或手术患者。结论将ERAS理念应用于早期NSCLC患者围手术期管理,安全有效,可加快患者术后恢复。

Objective To investigate the advantages and clinical value of enhanced recovery after surgery(ERAS)in peri-operative management of early-stage non-small cell lung cancer(NSCLC)after radial operation.Methods The clinical data of 98 patients with early-stage NSCLC receivied surgical treatment from January 2017 to May 2019 were collected.The patients with ERAS concept in the perioperative management were designed in ERAS group(n=49),and the patients with traditional perioperative concept were taken as control group(n=49).Preoperative general data and relevant clinical indicators were compared between two groups.Results There were no significant differences in the patient′s general data,operative time,number of resected lymph nodes,intraoperative blood loss,time of closed drainage tube removal,postoperative drainage volume and complications between two groups(all P>0.05).Numerical rating scale(NRS)scores at postoperative 24 h(2.6±0.6 vs 4.2±0.8),48 h(1.4±0.5 vs 3.3±0.6)and 72 h(0.9±0.4 vs 1.9±0.5),time of drainage tube removal[(2.5±0.5)d vs(3.0±0.5)d]and postoperative hospital stay[(6.0±1.5)d vs(7.5±3.0)d]in ERAS group were significantly lower than those in control group(all P<0.01).All patients were followed up for 1-3 months,and no death occurred in perioperative period.There were no re-hospitalized or re-operated cases due to complications within 1 month after discharge.Conclusion It is safe and effective to apply ERAS concept in perioperative management of early-stage NSCLC patients receiving radial operation and can accelerate the postoperative recovery of patients.