加速康复外科理念下的日间甲状腺手术围手术期管理

The application of enhanced recovery after surgery in perioperative management of thyroid ambulatory surgery

目的通过回顾性分析并总结加速康复外科(ERAS)理念用于日间甲状腺手术围手术期管理资料,为安全展开日间甲状腺手术提供参考依据。方法收集2019年1月至12月期间于中南大学湘雅医院日间手术中心ERAS理念下行甲状腺手术的患者,收集围手术期患者资料,记录术中不良事件,麻醉复苏情况,术后及出院后的恢复情况。结果本研究共纳入患者703例,其中甲状腺结节374例,甲状腺恶性肿瘤329例,二者手术时间、麻醉时间、苏醒时间及麻醉恢复室(PACU)停留时间比较差异无统计学意义(均P>0.05),且围手术期未出现高血压、低血压、心动过速、心动过缓及其他心律失常;未发生术中知晓、苏醒延迟等不良事件,术后未出现严重疼痛,未见恶心呕吐及头晕等不适;703例患者均在24 h内完成手术出院。结论ERAS理念下开展日间甲状腺手术,麻醉医师按照围术期医学要求全程参与患者管理,可安全实施日间甲状腺手术。

Objective Through retrospective analysis of perioperative management data of ambulatory thyroid surgery under the concept of enhanced recovery after surgery(ERAS),we provide foundation for the safe implementation of ambulatory thyroid surgery.Methods From January 2019 to December 2019,patients undergoing thyroid surgery were enrolled in the study under the concept of ERAS at the ambulatory surgery center of Xiangya Hospital,Central South University.Data of patients during perioperative period were collected,including adverse events,anesthesia recovery,postoperative and post-discharge recovery were recorded.Results This study was included 703 cases of patients,thyroid nodules in 374 cases,thyroid malignant tumor in 329 cases.There were no significance difference in the operation time,anesthesia time,wake up of time,and postanesthesia care unit(PACU)time between the two groups(all P>0.05).No hypertension,hypotension,tachycardia,bradycardia or other arrhythmias occurred during perioperative period.No adverse events such as intraoperative awareness and delay of wake up occurred.No severe pain,nausea,vomiting,dizziness and other discomfort occurred after surgery.All 703 patients were discharged from hospital within 24 hours.Conclusions Anesthesiologists participate in patient management according to the perioperative medicine requirements,and ambulatory thyroid surgery may be performed safely under the concept of ERAS.