ERAS理念对单孔胸腔镜肺叶切除患者围手术期的应用效果评估

Evaluation of the ERAS concept in patients undergoing single-port thoracoscopic lobectomy during perioperative period

目的探讨加速外科康复(ERAS)理念对单孔胸腔镜肺叶切除患者围手术期的应用效果。方法120例单孔胸腔镜肺叶切除患者,按入院时间分为对照组和研究组,各60例。对照组予以常规围手术期干预,研究组按ERAS理念进行围手术期干预。比较两组术后恢复情况、术后不同时间视觉模拟评分法(VAS)评分及术后并发症发生情况。结果研究组术后肛门排气时间(25.42±2.77)h、下床活动时间(23.19±3.41)h、尿管留置时间(4.15±2.06)h、引流管留置时间(1.79±0.51)d、术后住院时间(5.14±0.62)d均明显短于对照组的(28.19±2.05)h、(26.41±4.50)h、(7.01±3.13)h、(3.25±1.07)d、(6.37±0.57)d,差异具有统计学意义(P<0.05)。研究组术后12、24、48、72 h VAS评分均明显低于对照组,差异具有统计学意义(P<0.05)。研究组术后肺不张或感染、心律失常发生率均明显低于对照组,差异具有统计学意义(P<0.05);两组切口感染和下肢静脉血栓发生率比较,差异无统计学意义(P>0.05)。结论对单孔胸腔镜肺叶切除患者围手术期应用ERAS理念进行干预,可明显改善术后疼痛,缩短患者恢复时间,降低肺不张或感染、心律失常等并发症,是加快患者术后康复的有效途径。

Objective To discuss the application effect of enhanced recovery after surgery(ERAS)concept in patients undergoing single-port thoracoscopic lobectomy during perioperative period.Methods A total of 120 patients with single-port thoracoscopic lobectomy were divided into control group and research group according to the time of admission,with 60 cases in each group.The control group received conventional perioperative intervention,while the research group received perioperative intervention according to the ERAS concept.The postoperative recovery,postoperative visual analogue scale(VAS)scores at different time points,and postoperative complications were compared between the two groups.Results In the research group,the postoperative anal exhaust time was(25.42±2.77)h,the off-be activity time was(23.19±3.41)h,the indwelling time of urinary catheter was(4.15±2.06)h,the indwelling time of drainage tube was(1.79±0.51)d,the postoperative hospitalization time was(5.14±0.62)d,which were significantly shorter than(28.19±2.05)h,(26.41±4.50)h,(7.01±3.13)h,(3.25±1.07)d,and(6.37±0.57)d in the control group,and the differences were statistically significant(P<0.05).The VAS scores at 12,24,48 and 72 h postoperatively in the research group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The incidences of postoperative pulmonary atelectasis or infection and arrhythmia in the research group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of incisional infection and lower limb venous thrombosis between the two groups(P>0.05).Conclusion Perioperative intervention with ERAS concept in patients with single-port thoracoscopic lobectomy can significantly improve postoperative pain,shorten recovery time,and reduce complications such as atelectasis,infection,and arrhythmia,which is an effective way to speed up postoperative recovery.