术后快速康复策略对择期剖宫产术后慢性疼痛的影响

Effect of enhanced recovery after cesarean on chronic pain after elective cesarean section

目的 探讨术后快速康复(ERAC)策略对择期剖宫产术后慢性疼痛的影响。方法 选择2022年1—12月行择期剖宫产的单胎、足月初产妇,采用密封信封抽签法将产妇分为ERAC组(E组,125例)和对照组(C组,127例),E组产妇实施ERAC策略,C组产妇实施传统围术期管理方案。所有产妇均采用腰-硬联合麻醉,采用视觉模拟评分(VAS评分)评估剖宫产术后24、48、72 h产妇的静息痛和运动痛情况。记录剖宫产术后24、96 h产科康复质量评分(ObsQoR-11)。追踪术后3、6个月产妇慢性疼痛情况,采用医院焦虑抑郁量表(HADS)评估产妇术前和术后3、6个月的心理状况。结果 E组术后72 h运动VAS评分低于C组(t=2.940,P<0.05),C组术后72 h运动VAS评分高于术后24 h运动VAS评分(t=2.430,P<0.05)。E组术后24、96 h的ObsQoR-11评分分别为(84.8±17.2)分、(98.3±9.2)分;C组术后24、96 h的ObsQoR-11评分分别为(76.9±13.0)分、(95.9±10.4)分。E组术后24 h的ObsQoR-11评分高于C组(t=4.117,P<0.05),两组术后96 h的ObsQoR-11评分比较差异无统计学意义(t=1.939,P>0.05)。E组术后3、6个月慢性疼痛发生率分别为9.6%、7.2%,C组术后3、6个月慢性疼痛发生率分别为18.9%、11.0%。E组术后3个月慢性疼痛发生率及程度均低于C组(均P<0.05)。结论 与传统围术期管理方案相比,ERAC策略可获得择期剖宫产术后早期更好的康复质量,并缓解剖宫产术后3个月的慢性疼痛,但对剖宫产术后6个月的慢性疼痛无显著影响。

Objective To explore the effect of enhanced recovery after cesarean(ERAC)on chronic pain after elective cesarean sec⁃tion.Methods The full-term singleton primiparous women undergoing elective cesarean section from January to December 2022 were se⁃lected and divided into ERAC group(group E,125 cases)and control group(group C,127 cases)according to sealed envelope lottery.The promiparous women in group E received ERAC protocol,and the primiparous women in group C received conventional perioperative interven⁃tion.Combined spinal-epidural anesthesia was performed in the two groups.Pain intensity was assessed during rest and movement using vis⁃ual analogue scale(VAS)at 24,48,and 72 hours after cesarean delivery.Obstetric quality-of-recovery score(ObsQoR-11)were recor⁃ded at 24 and 96 hours after cesarean delivery.Chronic pain was followed up at 3 and 6 months after cesarean delivery.Hospital anxiety and depression scale(HADS)was used to investigate depression and anxiety symptoms before cesarean delivery and at 3 and 6 months after ce⁃sarean delivery.Results VAS score during movement at 72 hours after cesarean delivery in group E was statistically significantly lower than that in group C(t=2.940,P<0.05),VAS score during movement at 72 hours after cesarean delivery in group C was statistically significant⁃ly higher than that at 24 hours(t=2.430,P<0.05).ObsQoR-11 scores at 24 and 96 hours after cesarean delivery in group E were(84.8±17.2)and(98.3±9.2),respectively;ObsQoR-11 scores at 24 and 96 hours after cesarean delivery in group C were(76.9±13.0)and(95.9±10.4),respectively.ObsQoR-11 score at 24 hours after cesarean delivery in group E was statistically significantly higher than that in group C(t=4.117,P<0.05),there was no statistically significant difference in ObsQoR-11 score at 96 hours after cesarean delivery between the two groups(t=1.939,P>0.05).The incidence rates of chronic pain at 3 and 6 months after cesarean delivery in group E were 9.6%and 7.2%,respectively;the incidence rates of chronic pain at 3 and 6 months after cesarean delivery in group C were 18.9%and 11.0%,respectively.The incidence rate and degree of chronic pain at 3 months after cesarean delivery in group E were significantly lower than those in group C(P<0.05).Conclusion Compared with conventional perioperative intervention,administration of ERAC pro⁃tocol may achieve better early rehabilitation quality after elective cesarean section,alleviate chronic pain at 3 months after cesarean delivery,and it has no significant effect on chronic pain at 6 months after cesarean delivery.