加速康复外科在老年腰椎间盘突出症局部麻醉经皮脊柱内镜术中的应用研究  

Application research on enhanced recovery after surgery in percutaneous spinal endoscopy under local anesthesia for elderly patients with lumber disc herniation

作　　者：王路[1] 程才[1] 李凌霞 郭志远 辛大森 李维彬[1] 侯汉晖 韩红敏[1] WANG Lu;CHENG Cai;LI Lingxia;GUO Zhiyuan;XIN Dasen;LI Weibin;HOU Hanhui;HAN Hongmin(Department of OrthopedicsⅠ,Cangzhou Central Hospital,Hebei,Cangzhou 061001,China;Section of Clinical Pharmacy,Cangzhou People’s Hospital,Hebei,Cangzhou 061000,China)

机构地区：[1]河北省沧州市中心医院骨一科,河北沧州061001 [2]河北省沧州市人民医院临床药学室,河北沧州061000

出　　处：《中国医药科学》2022年第18期156-160,共5页China Medicine And Pharmacy

基　　金：河北省医学科学研究课题计划(20210205)。

摘　　要：目的探讨加速康复外科(ERAS)在老年腰椎间盘突出症局部麻醉经皮脊柱内镜术中的临床效果及应用价值。方法选取2020年10月至2021年10月沧州市中心医院收治的30例腰椎间盘突出症老年患者,采用随机数表法分为两组,其中ERAS组15例,对照组15例。对照组采用常规的禁食、补液、自控泵镇痛、术后放置引流等围手术期方案,ERAS组采用术前宣教、不禁食水、不放置引流、多模式镇痛、复合止血药物应用、早期功能锻炼等方案,比较两组患者在手术时间、术中出血量、离床下地活动时间、术后住院时间,手术相关并发症发生率方面的差别,并对两组患者术前、术后3 d、术后3个月采用视觉模拟疼痛量表(VAS)评分、Oswestry功能障碍指数(ODI)及改良Macnab评分进行临床效果比较。结果ERAS组手术时间、术中止血时间、术后住院时间、术后3 d VAS评分及ODI评分、术后并发症总发生率均优于对照组,差异有统计学意义(P<0.05)。而两组在术后3个月VAS评分、ODI评分、改良Macnab评分方面比较,差异无统计学意义(P>0.05)。结论在应用脊柱内镜治疗老年腰椎间盘突出症围手术期间应用ERAS模式,可以缩短患者术后住院时间、加快手术时间、减轻患者术后疼痛,有利于术后早期疼痛缓解和快速康复。Objective To investigate the clinical efficacy and application significance of enhanced recovery after surgery(ERAS)in percutaneous spinal endoscopy under local anesthesia for elderly patients with lumber disc herniation.Methods A total of 30 elderly patients with lumber disc herniation admitted to and treated in the Cangzhou Central Hospital from October 2020 to October 2021 were selected to receive percutaneous spinal endoscopic intervertebral foraminoplasty combined with enucleation of nucleus pulposus under local anesthesia as planned.The enrolled patients were divided into the ERAS group(n=15)and the control group(n=15)by random number table method.The control group was treated with conventional perioperative programs such as fasting,fluid infusion,analgesia with patient-controlled analgesia pump and postoperative drainage,while the ERAS group was treated with preoperative education,no fasting,no drainage,multi-mode analgesia,application of compound hemostatic drugs,and early functional exercise,etc.The differences in operation time,intraoperative hemorrhage volume,ambulation time,postoperative hospitalization time,and incidence of complications related to operation between the two groups of patients were compared.And the clinical efficacies of the two groups of patients before operation,3 days after operation and 3 months after operation were compared by using visual analogue scale(VAS)score,Oswestry dysfunction index(ODI)and modified Macnab score.Results The operation time,intraoperative hemostasis time,postoperative hospital stay,VAS score and ODI score at 3 days after operation,and the total incidence of postoperative complications in ERAS group were better than those in control group,and the differences were statistically significant(P<0.05).The early postoperative satisfaction of patients in ERAS group was significantly higher than that in control group,and the difference was statistically significant(P<0.05).There was no significant difference in VAS score,ODI score and modified Macnab score between t

关 键 词：老年 腰椎间盘突出症 脊柱内镜 加速康复 

分 类 号：R473.6[医药卫生—护理学]