快速康复管理模式在肺癌胸腔镜手术患者围术期的应用效果

Effect of enhanced recovery after surgery in the perioperative period of thoracoscopic surgery for lung cancer

目的评价快速康复(ERAS)管理模式在肺癌胸腔镜手术围术期的应用效果,并分析影响胸腔引流的相关因素。方法回顾性分析2019年6月至2020年12月我科收治的185例肺癌行胸腔镜手术患者的临床资料。根据围术期管理方式不同,将患者分为观察组(n=100,ERAS管理模式)和对照组(n=85,常规管理模式)。分析比较2组围术期有关指标的差异。采用Pearson相关性分析方法,分析留置引流时间与围术期有关指标的相关性。结果观察组在住院时间、住院费用、术后第1天排痰量、总排痰量、术后1 d及术后3 d疼痛视觉模拟评分法(VAS)评分和留置引流时间方面均显著优于对照组(P<0.001)。留置引流时间与术后第1天排痰量和术前血清白蛋白水平呈负相关(P<0.001);与总引流量、总排痰量、术后1 d VAS评分、术后3 d VAS评分、术中淋巴结清扫数量、手术时长呈正相关(P<0.001);与术后第1天引流量无相关性(P>0.05)。结论ERAS有利于加强胸腔镜手术后气道管理,可明显缩短留置引流时间和住院时间,从而减少患者的住院费用并使其显著获益。

Objective To evaluate the effect of enhanced recovery after surgery(ERAS)in the perioperative period of thoracoscopic surgery for lung cancer,and to analyze the related factors affecting thoracic drainage.Methods The clinical data of 185 patients with lung cancer who underwent thoracoscopic surgery from June 2019 to December 2020 were analyzed retrospectively.Based on the different perioperative management methods,the patients were divided into the observation group(n=100)and control group(n=85).ERAS protocols were used in the observation group,while routine management was used in the control group.The differences of perioperative indexes between the two groups were analyzed and compared.Based on the different indwelling and drainage time,the patients were divided into groups A and B.Pearson correlation analysis was used to analyze the correlation between indwelling drainage time and perioperative indexes.Results The observation group was superior to the control group in terms of hospitalization time,hospitalization expenses,sputum excretion volume on the first day after operation,total sputum excretion volume,visual analog scale(VAS)scores on the first and third days after operation,and indwelling drainage time.The difference was statistically significant(P<0.001).The indwelling drainage time was negatively correlated with the sputum excretion volume on the first day after operation and the level of serum albumin before operation(P<0.001).The indwelling drainage time was also positively correlated with total drainage volume,total sputum excretion volume,VAS scores on the first and third days after operation,number of intraoperative lymph node dissection,and operation time(P<0.001).There was no significant correlation with the drainage volume on the first day after operation(P>0.05).Conclusion The ERAS protocol has significant benefits on the strengthening of the postoperative airway management in the perioperative stage of thoracoscopic surgery,thereby shortening the indwelling drainage time and hospitalization time,and reducing the hospitalization cost.