加速康复外科在早中期肺癌围手术期的应用  

Perioperative application of enhanced recovery after surgery in early- and middle-stage non-small cell lung cancer

作　　者：张金 徐宝宁[1] ZHANG Jin;XU Baoning(Department of Thoracic Surgery,the Fourth Affiliated Hospital of China Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学附属第四医院胸外科

出　　处：《中华实用诊断与治疗杂志》2019年第6期573-576,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：辽宁省科技厅科学技术计划项目(2013408001)

摘　　要：目的探讨加速康复外科(enhanced recovery after surgery, ERAS)在早中期肺癌围手术期应用的临床效果及可行性。方法 60例非小细胞肺癌患者,其中围手术期采用ERAS方案的30例患者为ERAS组,采用传统治疗方案的30例患者为对照组,比较2组患者胸腔引流管拔除时间、住院时间、术后视觉模拟评分(visual analogue scale, VAS)、血清高敏C反应蛋白(high sensitivity C-reactive protein, hs-CRP)和降钙素原(procalcitonin, PCT)水平、肺功能及术后并发症发生率。结果 ERAS组胸腔引流管拔除时间[(4.6±1.2)d]和住院时间[(11.8±1.6)d]短于对照组[(6.7±1.6)d、(13.5±1.3)d](P<0.05),术后第1、3、5天VAS评分[(7.59±1.43)、(6.21±1.38)、(5.08±1.15)分]低于对照组[(8.62±1.57)、(6.96±1.24)、(5.74±1.30)分](P<0.05);ERAS组术后第1、3天血清hs-CRP[(11.56±2.74)、(13.62±2.55)mg/L]、PCT水平[(1.738±0.215)、(1.976±0.236)μg/L]低于对照组[(15.37±2.53)、(16.92±2.41)mg/L,(2.639±0.235)、(2.857±0.264)μg/L](P<0.05),术后第5天hs-CRP、PCT[(8.67±1.06)mg/L、(1.014±0.121)μg/L]与对照组[(9.02±1.15)mg/L、(1.067±0.139)μg/L]比较差异无统计学意义(P>0.05);ERAS组术后第3天肺功能水平高于对照组(P<0.05),术后第7天与对照组比较差异无统计学意义(P>0.05);ERAS组患者术后并发症发生率(26.7%)与对照组(36.7%)比较差异无统计学意义(P>0.05)。结论与围手术期传统治疗方案相比,ERAS在早中期肺癌围手术期的应用可减轻患者术后疼痛程度和炎性反应,有利于患者肺功能快速、有效恢复,缩短住院时间。Objective To explore the clinical effect and feasibility of perioperative application of enhanced recovery after surgery(ERAS) in early-and middle-stage non-small cell lung cancer(NSCLC). Methods Sixty patients with NSCLC were divided into ERAS group receiving perioperative ERAS treatment and control group receiving traditional treatment, with 30 patients in each group. The chest tube duration, length of hospital stay, postoperative visual analogue scale(VAS), high sensitivity C-reactive protein(hs-CRP), procalcitonin(PCT), pulmonary function and incidence of complications were compared between two groups. Results In ERAS group, the chest tube duration((4.6±1.2) d) and length of hospital stay((11.8±1.6) d) were significantly shorter than those in control group((6.7±1.6),(13.5±1.3) d)(P<0.05), and the VAS scores on the 1 st, 3 rd and 5 th postoperative day(7.59±1.43, 6.21±1.38, 5.08±1.15) were significantly lower than those in control group(8.62±1.57, 6.96±1.24, 5.74±1.30)(P<0.05). The levels of hs-CRP((11.56±2.74),(13.62±2.55) mg/L) and PCT((1.738±0.215),(1.976±0.236) μg/L) on the 1 st and 3 rd postoperative day in ERAS group were significantly lower than those in control group((15.37±2.53),(16.92±2.41) mg/L;(2.639±0.235),(2.857±0.264) μg/L)(P<0.05), and the levels of hs-CRP and PCT showed no significant differences on the 5 th postoperative day between ERAS group((8.67±1.06) mg/L,(1.014±0.121) μg/L) and control group((9.02±1.15) mg/L,(1.067±0.139) μg/L)(P>0.05). The pulmonary function was better in ERAS group than that in control group on the 3 rd postoperative day(P<0.05),and showed no significant difference on the 7 th postoperative day between two groups(P>0.05).No significant difference was found in the incidence of complications between ERAS group(26.7%)and control group(36.7%)(P>0.05).Conclusion Compared with traditional treatment,the perioperative application of ERAS in early-and middle-stage NSCLC may alleviate postoperative pain and inflammation,contribute to the rapid and effe

关 键 词：早中期肺癌 加速康复外科 围手术期 

分 类 号：R473.73[医药卫生—护理学]