ERAS在剖宫产术中的应用效果分析

Effect analysis of ERAS in cesarean section

目的观察加速康复外科理念(ERAS)在剖宫产围术期的应用及对产妇术后疼痛、肠道功能恢复的影响。方法选取2019年1月至2020年6月在秦皇岛市妇幼保健院行剖宫产术的150例孕妇作为研究对象,随机分成两组,对照组(n=75)为常规干预,观察组(n=75)施行以ERAS理念为指导的干预。用视觉模拟评分法(VAS)比较两组疼痛程度,用时间指标、胃肠功能参数评价肠道功能恢复,并观察比较临床结局状况。结果两组患者术后VAS评分分析,结果显示时间因素、组别因素及时间-组别的交互作用均有统计学意义(F值分别为366.604、173.888、92.690,P<0.05);多重比较结果显示,两组术后4~12h,VAS评分均随着时间的延长而显著升高,术后24h VAS评分显著降低,术后4h VAS评分差异无统计学意义(P>0.05),观察组术后6h、12h、24h VAS评分均低于对照组(t值分别为9.867、10.235、11.347,P<0.05)。观察组肠鸣音恢复时间、排气时间、排便时间均短于对照组(t值分别为8.188、5.082、3.869,P<0.05)。术后3d观察组血清胃动素(MLT)、胃泌素(GAS)水平均高于对照组,血管活性肠肽(VIP)低于对照组(t值分别为13.291、4.222、3.426,P<0.05)。观察组孕妇产后出血、产褥感染、切口感染、腹痛腹胀、恶心呕吐总发生率低于对照组(χ^(2)=4.040,P<0.05)。两组新生儿窒息、肺炎发生率及5min Apgar评分比较差异均无统计学意义(P>0.05)。结论ERAS理念用于剖宫产患者中,可降低术后疼痛程度,改善患者肠胃功能,并降低术后孕妇并发症。

Objective To observe the application of enhanced recovery after surgery(ERAS)concept in the perioperative period of cesarean section,and its effect on postoperative pain and intestinal function recovery.Methods A total of 150 pregnant women who underwent cesarean section in the Qinhuangdao Maternal and Child Health Hospital from January 2019 to June 2020 were selected as the research subjects.The subjects were randomly divided into two groups.The control group(n=75)was treated as routine intervention,and the observation group(n=75)was treated with the intervention guided by ERAS concept.The Visual Analogue Scale(VAS)was used to measure pain intensity between the two groups.Time index and gastrointestinal function parameters were used to evaluate the recovery of intestinal function,and clinical outcome was observed and compared.Results Postoperative VAS score analysis of the two groups showed statistically significant effects of time factor,group factor and time-group interaction(F values were 366.604,173.888,and 92.690,respectively,P<0.05).Multiple comparison results showed that 4-12 hours after surgery,VAS scores increased significantly with time,and decreased significantly 24h after surgery.There was no significant difference in VAS score at 4h after surgery between the two groups(P>0.05),and VAS scores at 6h,12h and 24h after surgery in the observation group were lower than those in the control group(t values were 9.867,10.235,and 11.347,respectively,P<0.05).The recovery time of bowel sound,exhaust time and defecation time in the observation group were shorter than those in the control group(t values were 8.188,5.082,and 3.869,respectively,P<0.05).The levels of serum motilin(MLT)and gastrin(GAS)in observation group were higher than those in the control group 3 days after surgery,while the levels of vasoactive intestinal peptide(VIP)were lower than those in the control group(t values were 13.291,4.222,and 3.426,respectively,P<0.05).The total incidence of postpartum hemorrhage,puerperal infection,incision infection,abdominal pain,abdominal distension,nausea and vomiting in the observation group was lower than that in the control group(χ^(2)=4.040,P<0.05).There were no significant differences in the incidences of neonatal asphyxia and pneumonia and Apgar score at 5min between the two groups(P>0.05).Conclusion The ERAS concept can be used in patients undergoing cesarean section to reduce postoperative pain,improve gastrointestinal function,and reduce postoperative complications for pregnant women.