加速康复外科对鼻内镜手术患者应激反应的影响  

Impact of enhanced recovery after surgery on stress response in patients undergoing endoscopic sinus surgery

作　　者：黎庆辉 陈雪梅[1] 肖斌[1] 曾永亮 杨超[1] Li Qinghui;Chen Xuemei;Xiao Bin;Zeng Yongliang;Yang Chao(Department of Otolaryngology&Head and Neck Surgery,Chongqing University Jiangjin Hospital,Chongqing 402260,China)

机构地区：[1]重庆大学附属江津医院耳鼻咽喉头颈外科,重庆402260

出　　处：《保健医学研究与实践》2024年第2期64-70,109,共8页Health Medicine Research and Practice

基　　金：重庆市科卫联合医学科研项目(2020FYYX097);重庆市江津区科技局基金项目(Y2021055)。

摘　　要：目的观察加速康复外科(ERAS)围手术期管理对功能性鼻内镜手术患者术后炎症及应激反应的影响。方法选取2020年12月—2022年3月重庆某医院收治的慢性鼻窦炎伴鼻息肉(CRSwNP)患者50例,通过随机数字表法分为ERAS组(ERAS 1组)和对照组(C1组),每组25例;选取同期收治的慢性鼻窦炎不伴鼻息肉(CRSsNP)患者50例,随机分为对照组(C2组)和ERAS组(ERAS 2组),每组25例。ERAS组给予ERAS围手术期管理,对照组给予常规围手术期管理。比较不同组别患者围手术期焦虑自评量表(SAS)评分、术前口渴及饥饿评分、术后疼痛和睡眠质量视觉模拟评分法(VAS)评分、炎症及应激指标变化情况。结果在术前、术后SAS评分方面,ERAS 1组患者均低于C1组(P<0.05),ERAS 2组患者均低于C2组(P<0.05)。在术前口渴及饥饿评分方面,ERAS 1组患者均低于C1组(P<0.05),ERAS 2组患者均低于C2组(P<0.05)。在术后2 h、6 h、24 h的疼痛VAS评分方面,ERAS 1组患者均低于C1组(P<0.05),ERAS 2组患者均低于C2组(P<0.05);在术后48 h、72 h的疼痛VAS评分方面,ERAS 1组与C1组患者比较,差异均无统计学意义(P>0.05),ERAS 2组与C2组患者比较,差异均无统计学意义(P>0.05)。在术后1 d、2 d的睡眠质量VAS评分方面,ERAS 1组患者均低于C1组(P<0.05),ERAS 2组患者均低于C2组(P<0.05);在术后3 d的睡眠质量VAS评分方面,ERAS 1组与C1组患者比较,差异无统计学意义(P>0.05),ERAS 2组与C2组患者比较,差异无统计学意义(P>0.05)。在术前白细胞(WBC)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)水平方面,ERAS 1组和C1组患者的差异均无统计学意义(P>0.05),ERAS 2组和C2组患者的差异均无统计学意义(P>0.05);在术后WBC、CRP、TNF-α、Cor、ACTH水平方面,ERAS 1组患者均低于C1组(P<0.05),ERAS 2组患者均低于C2组(P<0.05)。结论ERAS围手术期管理可减轻鼻内镜手术患者围手术期焦虑,改善患者术前�Objective To observe the impact of Enhanced Recovery After Surgery(ERAS)perioperative management on postoperative inflammation and stress response in patients undergoing functional endoscopic sinus surgery.Methods Fifty patients with chronic rhinosinusitis with nasal polyps(CRSwNP)admitted to a hospital in Chongqing from December 2020 to March 2022 were selected and randomly assigned to the ERAS group(ERAS 1 group)and the control group(C1 group),with 25 patients in each group.Fifty patients with chronic rhinosinusitis without nasal polyps(CRSsNP)admitted during the same period were randomly assigned to the control group(C2 group)and the ERAS group(ERAS 2 group),with 25 patients in each group.The ERAS group received ERAS perioperative management,while the control group received conventional perioperative management.The Self-Rating Anxiety Scale(SAS)score,preoperative thirst and hunger score,postoperative pain and sleep quality Visual Analog Scale(VAS)score,and changes in inflammation and stress indicators were compared among different groups.Results In terms of preoperative and postoperative SAS scores,the ERAS 1 group had significantly lower scores than the C1 group(P<0.05),and the ERAS 2 group had significantly lower scores than the C2 group(P<0.05).In terms of preoperative thirst and hunger scores,the ERAS 1 group had significantly lower scores than the C1 group(P<0.05),and the ERAS 2 group had significantly lower scores than the C2 group(P<0.05).In terms of postoperative pain VAS scores at 2 hours,6 hours,and 24 hours,the ERAS 1 group had significantly lower scores than the C1 group(P<0.05),and the ERAS 2 group had significantly lower scores than the C2 group(P<0.05).The differences in postoperative pain VAS scores at 48 hours and 72 hours were not statistically significant between the ERAS 1 group and the C1 group(P>0.05),and no significant difference was found between the ERAS 2 group and the C2 group(P>0.05).In terms of postoperative sleep quality VAS scores at 1 day and 2 days,the ERAS 1 group had signific

关 键 词：加速康复外科 功能性鼻内镜手术 炎症 应激 慢性鼻窦炎 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]