加速康复外科干预对老年患者腹腔镜前列腺癌根治术后早期转归的影响

The influence of optimized strategies for enhanced recovery after surgery on the early outcomes in elderly patients after laparoscopic radical prostatectomy

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)干预在老年患者腹腔镜前列腺癌根治术中的应用效果及其对早期恢复的影响。方法回顾性分析2016年1月至2020年10月于首都医科大学附属北京朝阳医院行腹腔镜前列腺癌根治术的51例老年患者的临床资料,其中2016年1月至2017年5月26例患者接受常规康复外科(conventional recovery after surgery,CRAS)干预(CRAS组),2017年5月至2020年10月25例患者接受ERAS干预(ERAS组)。比较两组患者围手术期资料,麻醉前1 d和术后1 d蒙特利尔认知评估(Montreal cognitive assessment,MOCA)量表评分,术后30 min、6 h、24 h视觉模拟评分法(visual analogue scale,VAS)评分。结果 ERAS组患者术后1 d MOCA量表评分显著高于CRAS组(P<0.05),术后30 min、6 h、24 h VAS评分均显著低于同期CRAS组(均P<0.05),术后恶心、呕吐发生率均显著低于CRAS组(均P<0.05),术中晶体液用量、瑞芬太尼和舒芬太尼用量均显著少于CRAS组(均P<0.01),术后首次排气时间、术后首次下床活动时间均显著早于CRAS组(均P<0.05),住院天数显著短于CRAS组(P<0.05)。两组患者手术时间、术中出血量和术中胶体液用量比较差异均无统计学意义(均P>0.05)。结论在老年患者腹腔镜前列腺癌根治术围手术期应用ERAS干预是一种安全、可行的策略,不仅可以减少围手术期应激反应、加速患者胃肠功能恢复、减轻术后疼痛、促进术后早期康复、缩短住院天数,还可以改善患者术后认知功能。

Objective To investigate the effect of enhanced recovery after surgery(ERAS)intervention and the influence on the recovery of early outcomes in elderly patients after laparoscopic radical prostatectomy.Method Clinical data of 51 patients received laparoscopic radical prostatectomy in Beijing Chaoyang Hospital,Capital Medical University from January 2016 to October 2020 were retrospectively analyzed.Among them,26 patients intervened with conventional recovery after surgery(CRAS)from January 2016 to May 2017 were included in CRAS group,and 25 patients intervened with ERAS from May 2017 to October 2020 were included in ERAS group.The perioperative data,the Montreal cognitive assessment(MOCA)scale scores 1 day before anesthesia and 1 day after operation,and the visual analogue scale(VAS)scores at 30 min,6 h and 24 h after operation were compared between the two groups.Result The MOCA scale score 1 day after operation in ERAS group was significantly higher than that in CRAS group(P<0.05),the VAS scores at 30 min,6 h and 24 h after operation were significantly lower than those in CRAS group at the same period(all P<0.05),the incidence of postoperative nausea and vomiting were significantly lower than those in CRAS group(all P<0.05),the intraoperative crystal fluid consumption,remifentanil and sufentanil consumption were significantly lower than those in CRAS group(all P<0.01),the first postoperative exhaust time and the first postoperative ambulation time were significantly earlier than those in CRAS group(all P<0.05),the hospital day was significantly shorter than that in CRAS group(P<0.05).There were no significant differences in operation time,bleeding volume or colloid volume between the two groups(all P>0.05).Conclusion ERAS performed during the perioperative period are safe and feasible in elderly patients receiving laparoscopic radical prostatectomy,which can reduce perioperative stress response and intraoperative opioid dosages,shorten the postoperative period of exhaust and length of stay,accelerate the recovery of gastrointestinal function,alleviate postoperative pain,thus promoting the recovery.In addition,ERAS also can improve postoperative cognitive function.