加速康复外科在子宫内膜异位性疾病患者中的应用研究

Study on the application of enhanced recovery after surgery in patients with endometriosis and adenomyosis

目的分析加速康复外科(enhanced recovery after surgery,ERAS)临床路径在子宫内膜异位性疾病患者中应用的安全性及有效性。方法采用病例对照研究方法分析2017年8月1日至2018年8月31日期间于中国医科大学附属盛京医院住院行手术治疗的子宫内膜异位性疾病患者。进入ERAS路径的183名患者为ERAS组,传统路径的255名患者为对照组,分析两组手术后的康复情况。结果共纳入438例患者。ERAS组患者手术后排气时间[(37.57±12.10)h]早于对照组[(47.28±17.36)h,P<0.001];ERAS组手术后疼痛评分(手术后第1日晨8时:2.86±0.89,手术后第2日晨8时:1.99±0.73)低于对照组(2.96±0.92,2.41±0.82,P均<0.001);ERAS组手术后较手术前血液中D-二聚体升高倍数[1.67(0.68,3.04)]低于对照组[3.17(1.55,5.72),P<0.001];ERAS组手术后住院时间[(5.20±1.07)d]短于对照组[(5.52±1.46)d,P=0.009]。结论ERAS路径的应用可缩短子宫内膜异位性疾病患者手术后排气时间,减轻手术后疼痛,改善手术后血液高凝状态以及减少住院时间;ERAS在子宫内膜异位性疾病患者中的应用安全可行且有效。

Objection To study the safety and effect of enhanced recovery after surgery(ERAS)in patients with endometriosis and adenomyosis.Methods Totally 483 patients with endometriosis and adenomyosis who were admitted to Shengjing Hospital of China Medical University from August 1,2017 to August 31,2018 were included.Totally 183 patients underwent ERAS(ERAS group)and 255 patients underwent conventional pathway(control group)were enrolled.Perioperative intestinal function,pain score,inflammatory index,postoperative complications and length of hospital stay were analyzed.Results Compared with control group,the time of postoperative exhaust in ERAS group was earlier[(37.57±12.10)h vs.(47.28±17.36)h,P<0.001].Postoperative pain score was decreased[8:00 am at postoperative day 1(2.86±0.89 vs.2.96±0.92);8:00 am at postoperative day 2(1.99±0.73 vs.2.41±0.82),all P<0.001].The increase of D-dimer in blood after surgery was lower[1.67(0.68,3.04)vs.3.17(1.55,5.72),P<0.001].Postoperative hospital stay was shorter[(5.20±1.07)d vs.(5.52±1.46)d,P=0.009].Conclusion The application of ERAS path in patients with endometriosis and adenomyosis can shorten the postoperative exhaust time,reduce the postoperative pain,improve the postoperative hypercoagulability of blood and reduce the length of hospital stay.ERAS is safe,feasible and effective in patients with endometriosis and adenomyosis.