瘢痕子宫剖宫产应用加速康复外科理念麻醉管理的效果观察

Observation on the Clinical Effect of Anesthesia Management in Cesarean Section of Scar Uterine with the Concept of Enhanced Recovery after Surgery

目的探讨瘢痕子宫剖宫产产妇应用加速康复外科理念(enhanced recovery after surgery,ERAS)麻醉管理的临床安全性及有效性。方法选择择期行瘢痕子宫剖宫产的单胎足月产妇100例,采用随机数字表法均分为ERAS组和对照组。ERAS组围术期应用ERAS麻醉管理,对照组围术期采用常规麻醉管理方案。比较两组术后6、12、24、48 h静息和运动状态疼痛视觉模拟评分(visual analogue score,VAS),入院时及术后24 h心率、收缩压和汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)评分,麻醉效果,术日7︰00及术后第1日7︰00两组空腹血糖、血乳酸、皮质醇和胰岛素水平,以及两组下地活动时间、肛门排气时间、初乳时间、术后72 h纯母乳喂养率、术后并发症发生情况。结果ERAS组术后6、12、24 h静息、运动状态VAS评分,术后24 h心率、收缩压和HAMA评分,术后第1日7︰00空腹血糖、血乳酸、皮质醇和胰岛素水平均低于对照组,麻醉效果优于对照组,差异均有统计学意义(P<0.05或P<0.01)。ERAS组下地活动时间、肛门排气时间、初乳时间均短于对照组,72 h纯母乳喂养率高于对照组,并发症发生率低于对照组,差异均有统计学意义(P<0.05或P<0.01)。结论瘢痕子宫剖宫产产妇应用ERAS麻醉管理可使麻醉效果更加确切,并有效缓解术后疼痛,改善应激状态,降低并发症发生率,促进术后康复。

Objective To investigate the clinical safety and effectiveness of the application of enhanced recovery after surgery(ERAS)anesthesia management in cesarean section(C-section)of scar uterine.Methods A total of 100 singleton full-term parturients of selective C-section of scar uterine were divided into ERAS group and control group by random number table method.The ERAS group received ERAS anesthesia management during the perioperative period,and the control group received conventional anesthesia management plan.Visual Analogue Score(VAS)at a resting and post-exercise state at 6,12,24,and 48 h after surgery,the heart rate(HR),systolic blood pressure(SBP)and Hamilton anxiety scale score(HAMA score)at admission and at 24 h after surgery,the anesthesia effect,the fasting blood glucose,blood lactate,cortisol and insulin levels at 7︰00 on the day of operation and 7︰00 on the first day after surgery,as well as the maternal activity time,anal exhaust time,colostrum time,72 h exclusive breastfeeding rate and the postoperative complications were compared between the two groups.Results The VAS scores at a resting and post-exercise state at 6,12 and 24 h after surgery,HR,SBP and HAMA score at 24 h after surgery,the fasting blood glucose,blood lactate,cortisol and insulin levels at 7:00 on the first day after surgery in the ERAS group were lower than those in the control group,and the anesthetic effect was better than that in the control group(P<0.05 or P<0.01).The maternal activity time,anal exhaust time,and the colostrum time in the ERAS group were shorter than those in the control group,the 72 h exclusive breastfeeding rate was higher than that of the control group,and the rate of complications was lower than that of the control group(P<0.05 or P<0.01).Conclusion The application of ERAS anaesthesia management in C-section of scar uterine can make the anesthetic effect more accurate,relieve postoperative pain effectively,improve stress state,reduce the incidence of complications,and promote postoperative rehabilitation.