ERAS胃肠道管理方案在腰椎后路融合术患者中的应用  

The Application of Enhanced Recovery After Surgery Gastrointestinal Management Scheme in Patients with Posterior Lumbar Interbody Fusion Surgery

作　　者：齐琼 曾立云[3] 潘莺燕 Qi Qiong;Zeng Liyun;Pan Yingyan(Department of Spine Surgery,People's Hospital of Hunan Provincial,Changsha 410005,China;Xiangya School of Nursing of Central South University,Changsha 410013,China;Clinical Nursing Teaching and Research Department,The Second Xiangya Hospital of Central South University,Changsha 410012,China)

机构地区：[1]湖南省人民医院脊柱外科,湖南长沙410005 [2]中南大学湘雅护理学院,湖南长沙410013 [3]中南大学湘雅二医院临床护理学教研室,湖南长沙410012

出　　处：《实用骨科杂志》2021年第9期769-773,共5页Journal of Practical Orthopaedics

基　　金：2017年第五批科技发展计划(创新平台与人才计划)项目(2017TP1004)。

摘　　要：目的比较加速康复外科(enhanced recovery after surgery,ERAS)胃肠道管理方案与传统胃肠道管理方案对腰椎后路融合术(posterior lumbar interbody fusion,PLIF)患者的影响。方法将符合纳入排除标准的80例腰椎间盘突出症(lumbar disc herniation,LDH)患者随机分为对照组和试验组各40例。其中对照组男21例,女19例,平均年龄(53.73±14.07)岁;试验组男23例,女17例,平均年龄(57.98±11.61)岁。对照组实施传统胃肠道管理方案,试验组实施ERAS胃肠道管理方案。比较两组患者术中误吸与非计划性排便发生率、术后口渴与饥饿程度、术后胃肠道功能恢复情况以及术后住院天数的差异。结果两组患者均未发生术中误吸与非计划性排便。试验组术后口渴与饥饿程度、胃肠道症状积分量表(gastrointestinal symptom score,GIS)评分较对照组降低(P<0.05),术后首次排气时间早于对照组(P<0.05)。两组患者术后首次排便时间、便秘发生率、便秘症状自评量表(patient assessment of constipation symptom,PAC-SYM)评分、住院天数比较差异无统计学意义(P>0.05)。结论对于腰椎间盘突出症PLIF应用ERAS胃肠道管理方案可以改善患者术后口渴、饥饿的不良体验,促进肠蠕动早期恢复,减轻术后功能性消化不良症状,不会增加术中误吸、非计划性排便及术后便秘风险,可以在临床推广应用。Objective To compare the different effects of the enhanced recovery after surgery(ERAS)preoperative gastrointestinal preparation measures and traditional gastrointestinal preparation measures in posterior lumbar interbody fusion(PLIF)surgery for lumbar disc herniation(LDH)patients.Methods To tally 80 LDH patients before PLIF surgery were randomized into a control group and an intervention group,with 40 patients in each group,among them.There were 21 males and 19 females in the control group.The average age of patients was(53.73±14.07)years old.There were 23 males and 17 females in the control group,and the average age of patients was(57.98±11.61)years old.Control group received traditional gastrointestinal management measures,while the intervention group received ERAS gastrointestinal management measures.The incidence of aspiration and defecation during the surgery,postoperative hunger and thirsty,postoperative gastrointestinal recovery and length of stay between the two groups were compared.Results No aspiration or defecation occurred in the two groups.The hunger,thirsty,gastrointestinal symptom score of the intervention group were lower than those of the control group(P<0.05),and The first time of exhaust after operation was earlier than that of the control group(P<0.05).There was no statistically significant difference between the two groups in the time of first postoperative defecation,abdominal distention,constipation,time of defecation reconstruction,patient assessment of constipation symptom,postoperative length of hospital stay(P>0.05).Conclusion The application of ERAS gastrointestinal management plan to patients undergoing PLIF surgery can improve the perioperative subjective experience of patients,promote the recovery of early postoperative intestinal peristalsis,and do not increase the risk of abdominal distention,constipation,and prolonged postoperative hospital stay.It can be applied gradually.

关 键 词：腰椎间盘突出症 腰椎后路融合术 机械性肠道准备 加速康复外科 胃肠道管理 

分 类 号：R681.53[医药卫生—骨科学]