不同时段行腔镜下子宫全切联合附件切除对患者术后康复效果的影响

Effect of laparoscopic total hysterectomy combined with adnexectomy at different time periods on postoperative rehabilitation effect of patients

目的 探讨不同时段行腔镜下子宫全切联合附件切除对患者术后康复效果的影响。方法 采用回顾性分析,选取2021年1-7月于该院行腔镜下子宫全切联合附件切除手术的232例患者病例资料。根据手术开始时间分为上午手术组(8:00左右接受麻醉手术)、下午手术组(14:00及以后接受麻醉手术)。统计患者年龄、身高、体重、美国麻醉医师协会分级、手术时长、术中出血量、术后生命体征、外周血白细胞计数、全身炎症反应综合征的发生率、围手术期感染相关并发症及住院时间。结果 两组患者人口统计学资料及术前术中情况匹配,差异均无统计学意义(P>0.05)。上午手术组患者术后体温>38℃或<36℃、呼吸>20次/min、外周血白细胞计数>12×10^(9)/L或<4×10^(9)/L的发生率均明显高于下午手术组患者(P<0.05),但心率>90次/min的发生率与下午手术组比较差异无统计学意义(P>0.05),上午手术组同时满足上述2项及以上指标的患者数明显多于下午手术组(P<0.05)。上午手术组患者住院时间大于下午手术组(P<0.05),两组围手术期感染相关并发症发生率比较差异无统计学意义(P>0.05)。结论 下午行腔镜下子宫全切联合附件切除患者术后全身炎症反应的发生率明显低于上午,更利于患者的术后康复,缩短住院时间。

Objective To investigate the effect of laparoscopic total hysterectomy combined with adnexectomy on postoperative rehabilitation of patients at different periods.Methods A retrospective analysis was used to select the case data of 232 patients who underwent laparoscopic total hysterectomy combined with adnexectomy in this hospital from January 2021 to July 2021.According to the start time of surgery, patients were divided into the morning surgery group(receiving anesthesia around 8:00) and the afternoon surgery group(receiving anesthesia at 14:00 and later).The patient’s age, height, weight, ASA classification, operation time, intraoperative blood loss, postoperative vital signs, peripheral white blood cell count, the incidence of systemic inflammatory response syndrome, perioperative infection-related complications, and hospitalization days were counted.Results The demographic data and preoperative and intraoperative conditions of the two groups were matched(P>0.05).The incidence rates of postoperative body temperature>38 ℃ or <36 ℃,respiration>20 breaths/min, and peripheral blood white blood cell count>12×10^(9)/L or <4×10^(9)/L in the morning operation group were significantly higher than those in the afternoon operation group(P<0.05).There was no significant difference in the incidence of heart rate >90 beats/min compared with the afternoon operation group(P>0.05).The number of patients in the morning operation group who met the above two or more indicators at the same time was significantly greater than that in the afternoon operation group(P<0.05).The hospital stay of patients in the morning surgery group was longer than that in the afternoon surgery group(P<0.05),and there was no significant difference in perioperative infection-related complications between the two groups(P>0.05).Conclusion The incidence of postoperative systemic inflammatory reaction in patients undergoing laparoscopic total hysterectomy combined with adnexectomy in the afternoon(under anesthesia at 14:00 and later) was significantly lower than that in the morning, which was more conducive to patients’ postoperative recovery and shortened hospital stay.