加速康复外科在妇科微创手术围术期应用的临床研究

Application of enhanced recovery after surgery in perioperative period of minimally invasive gynecological surgery

目的探讨加速康复外科(ERAS)在妇科微创手术围术期应用。方法选取2019年2月至5月,于乌鲁木齐市某三甲医院妇科中心进行妇科微创手术治疗的151例患者为研究对象。采用简单随机化法,将其分为研究组(n=105,围术期采取ERAS管理措施)和对照组(n=46,围术期采取常规管理措施)。收集2组患者的一般临床资料,疾病类型与手术范围,术后首次下床活动、肛门排气、饮水、恢复常规饮食时间,术后当天、术后第1天安静及活动状态下视觉模拟评分量表(VAS)评分,并采用成组t检验、Mann-Whitney U检验或χ~2检验进行统计学比较。本研究获得病例收集医院伦理委员会审批(审批文号:K202001-20)。所有受试者均签署临床研究知情同意书。2组患者年龄、身高、体重、人体质量指数(BMI)等一般临床资料比较,差异均无统计学意义(P>0.05)。结果 (1)研究组患者恶性疾病、术前评估手术范围≥腹腔镜下子宫切除术手术范围者所占比例分别为12.4%(13/105)与30.5%(32/105),均显著高于对照组的0与15.2%(7/46),并且差异均有统计学意义(χ~2=6.232、3.888,P=0.013、0.049)。(2)研究组患者术后首次饮水时间和恢复常规饮食时间分别为5.0 h(3.0~9.0 h)与17.0 h(10.0~24.0 h),显著短于对照组的16.0 h(13.7~19.0 h)与24.0 h(19.5~30.2 h),并且差异均有统计学意义(Z=-7.255、-4.488,P<0.001)。(3)研究组患者术后当天及术后第1天活动状态下VAS评分分别为3.0分(3.0~4.0分)与2.0分(1.0~3.0分),均显著高于对照组的2.0分(2.0~3.0分)与1.0分(0~2.0分),并且差异均有统计学意义(Z=-5.458、-4.207,P<0.001)。(4)2组患者术后住院时间与住院总费用分别比较,差异均无统计学意义(P>0.05)。结论对妇科微创手术患者围术期实施ERAS管理措施,可明显加快患者术后恢复。由于本研究纳入样本量相对较小,并且研究组患者疾病严重程度更高、手术范围更大,ERAS在妇科微创手术围术期中的应用效果,仍然有待更多大样本、多中心、随机对照试验进一步研究、证实。

Objective To investigate application of enhanced recovery after surgery(ERAS)in perioperative period of minimally invasive gynecological surgery.Methods From February to May,2019,a total of 151 patients who underwent minimally invasive gynecological surgery in Gynecology Center of a grade A hospital in Urumqi were selected as research subjects.They were randomly divided into study group(n=105,taking ERAS management measures in perioperative period)and control group(n=46,taking routine management measures in perioperative period)by simple randomization method.The general clinical data,disease classification and resection extent of operation,the first time to out-of-bed activity after operation,anal exhaust,drinking water and time to return to routine diet,visual analogue scale(VAS)scores on the day after surgery and in the state of rest and activity on the first day after surgery of two groups were collected.Independent-samples t test,Mann-Whitney U test or chi-square test were used for statistical comparisons.This study was approved by the Ethics Committee of the grade A hospital in Urumqi(Approval No.K202001-20).Each patient signed the informed consent for clinical research.There were no statistical significances in age,height,weight,body mass index(BMI)and other general clinical data between two groups(P>0.05).Results①The proportion of malignant disease and preoperative assessment of resection extent of operation≥laparoscopic hysterectomy in study group were 12.4%(13/105)and 30.5%(32/105)respectively,which were significantly higher than those 0 and 15.2%(7/46)in control group,and both differences were statistically significant(χ2=6.232,3.888;P=0.013,0.049).②The first time to drink water after surgery and to return to routine diet in study group were 5.0 h(3.0-9.0 h)and 17.0 h(10.0-24.0 h),respectively,which were significantly shorter than those in control group 16.0 h(13.7-19.0 h)and 24.0 h(19.5-30.2 h),and both differences were statistically significant(Z=-7.255,-4.488;P<0.001).③VAS scores on the day after surgery and in the state of activity on the first day after surgery in study group were 3.0 scores(3.0-4.0 scores)and 2.0 scores(1.0-3.0 scores),respectively,which were significantly higher than those in control group 2.0 scores(2.0-3.0 scores)and 1.0 score(0-2.0 scores),and both the differences were statistically significant(Z=-5.458,-4.207;P<0.001).④There were no significant differences in the length of hospital stay after surgery and the total cost of hospital stay between two groups(P>0.05).Conclusions ERAS can significantly accelerate postoperative recovery in patients undergoing minimally invasive gynecological surgery in perioperative period.Due to the relatively small sample size included in this study,and the patients in study group have more severe disease and greater scope of surgery,the application effect of ERAS in perioperative period of minimally invasive gynecological surgery still needs more large samples,multi-center,randomized controls to further studied and confirmed.