围手术期快速康复外科路径管理对足部组织瓣移植修复手部缺损手术效果的影响  

The influence of perioperative enhanced recovery after surgery pathway management on the effect of foot tissue flap transplantation for hand defect repair

作　　者：王德明 姜凯 吴彩风 陈艳清 孙乐天 曲彦亮 Wang Deming;Jiang Kai;Wu Caifeng;Chen Yanqing;Sun Letian;Qu Yanliang(Hand Surgery Center of the 971st Hospital of the Navy,Qingdao 266071,China)

机构地区：[1]海军第九七一医院全军手外科中心,青岛266071

出　　处：《中华手外科杂志》2021年第4期275-279,共5页Chinese Journal of Hand Surgery

摘　　要：目的探讨加速康复外科(enhanced recovery after surgery,ERAS)在足部游离组织移植修复手部缺损围手术期的应用效果,建立该术式标准化、规范化的手术路径。方法选取自2015年6月至2019年12月我们收治的足部游离组织移植修复手部组织缺损的患者98例,随机分为ERAS组和对照组,每组49例,围手术期行不同的干预策略。ERAS组实施全面系统的ERAS围手术期处理策略,对照组实施传统常规围手术期处理和治疗方法。对比分析两组患者术中平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、血氧饱和度(SpO_(2))、Nareotrend麻醉深度指数(NT指数)的变化情况,记录术后不同时间点视觉模拟评分(visual analogue scale,VAS)、Ramsay镇静评分、围手术期并发症及患者治疗满意度等情况。结果两组组间比较,手术开始后各时间点(切皮、手术进行30 min、1h、2h、术毕)NT指数较对照组低(P<0.05),ERAS组术后4、8、12、24h的VAS低于对照组、Ramsay评分高于对照组(P<0.05);术后48 h内,ERAS组患者静脉自控镇痛电子泵有效按压次数明显少于对照组(P<0.05);ERAS组围手术期并发症发生率少于对照组(P<0.05);ERAS组患者治疗满意度高于对照组(P<0.05)。结论ERAS理念在足部游离组织移植术围手术期的应用效果确切,采取程序化的干预措施,可减少患者在生理、心理上的创伤应激反应,减少并发症,提高治疗满意度。Objective To explore the perioperative effect of enhanced recovery after surgery(ERAS)in repairing hand defects with free tissue transplantation of foot,and to establish a standardized operation pathway.Methods From June 2015 to December 2019,98 patients with foot free tissue transplantation to repair hand defects were selected and randomly divided into ERAS group and control group,with 49 cases in each group,and different intervention strategies were given during the perioperative period.The ERAS group was treated with comprehensive and systematic perioperative management strategy of ERAS,while the control group was treated with conventional perioperative management and treatment.The changes of mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(Sp0_(2))and Narcotrend anesthesia depth index(NT index)in the two groups were compared and analyzed.The visual analogue scale(VAS),Ramsay sedation score,perioperative complications and treatment satisfaction were recorded at different time points after operation.Results Compared with the control group,the NT index was lower at each time point after operation(skin cutting,operation for 30 min,1 hour,2 hours,and after operation)(P<0.05).The VAS of ERAS group was lower than that of control group at 4,8,12 and 24 hours after operation,and Ramsay score was higher than that of control group(P<0.05).Within 48 hours after operation,the effective pressing times of patient-controlled intravenous analgesia electronic pump in ERAS group were significantly less than those in control group(P<0.05).The incidence of perioperative complications in ERAS group was less than that in control group(P<0.05).The treatment satisfaction of ERAS group was higher than that in the control group(P<0.05).Conclusion The application effect of ERAS concept in the perioperative period of foot free tissue transplantation is exact.The programmed intervention measures can reduce the physiological and psychological trauma stress reaction of patients,reduce complications,and improve treatment sa

关 键 词：组织移植 镇痛 加速康复外科 区域麻醉 目标导向镇静 

分 类 号：R658.2[医药卫生—外科学]