基于加速康复外科理念的麻醉管理在颅内动脉瘤夹闭术中的应用

Application of Enhanced Recovery After Surgery for multi-directional perioperative anesthesia management in Intracranial Aneurysm clipping

目的评价基于加速康复外科(ERAS)理念的围手术期麻醉管理用于颅内前循环动脉瘤夹闭术中的临床效果。方法选择择期行全麻颅内前循环动脉瘤夹闭手术的患者130例,男56例,女74例,年龄18~64岁,体重指数(BMI)18~30 kg/m2,美国麻醉医师协会(ASA)分级Ⅰ~Ⅲ级,Hunt‑Hess分级0~Ⅱ级。根据纳入时间将患者分为两组(每组65例):加速康复外科(ERAS)组(E组,2019年7月至2021年4月)和对照组(C组,2018年7月至2019年6月)。E组实施ERAS围手术期麻醉管理方案,C组采取传统麻醉管理方案。记录两组患者术后住院时间,住院费用,术中情况,术后恢复情况,术后2、4、8、12、18、24、48 h数字分级评分法(NRS)疼痛评分和镇痛情况,术后并发症发生情况,出院时患者对临床服务的满意度,出院后第4周卡氏功能状态(KPS)评分及再入院事件。结果与C组比较:E组术后住院时间较短(P<0.05),住院费用较少(P<0.05);术中晶体液输入量、舒芬太尼和瑞芬太尼用量较少(均P<0.05);术后2、4、8、12、18、24、48 h NRS疼痛评分较低(均P<0.05),患者自控镇痛(PCA)泵有效按压次数、总按压次数、补救镇痛例数较少(均P<0.05);术后拔除尿管时间、首次下地活动时间、首次进普食时间较短(均P<0.05);深静脉血栓(DVT)发生率较低(P<0.05)。两组患者其余术中指标、其他并发症发生情况、出院后第4周KPS评分差异均无统计学意义(均P>0.05)。出院时患者对临床服务的满意度均为100%,两组均无再入院事件。结论颅内前循环动脉瘤夹闭术运用ERAS理念进行多方位围手术期麻醉管理,能够缩短患者术后住院时间,降低住院费用、术后疼痛评分及术后并发症发生率,提高术后恢复质量。

Objective To evaluate the clinical effectiveness of perioperative anesthesia management based on enhanced recovery after surgery(ERAS)for clipping of the intracranial anterior circulation aneurysm.Methods A total of 130 patients,including 56 men and 74 women,aged 18‒64 years,with body mass index(BMI)at 18‒30 kg/m2,at American Society of Anesthesiologists(ASA)Ⅰ‒Ⅲ,Hunt‑Hess 0‒Ⅱ,who were scheduled for clipping of the anterior intracranial circulation aneurysm under general anesthesia were selected.According to the inclusion time,the patients were divided into two groups(n=65):an ERAS group(group E,from July 2019 to April 2021)and a control group(group C,from July 2018 to Jun 2019).Group E was subject to perioperative anesthesia management for ERAS,while group C underwent routine anesthesia management.Their length of postoperative hospitalization stay,hospitalization expense,intraoperative characteristics,postoperative recovery,and the Numeric Rating Scales(NRS)scores at postoperative 2,4,8,12,18,24 and 48 h,and analgesia were recorded.The incidence of complications,patient satisfaction toward clinical services at discharge,Karnofsky Performance Scale(KPS)score at week four of follow‑up period after discharge,and readmission events were recorded.Results Compared with group C,group E showed shortened length of postoperative hospitalization stay(P<0.05)and reduced hospitalization expense(P<0.05),as well as remarkable decreases in intraoperative lens input,sufentanil and remifentanil doses(all P<0.05),NRS scores at postoperative 2,4,8,12,18,24 and 48 h(all P<0.05),the number of effective and total compressions of patient controlled analgesia(PCA)pump and the number of remedial analgesia cases(all P<0.05),and decreases in the time to urinary catheter removal,time to first out‑of‑bed activity,and time to first feeding(all P<0.05),with a reduced incidence of deep vein thrombosis(DVT)(P<0.05).There was no statistical difference in other intraoperative indicators,other complications and KPS score at week four of follow‑up period after discharge between the two groups(all P>0.05).Patient satisfaction toward clinical service after discharge was 100%and no readmission event was reported in the two groups.Conclusions Clipping of the intracranial anterior circulation aneurysm through multi‑directional perioperative anesthesia management based on ERAS can shorten the length of postoperative hospitalization stay,reduce hospitalization expense,postoperative pain scores and the incidence of postoperative complications,and improve the quality of postoperative recovery.