加速康复外科理念在中转剖宫产围手术期中的应用

Application of enhanced recovery after surgery in the perioperative period of conversion to cesarean section

目的:相对于择期剖宫产,中转剖宫产产妇术后更容易发生各类并发症,不利于术后康复,本研究拟探讨加速康复外科(enhanced recovery after surgery,ERAS)理念在中转剖宫产围手术期中的应用效果。方法:选取入住长沙市妇幼保健院行中转剖宫产术的初产妇260例,将2021年1月1日至11月30日的130例初产妇作为对照组,围手术期实施常规护理干预,将2021年12月1日至2022年10月31日的130例初产妇作为观察组,围手术期实施ERAS理念指导的护理干预。比较2组产妇术中和术后出血量、术后不同时间段疼痛评分、术后首次离床时间、肛门排气时间,术后腹胀、肠梗阻、尿潴留发生情况,以及住院时间、初始泌乳时间、满意度及抑郁焦虑评分。结果:观察组术后不同时段的疼痛指数均低于对照组,术后首次离床时间、肛门排气时间、初始泌乳时间均早于对照组(均P<0.05);观察组术后腹胀发生率低于对照组,住院时间短于对照组(均P<0.05);观察组术后满意度及心理状态优于对照组,差异均有统计学意义(均P<0.05)。2组产妇术中和术后出血量、尿潴留发生情况差异均无统计学意义(均P>0.05),2组产妇均未发生肠梗阻。结论:ERAS理念下围手术期管理能减少中转剖宫产产妇术后并发症的发生,缩短住院时间,促进母乳喂养,提高产妇住院满意度,改善其产后心理状态。

Objective:Compared to elective cesarean sections,parturients undergoing conversion to cesarean section are more prone to various postoperative complications,hindering recovery.This study aims to explore the effects of applying the enhanced recovery after surgery(ERAS)concept in the perioperative period of conversion to cesarean section.Methods:A total of 260 primiparous women who underwent conversion to cesarean section at Changsha Maternal and Child Health Hospital were selected.Of these,130 cases from January 1 to November 30,2021,were selected as a control group,receiving routine perioperative care.Another 130 cases from December 1,2021 to October 31,2022,were selected as an observation group,receiving perioperative care guided by the ERAS concept.The intraoperative and postoperative bleeding volume,postoperative pain scores at different times,time to first ambulation,time to first anal gas passage,incidence of postoperative abdominal distension,intestinal obstruction,urinary retention,length of hospital stay,time to initial lactation,patient satisfaction,and depression and anxiety scores were compared between the 2 groups.Results:The observation group had lower pain scores at various postoperative times compared to the control group,and earlier times to first ambulation,first anal gas passage,and initial lactation(all P<0.05).The incidence of postoperative abdominal distension was lower,and the length of hospital stay was shorter in the observation group(both P<0.05).Postoperative satisfaction and psychological status were better in the observation group,with statistically significant differences(P<0.05).There were no statistically significant differences in intraoperative and postoperative bleeding volumes or incidences of urinary retention between the 2 groups(both P>0.05).No cases of intestinal obstruction was reported in either group.Conclusion:Perioperative management under the ERAS concept can reduce the incidence of postoperative complications in parturients undergoing conversion to cesarean section,shorten hospital stay,promote breastfeeding,enhance patient satisfaction,and improve postpartum psychological status.