局部冷热敷序贯治疗在颈椎后路术后加速康复中的应用

Efficacy and safety of sequential local cold-hot compresses used in enhanced recovery after surgery for unilateral posterior cervical expansive open-door laminoplasty

目的:探讨颈椎后路单开门椎管扩大成形术后伤口局部冷热敷序贯治疗的有效性及安全性。方法:前瞻性纳入2020年6月至2021年6月行颈椎后路单开门减压手术患者60例,根据术后是否予以伤口局部冷热敷序贯治疗,按手术台次的先后顺序非随机对照分为序贯治疗组和非序贯治疗组,每组各30例患者。主要评价指标为各时间点视觉模拟疼痛(VAS)评分、颈部功能障碍指数(NDI)、日本骨科学会(JOA)评分、术后引流情况及术后住院时间、镇痛泵使用次数及补充药物频次、恶心呕吐发生率、切口相关并发症等。结果:两组患者术前及术中一般资料差异无统计学意义。序贯治疗组术后各时间点VAS评分(除术后6 h)及NDI均显著低于非序贯治疗组(P<0.05),JOA评分差异无统计学意义(P>0.05)。序贯治疗组术后引流量及术后拔管时间较非序贯治疗组呈现降低趋势,但差异无统计学意义(P>0.05),而术后住院时间则明显短于非序贯治疗组[(5.6±1.0)d vs.(6.9±1.3)d,P<0.05]。序贯治疗组术后镇痛泵按压次数及补充药物率均少于非序贯治疗组[(7.2±1.9)次vs.(12.6±3.0)次,P<0.001;10.0%vs.33.3%,P=0.028]。序贯治疗组恶心呕吐发生率明显低于非序贯治疗组(13.3%vs.36.7%,P=0.037)。序贯治疗组无冻伤、烫伤等相关并发症,患者满意度为93.3%。结论:颈椎后路单开门椎管扩大成形术后伤口局部冷热敷序贯治疗可减轻局部疼痛,减少术后镇痛药物使用及镇痛药物引起的恶心呕吐,同时减少术后住院时间,有利于患者加速康复。

Objective: To study the efficacy and safety of sequential local cold-hot compresses used in enhanced recovery after surgery(ERAS) in patients undergoing unilateral posterior cervical expansive open-door laminoplasty. Methods: We performed a prospective analysis in a total of 60 patients who underwent unilateral posterior cervical open-door laminoplasty from June 2020 to June 2021.According to whether sequential local cold-hot compressions used postoperatively, the patients were divided into observation group and control group(n=30). The visual analogue scale(VAS) score, neck disability index(NDI), Japanese Orthopaedic Association(JOA)score, postoperative drainage volume, drainage time, postoperative hospital stay, analgesic pump use time, supplementary analgesia drug use, nausea and vomiting rate, and incision-related complication were recorded and compared between two groups. Results: There was no significant difference in the age, sex ratio, body mass index(BMI), operation time or intraoperative blood loss between two groups. The VAS score(except 6 h after operation) and NDI score in observation group were significantly lower than those in control group at each postoperative time point(P<0.05), while JOA score was similar(P>0.05). The drainage volume and drainage time in observation group was less compared to control group, but showed no significant difference(P>0.05). Moreover, postoperative hospital stay was significantly less in observation group([5.6±1.0] d vs. [6.9±1.3] d, P<0.05). The analgesic pump use times and supplementary analgesia drug use in observation group were less than those in the control group(7.2±1.9 vs. 12.6±3.0, P<0.001;10.0% vs. 33.3%, P=0.028), and incidence of nausea and vomiting was significantly reduced in observation group(13.3% vs. 36.7%, P=0.037). In observation group, there was no related complication such as frostbite and scald, with a satisfaction rate of 93.3% to sequential local cold-hot compresses method. Conclusions: The use of sequential local cold-hot compress is effective and safe in cervical laminoplasty.It can help to reduce postoperative pain, which also lead to less postoperative analgesics use and lower rate of nausea and vomiting.This can be an effective and safe method to enhance postoperative recovery.