快速康复外科在贵州遵义地区结核外科围术期的应用探索

Application of enhanced recovery after surgery in the perioperative period of tuberculosis surgery in Zunyi area,Guizhou

目的分析和验证快速康复外科在贵州遵义地区肺结核患者围术期应用的有效性及安全性。方法选取2021年5月至2022年2月遵义医科大学附属医院胸外科各类因肺结核行外科手术治疗患者110例,随机数字表法分为观察组与对照组,各55例。对照组男42例、女13例,年龄(54.65±14.94)岁,在围术期选择传统康复手段促进患者康复;观察组男34例、女21例,年龄(52.15±14.12)岁,在围术期选择快速康复外科措施干预。对患者相关指标进行观测及数据分析。计数资料采用χ^(2)检验,计量资料采用独立样本t检验或Mann-Whitney U检验。结果观察组出血量为100(50,110)ml,对照组为100(90,160)ml,差异无统计学意义(P=0.471)。两组患者手术时间、手术费用比较,差异均无统计学意义(均P>0.05);观察组术后视觉模拟评分法(VAS)评分、术后白细胞计数、住院时间、拔管时间、术后住院时间、住院总费用分别为(3.82±1.36)分、(8.98±2.37)×10^(9)/L、(10.69±2.27)d、(5.13±1.73)d、(7.89±2.45)d、(59932.16±12914.00)元,均低于对照组的(4.62±1.89)分、(10.83±3.93)×10^(9)/L、(12.13±2.63)d、(6.09±2.56)d、(8.95±2.54)d、(65421.43±14684.88)元,差异均有统计学意义(均P<0.05)。观察组并发症发生率为3.6%(2/55),低于对照组14.5%(8/55),差异有统计学意义(χ^(2)=3.960,P=0.047)。结论快速康复外科在肺结核患者围术期应用能有效促进患者快速康复,安全且有效,具备实施可行性。

Objective To analyze and validate the efficacy and safety of enhanced recovery after surgery(ERAS)in the perioperative period of pulmonary tuberculosis patients in Zunyi area,Guizhou.Methods A total of 110 patients with pulmonary tuberculosis underwent surgery in Department of Thoracic Surgery,The Affiliated Hospital of Zunyi Medical University from May 2021 to February 2022,and they were divided into an observation group and a control group by the random number table method,55 cases in each group.The control group included 42 males and 13 females,aged(54.65±14.94)years;the observation group included 34 males and 21 females,aged(52.15±14.12)years.In the control group,the traditional rehabilitation measures were used to promote the patients'rehabilitation during the perioperative period;the observation group was given ERAS during the perioperative period.The related indexes in the patients were observed and analyzed.χ^(2) test was used for the count data,and independent sample t test or Mann-Whitney U test was used for the measurement data.Results The amount of blood loss was 100(50,110)ml in the observation group and 100(90,160)ml in the control group,without statistically significant difference(P=0.471).There were no statistically significant differences in the operation time and cost between the two groups(both P>0.05).The postoperative Visual Analog Scale(VAS)score,postoperative white blood cell count,length of hospital stay,extubation time,postoperative length of stay,and total cost of hospitalization were(3.82±1.36)points,(8.98±2.37)×10^(9)/L,(10.69±2.27)d,(5.13±1.73)d,(7.89±2.45)d,and(59932.16±12914.00)yuan,which were lower than those in the control group[(4.62±1.89)points,(10.83±3.93)×10^(9)/L,(12.13±2.63)d,(6.09±2.56)d,(8.95±2.54)d,and(65421.43±14684.88)yuan],with statistically significant differences(all P<0.05).The incidence of complications in the observation group was 3.6%(2/55),which was significantly lower than that in the control group[14.5%(8/55)](χ^(2)=3.960,P=0.047).Conclusion The perioperative application of ERAS in patients with pulmonary tuberculosis can effectively promote their rapid recovery,which is safe and effective and has the feasibility of implementation.