快速康复外科措施对精索静脉曲张患者术后康复进程、应激反应、并发症的影响

Effect of enhanced recovery after surgery on rehabilitation process,stress response and complications in patients with varicocele

目的探讨快速康复外科(ERAS)措施对精索静脉曲张(VC)患者术后康复进程、应激反应、并发症的影响。方法收集2019年1月至2021年12月首都医科大学附属北京地坛医院收治的80例VC患者的临床资料,将2019年1月至2020年5月采用常规围手术期干预措施的患者作为常规组,将2020年6月至2021年12月采用ERAS措施的患者作为ERAS组,每组40例。比较两组患者的手术相关指标及术后康复进程指标,包括手术用时、术中出血量、排气恢复时间、术后下床时间、住院时间。采用视觉模拟量表(VAS)评估并比较两组患者术后6、12、24 h时的疼痛程度。比较两组患者术前1 d、术后3 d的炎性反应指标,包括C反应蛋白(CRP)、白细胞介素-6(IL-6)、内皮素(ET)。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估并比较两组患者干预前后的心理状态。比较两组患者干预后下肢深静脉血栓(DVT)及其他手术并发症的发生率。结果ERAS组患者的术后排气恢复时间、术后下床时间、住院时间均明显短于常规组患者(P<0.01)。ERAS组患者术后6、12、24 h的VAS评分均低于常规组患者(P<0.05)。术后3 d,ERAS组患者的CRP、IL-6、ET水平均低于常规组患者(P<0.05)。干预后,ERAS组患者的SAS、SDS评分,下肢DVT的发生率及其他手术并发症总发生率均低于常规组患者(P<0.05)。结论ERAS措施能够促进VC患者术后康复,改善患者的心理状态,减轻术后炎性反应,降低下肢DVT及其他术后并发症的发生风险。

Objective To investigate the effect of enhanced recovery after surgery(ERAS)on rehabilitation process,stress response and complications in patients with varicocele(VC).Method Data of 80 patients with varicocele(VC)treated in Beijing Ditan Hospital Capital Medical University from January 2019 to December 2021 were collected,40 patients who received routine perioperative intervention from January 2019 to May 2020 were included in the conventional group and 40 patients who underwent ERAS from June 2020 to December 2021 were enrolled into ERAS group.The operation and postoperative rehabilitation indexes of the two groups were compared,including the operation time,intraoperative blood loss,exhaust recovery time,postoperative time of ambulation,and length of hospital stay.The pain degree of patients in the two groups at 6,12,and 24 h after surgery was evaluated and compared by visual analogue scale(VAS).Inflammatory response indexes[C-reactive protein(CRP),interleukin-6(IL-6)and endothelin(ET)]1 day before surgery and 3 days after surgery were compared.The psychological status[self-rating anxiety scale(SAS)and self-rating depression scale(SDS)]of patients in the two groups before and after intervention was observed.Incidence of lower extremity deep vein thrombosis(DVT)after intervention and other surgical complications were compared between the two groups.Result The recovery time of postoperative exhaust,postoperative time of abmulation and length of hospital stay in ERAS group were shorter than those in conventional group(P<0.01).VAS scores at 6,12 and 24 h in ERAS group were lower than those in conventional group(P<0.05).Three days after surgery,CRP,IL-6 and ET levels in ERAS group were lower than those in the conventional group(P<0.05).After intervention,SAS and SDS scores,incidence of lower extremity DVT and total incidence of other surgical complications in ERAS group were lower than those in conventional group(P<0.05).Conclusion ERAS can promote postoperative rehabilitation of patients with varicocele,improve psychological state,and reduce postoperative inflammatory response and the risks of DVT of lower extremities and other postoperative complications.