颈椎前路手术术前行气管食管推移训练的必要性研究

An investigation of the necessity on performing preoperative trachea and esophageal pushing in cervical operation using anterior approach

目的 探讨气管食管推移训练与不行气管推移训练对颈椎前路手术患者术后并发症的影响.方法 利用随机种子生成随机数将1 12例患者进行随机分组,设立实验组与对照组各56例,对照组按常规术前进行气管食管推移训练,实验组不进行气管食管推移训练,记录2组患者手术时间,手术医生对术野暴露情况满意度,术中出血量和心率、血压、血氧饱和度,住院时间,住院费用等手术情况.观察并对比2组患者术后24 h时咽部疼痛视觉模拟评分(VAS评分),咽喉相关并发症发生率等情况.结果 2组患者在手术时间、术中出血量、术中各项生命体征、手术医生对术野暴露情况满意度方面比较差异无统计学意义.实验组的住院时间比对照组时间短[(5.8±1.4)d比(7.3±1.6)d],t=5.280,P＜0.01,差异有统计学意义,实验组住院费用低于对照组[(45 228.4±4 124.6)元比(48 468.3±4 313.8)元],t=4.062,P＜0.01,差异有统计学意义.2组患者术后咽部疼痛视觉模拟评分、吞咽困难及异物感、饮水呛咳、声音嘶哑等总体咽喉相关并发症的发生率方面比较差异均无统计学意义.结论 气管食管推移训练对于患者咽喉相关的并发症及总体并发症并无明显影响,对手术医生的操作无明显影响,但会增加患者的总住院费用及住院时间,增加护士的工作量和患者的痛苦,因此,气管食管推移训练没有必要在全麻下行颈椎前路减压植骨融合中应用.

Objective To investigate the influence of preoperative training of pushing trachea and esophagus or not on cervical operation by anterior approach.Methods All patients were randomly divided into two groups:experimental group and control group (56 cases,respectively).Patients in the former group had no training of pushing trachea and esophagus,while patients in the latter group had,recording the data of surgery duration,operator's degree of satisfaction,blood loss,blood pressure,heart rate,and oxygen saturation during operation,hospital stay and cost.Meanwhile,we observed and compared the VAS scores and the complication rate etc.between two groups.Results There were no differences between two groups in surgery duration,operator's degree of satisfaction,blood loss,blood pressure,heart rate,and oxygen saturation during operation,hospital stay and cost,nor in the VAS scores and the throat-related complications rate.The hospital stay and cost of patients in experimental group were longer and higher than that of patients in control group,(7.3±1.6) d vs (5.8±1.4) d,(48 468.3±4 313.8) vs (45 228.4±4 124.6) yuan,t=5.280,4.062,P＜0.05.Conclusions Training of pushing trachea and esophagus has no influence in the throat-related complications rate,VAS scores and operator's degree of satisfaction.Instead,training of pushing trachea and esophagus increases hospital stay and cost and amount of nurse's work.So,it's not necessary to undertake the preoperative training before cervical operation by anterior.