加速康复外科理念在老年单节段退行性腰椎疾病中应用研究

Application of ERAS in the treatment of single segmental lumbar degenerative disease in the elderly

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念在老年单节段腰椎退行性疾病中的临床应用。方法回顾分析2016年1月至2017年1月,我院收治的80例60岁以上患腰椎退行性疾病并采用单节段腰椎融合术治疗患者的临床资料,其中ERAS组40例,男15例,女25例。ERAS术前措施包括院前宣教、营养指导、血栓预防、超前镇痛,术中措施包括选择短效麻醉剂、采用微创经椎间孔腰椎椎间融合术(minimal invasive transforaminal lumbar interbody fusion,MISTLIF)术式、切口局部注射长效局麻药镇痛、不放引流,术后措施包括术后减少补液、早期进食、24 h内拔除导尿管并下床进行康复锻炼。对照组采用常规MISTLIF,其中男14例,女26例。比较两组患者手术时间、出血量、住院时间、住院费用,术前、术后1天、3天、术后1个月、3个月、6个月疼痛视觉模拟评分(visual analogue scale,VAS),术前、术后1个月、3个月、6个月Oswestry功能障碍指数(oswestry disability index,ODI)。结果两组患者均获得6个月以上随访,两组性别、年龄差异无统计学意义(P>0.05),VAS评分ERAS组术后1天、术后3天分别为2.5±1.2、2.0±1.3;对照组分别3.5±1.6、3.1±1.1,两组比较差异有统计学意义(P<0.05)。两组术后1个月、3个月、6个月VAS、ODI评分差异无统计学意义(P>0.05)。ERAS组平均手术时间为(115.8±16.2) min,平均出血量(85.0±24.2) ml,平均住院日为(7.3±1.2)天,平均住院费用为(59750.8±21242.3)元,对照组为平均手术时间为(190.6±40.5) min,出血量(155.5±68.5) ml,平均住院日(14.3±7.6)天,平均住院费用为(94374.9±22345.8)元,两组平均手术时间差异无统计学意义(P>0.05),两组平均出血量、住院日、住院费用差异有统计学意义(P<0.05)。结论老年腰椎退行性疾病手术过程中应用ERAS措施,在达到与常规手术相同疗效的基础上,具有缓解术后疼痛,利于早期下床活动,缩短住院时间,降低住院费用等优势。

Objective To investigate the concept of enhanced recovery after surgery(ERAS)in the treatment of single segmental lumbar degenerative disease in the elderly.Methods From January 2016 to January 2017,80 patients after lumbar degenerative disease operation in our hospital were retrospectively studied.There were40 cases in ERAS group(15 males;25 females).Pre-operation measures of ERAS included pre-hospital education,nutrition guidance,thrombus prevention,preemptive analgesia.Intraoperative measures of ERAS included application short-acting anesthetic and minimal invasive transforaminal lumbar interbody fusion(MISTLIF),injection of longacting local anesthetic at the edge of the incision,none use of drainage tube.Post-operation measures included reduction of venous transfusion,early nourish,catheter removal and out-of-bed in the first 24 hours after surgery.The control group(n=40;14 males and 26 females)underwent conventional MISTLIF.Operation time,blood loss,length of stay,hospitalization expenses,VAS score(pre-operation;1 day,3 days,1 month,3 months,6 months postoperation),ODI score(pre-operation;1 month,3 months,6 months post-operation)between the 2 groups were compared.Results All patients received more than 6 months’follow-up.There was no statistical significance between the 2 groups in the age and gender(P>0.05).VAS scores of the ERAS group 1 day and 3 days post-operation were(2.5±1.2),(2.0±1.3),while the control group(3.5±1.6),(3.1±1.1);showing statistical significance between the 2 groups(P<0.05).VAS and ODI scores 1 month,3 months and 6 months post-operation showed no statistical significance between the 2 groups(P>0.05).The average operation time of ERAS group was(115.8±16.2)min,blood loss(85.0±24.2)ml,length of stay(7.3±1.2)days,hospitalization expense(59750.8±21242.3)yuan.The average operation time of control group was(190.6±40.5)min,blood loss(155.5±68.5)ml,length of stay(14.3±7.6)days,hospitalization expense(94374.9±22345.8)yuan.There was no statistical significance between the 2 groups on the operation time(P>0.05),but the blood loss,length of stay,hospitalization expenses showed statistical significance(P<0.05).Conclusions ERAS measures can reach similar curative effects to conventional operation for patients after single segmental degenerative lumbar operation.It has advantages on perioperative pain relief,early out-of bed,length of stay shortening,and hospitalization expense reduction.