中医特色快速康复外科理念在重复剖宫产围手术期的应用研究  

Application of enhanced rehabilitation after surgery with Chinese medicine characteristics in perioperative period of repeated cesarean deliver

作　　者：许瑞青 Xu Ruiqing(Department of Gynaecology and Obstetrics,Tianjin Hospital of Integrated Chinese and Western Medicine/Tianjin Nankai Hospital,Tianjin 300100,China)

机构地区：[1]天津市中西医结合医院天津市南开医院妇产科,天津300100

出　　处：《齐齐哈尔医学院学报》2024年第7期652-657,共6页Journal of Qiqihar Medical University

摘　　要：目的 探讨传统中医药联合快速康复理念(ERAS)在促进重复剖宫产术患者术后恢复的临床价值。方法 选择2020年12月—2022年12月本院收治的足月妊娠(37~42周)计划二次剖宫产分娩的孕妇120例作为研究对象,随机分为观察组和对照组两组,每组各60例。观察组患者在围手术期给予ERAS技术支持,同时术前术后给与中医药技术干预措施,对照组患者采用传统围手术期管理方法。比较在两种不同围手术期处理方案下,相关指标的差别如:术中及术后第1天、第3天阴道出血量;术后两组病人的VAS疼痛评分:首次进食流质时间、术后首次肛门排气时间、首次下床活动时间、住院时间、平均住院费用;患者术后不良反应和并发症发生率;术后24 h及72 h化验室指标中WBC及CRP、D-二聚体等化验指标的差异,来评估两种不同围手术期处理方式在重复剖宫产术应用中的优劣。结果 术中及术后第1天、第3天阴道出血量,观察组病人均明显少于对照组,差异具有统计学意义(P<0.05)。在患者自我评价方面,比较两组患者视觉模拟疼痛(VAS)评分,差异有统计学意义(P<0.05)。表明中医穴位针刺协助术后多模式镇痛有确定疗效。术后首次进食流质时间,首次肛门排气时间,首次下床活动及首次排便时间,观察组较对照组均明显缩短,差异有统计学意义(P<0.05)。表明中医联合快速康复组比传统治疗组在促进胃肠功能恢复上更有优势。两组术后72 h实验室检查,白细胞、CRP、D-二聚体均低于对照组,差异有统计学意义,表明中医联合快速康复组较传统治疗能降低创伤应激反应。术后住院时间观察组相比对照组明显缩短,平均住院费用明显下降,差异有统计学意义(P<0.05)。比较两组术后不良反应情况,观察组出现恶心呕吐、肠梗阻、尿潴留等不良反应均较对照组明显减少,差异有统计学意义(P<0.05),观察切口感染、下肢血�Objective To investigate the clinical value of traditional Chinese medicine combined with enhanced recovery after surgery(ERAS) in promoting the recovery of patients undergoing repeat cesarean section.Methods 120 cases of full-term(37 weeks-42 weeks) pregnant women scheduled for second cesarean delivery in Nankai Hospital from December 2020 to December 2022 were selected as the study subjects,they were randomly divided into the control group and the observation group,with 60 cases in each group.The observation group was given ERAS technical support during the perioperative period,as well as preoperative and postoperative TCM appropriate technology interventions,while the control group adopted traditional perioperative management methods.By comparing the differences in indicators of the two different perioperative management plans,the relevant indicators such as:intraoperative and postoperative vaginal bleeding on the first and third day;postoperative VAS pain scores of patients in the two groups;postoperative time of the first fluid intake,time of the first anal defecation,time of the first time to get out of bed,length of hospitalization,the average hospitalization cost;the incidence of postoperative adverse reactions and complications;the amount of WBC,levels of CRP and D-dimerization in the laboratory indicators at 24h and 72h postoperative;the advantages and disadvantages of the two different perioperative treatments in the application of repeat cesarean section were evaluated.Results Intraoperative and postoperative bleeding on day 1 and day 3 in the observation group were significantly less than those in the control group,and the differences were statistically significant(P<0.05).In terms of patient self-assessment,the difference in visual analog pain(VAS) scores between the two groups were statistically significant(P<0.05).The results showed that acupuncture assisted multi-mode postoperative analgesia had definite curative effect.The postoperative time of first fluid intake,the postoperative time of first

关 键 词：中医特色 快速康复外科理念 重复剖宫产 围手术期 

分 类 号：R714.7[医药卫生—妇产科学]