加速康复外科在绝经后女性腹腔镜全子宫切除术围手术期管理中的应用  

Application of enhanced recovery after surgery in perioperative management of laparoscopic total hysterectomy in postmenopausal women

作　　者：刘婷 陈维燕 李喆 LIU Ting;CHEN Wei-yan;LI Zhe(Department of Gynecology,Linyi Cancer Hospital,Linyi 276000,China)

机构地区：[1]临沂市肿瘤医院妇科,山东临沂276000

出　　处：《腹腔镜外科杂志》2023年第6期454-458,共5页Journal of Laparoscopic Surgery

基　　金：临沂市科技发展计划项目(2022YX0130);临沂市科技发展计划项目(201818059)。

摘　　要：目的:探讨加速康复外科(ERAS)在绝经后女性行腹腔镜全子宫切除术围手术期的临床应用效果。方法:选择2018年11月至2022年10月因妇科良性疾病行腹腔镜全子宫切除术的140例绝经后女性患者,采用随机化分组将患者分为ERAS组(n=70)与对照组(n=70)。对照组采用传统围手术期处理,ERAS组采用ERAS处理,比较两组患者手术前后的心理状态、术后恢复情况、并发症发生情况及住院时间、住院费用。结果:ERAS组首次下床时间、肛门排气时间、首次进食时间、住院时间、住院费用均低于对照组(P<0.05);两组术前焦虑自评量表、抑郁自评量表评分差异无统计学意义(P>0.05),ERAS组术后焦虑、抑郁自评量表评分均低于对照组(P<0.05);ERAS组恶心呕吐评分>2分的发生率低于对照组,差异有统计学意义(P<0.05);ERAS组术后6 h、12 h、24 h疼痛评分均低于对照组(P<0.05);两组术后出血(阴道、腹腔穿刺孔、盆腔)、感染(盆腔、泌尿系统、肺部)、血栓形成(下肢静脉、肺)、肠梗阻的发生率差异无统计学意义(P>0.05)。结论:ERAS应用于绝经后女性腹腔镜全子宫切除术围手术期,在不增加并发症发生率的情况下,可减轻术后恶心、呕吐、疼痛等不适反应,改善焦虑、抑郁情绪,缩短住院时间,节约医疗费用。Objective:To investigate the clinical effects of enhanced recovery after surgery(ERAS)in perioperative period of laparoscopic total hysterectomy in postmenopausal women.Methods:A total of 140 postmenopausal women who received laparoscopic total hysterectomy due to benign gynecological diseases from Nov.2018 to Oct.2022 were selected and randomly divided into ERAS group(n=70)and control group(n=70).The control group was treated with traditional perioperative management,while the ERAS group was treated with ERAS.The psychological state before and after surgery,postoperative recovery,complications,hospital stay and cost of hospitalization were compared between the two groups.Results:The first time to ambulation,anal exhaust time,first feeding time,hospital stay and hospitalization expenses in ERAS group were significantly lower than those in control group(P<0.05).There was no significant difference in preoperative self-rating anxiety scale and self-rating depression scale scores between the two groups(P>0.05).The scores of postoperative self-rating anxiety scale and self-rating depression scale in ERAS group were significantly lower than those in control group(P<0.05).The incidence of postoperative nausea and vomiting scores>2 in ERAS group was significantly reduced compared with that in control group,and the difference was statistically significant(P<0.05).Pain scores at 6 h,12 h and 24 h in ERAS group were lower than those in control group(P<0.05).Postoperative complications between the two groups showed no signi-ficant differences in bleeding(vagina,abdominal puncture site,pelvic cavity),infection(pelvic cavity,urinary tract,lung),thrombosis(lower limb vein,lung)and intestinal obstruction(P>0.05).Conclusions:The application of ERAS in perioperative period of laparoscopic total hysterectomy in postmenopausal women can reduce postoperative discomfort reactions such as nausea,vomiting and pain,i mprove anxiety and depression,shorten hospital stay and save medical costs without increasing the incidence of complicatio

关 键 词：子宫切除术 术后加速康复 腹腔镜检查 绝经期 围手术期 

分 类 号：R713.4[医药卫生—妇产科学]