加速康复外科对腹腔镜宫颈癌根治术术后恢复及疼痛的影响  

Effects of enhanced recovery after surgery on postoperative recovery and pain in patients with cervical cancer undergoing laparoscopic radical surgery

作　　者：陈杰[1] 王琤 王丽[3] 黄冬琴 姚德生[4] 谢显龙[5] 黎阳[5] 黄冰[1] CHEN Jie;WANG Cheng;WANG Li;HUANG Dong-qin;YAO De-sheng;XIE Xian-long;LI Yang;HUANG Bing(Department of Anesthesiology,Affiliated Tumor Hospital of Guangxi Medical University,Nanning 530022,Guangxi,China)

机构地区：[1]广西医科大学附属肿瘤医院麻醉科,广西南宁530022 [2]广西医科大学附属肿瘤医院营养科,广西南宁530022 [3]北海市第二人民医院妇产科,广西北海536000 [4]广西医科大学附属肿瘤医院妇瘤二科,广西南宁530022 [5]广西医科大学附属肿瘤医院重症医学科,广西南宁530022

出　　处：《广东医学》2020年第7期692-696,共5页Guangdong Medical Journal

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(Z20190693)。

摘　　要：目的探讨加速康复外科(enhanced recovery after surgery,ERAS)在宫颈癌腹腔镜下根治术中对患者术后恢复质量和疼痛的影响。方法前瞻性研究行腹腔镜下宫颈癌根治术治疗的80例患者,年龄18~70岁,ASAⅠ~Ⅱ级。运用随机数字表法,把其分成ERAS组(n=39)和对照组(n=41)。ERAS组应用术前宣教、术前2 h摄入碳水化合物、限制输液、多模式镇痛、术后早期普食及下床活动等ERAS策略。对照组采用常规麻醉管理。记录患者手术后的住院时间以及住院的总花费、术后第6、12、24小时视觉模拟评分(VAS)及PACU观察时长、术后移除气管导管时间、术后第1次通气时间、第1次下地活动时间、第1次普食时间。结果与对照组相比,ERAS组术后24 h的VAS评分和PCIA按压次数都明显下降(P<0.01);ERAS组的术后移除气管导管时间和PACU的观察时长都缩短(P<0.05),但手术时长增加(P=0.020);ERAS组术后第1次通气时间、下地活动时间和普食时间均缩短(P<0.05);ERAS组术后的恶心呕吐及寒颤概率降低(P<0.05)。两组患者术后6和12 h VAS评分、手术后的住院时间和总花费差异无统计学意义(P>0.05)。结论宫颈癌腹腔镜下根治术围手术期麻醉管理中实施ERAS策略可显著改善患者术后恢复质量和远期疼痛。Objective To investigate the effects of enhanced recovery after surgery(ERAS) on postoperative recovery and pain in patients with cervical cancer undergoing laparoscopic radical surgery. Methods Clinical data of 80 laparoscopic radical surgeries were prospectively analyzed. Eighty cases(aged between 18 and 70 years, ASA grade Ⅰ-Ⅱ) were randomly divided into two groups using a random number table, ERAS group(n=39) and control group(n=41). In ERAS group, patients were treated with ERAS strategy including preoperative education, carbohydrate intake 2 hours before operation, limitative fluid management, multimodal analgesia, early postoperative general food and out of bed activities. In control group, routine anesthetic management were used. The visual analogue score(VAS) 6, 12 and 24 h after operation, time to extubation, PACU stay, postoperative gas passing time, first ambulation time, first common food time, hospital stay and the total cost were recorded. Results Compared with control group, the VAS score 24 h after surgery and PCIA bolus count in the ERAS group were both significantly reduced(P<0.01). The time to extubation and length of PACU stay in the ERAS group were significantly shorter than those in the control group, while ERAS group had significantly longer surgery time(P<0.05). The first gas passing time, first normal diet time and first ambulation time in the ERAS group were significantly shorter than those in the control group(P<0.05). The incidence of postoperative nausea and vomiting, shiver was significantly lower in ERAS group than that in the control group(P<0.05). There was no significant difference in VAS score 6 h or 12 h after operation, blood loss, hospital stay or total cost between the two groups(P>0.05). Conclusion The application of ERAS strategy in the anesthesia management of patients with cervical cancer undergoing laparoscopic radical surgery can significantly improve the quality of postoperative recovery and attenuate long-term pain after surgery.

关 键 词：宫颈癌 加速康复外科 术后康复 术后疼痛 

分 类 号：R713.42[医药卫生—妇产科学] R614.27[医药卫生—临床医学]