加速康复外科在青年患者腰椎开窗减压椎间盘髓核摘除术中的应用研究

Application of enhanced recovery after surgery(ERAS)in young patients with lumbar decompression and the removal of nucleus pulposus

背景:腰椎开窗减压髓核摘除术在临床应用多年,疗效确切;但术后仍然存在一些并发症及不良反应。目的:研究加速康复外科(enhanced recovery after surgery,ERAS)在青年患者腰椎开窗减压椎间盘髓核摘除术中的应用效果。方法:前瞻性对2017年12月至2018年11月于我科因单节段腰椎间盘突出而行腰椎开窗减压椎间盘髓核摘除术的患者随机进行分组:ERAS组(36例)和对照组(36例)。ERAS组进行加速康复的干预,对照组进行常规围手术期处理。ERAS措施包括:术前宣教;术前饮食管理;氨甲环酸注射液的使用;显微镜下行椎管内操作;切口内引流管管理;切口缝合前皮下给予0.25%布比卡因行局部长效麻醉;尿管管理;围手术期限制补液量;早期功能锻炼等。对比分析两组患者术前、术后及末次随访时腰痛及下肢疼痛的VAS、ODI评分,术后阿片类镇痛药物使用量,手术时间,出血量,切口长度,下地时间,术后住院时间,手术相关并发症等;使用Likert 10级量表评估术后及末次随访时患者对治疗的满意度。结果:ERAS组术后早期VAS评分、术后恶心呕吐、泌尿系感染发生率、阿片类药物使用量、术后平均住院时间均低于对照组,差异有统计学意义(P<0.05)。ERAS组患者术后早期满意度明显高于对照组,差异具有统计学意义(P<0.05)。而两组在手术时间、切口长度、术中出血量等无统计学差异。结论:通过ERAS措施的实施,可以提高腰椎开窗减压椎间盘髓核摘除术患者的术后舒适度,缩短患者术后住院时间、减轻患者术后疼痛、降低术后并发症发生率及阿片类药物的使用,值得在脊柱外科临床推广。

Background:Lumbar decompression and nucleus pulposus removal has been used for many years,but there are still some complications and adverse reactions.Objective:To study the effect of enhanced recovery after surgery(ERAS)in young patients undergoing lumbar decompression and the removal of nucleus pulposus.Methods:In this prospective study,patients who underwent lumbar decompression and nucleus pulposus removal due to single segment lumbar disc herniation in our hospital from December 2017 to November 2018 were randomly divided into two groups:ERAS group and control group(n=36).Patients in the ERAS group was given ERAS intervention,and patients in the control group received conventional perioperative management.The measures of ERAS included preoperative education,preoperative diet management;use of tranexamic acid,intraspinal operation under microscope;management of drainage tube in incision,subcutaneous administration of0.25%bupivacaine for local long-term anesthesia before incision suture;management of urinary tube,perioperative fluid restriction,early functional exercise,etc.The VAS and ODI scores of low back pain and lower extremity pain before operation,after operation and at the last follow-up,the amount of postoperative opioid analgesics,operation time,bleeding volume,incision length,landing time,postoperative hospital stay,operation related complications of the two groups were compared.The patients’satisfaction after operation and at the last follow-up was evaluated by Likert 10 scale.Results:The early postoperative VAS score,the incidence of postoperative nausea and vomiting,urinary tract infection,the use of opioids and average hospital stay in the ERAS group were significantly less than those in the control group(P<0.05).The early postoperative satisfaction degree of patients in ERAS group was significantly higher than that in the control group(P<0.05).There was no significant difference in operation time,incision length or intraoperative hemorrhage between the two groups.Conclusions:ERAS measures can improve postoperative comfort,shorten postoperative hospital stay,reduce postoperative pain,the incidence of postoperative complications and the use of opioids.