围手术期加速康复临床路径在单侧双通道脊柱内镜腰椎间盘切除术中的应用  

Application of perioperative enhanced recovery after surgery clinical pathway in unilateral biportal endoscopic lumbar discectomy

作　　者：倪国玉[1] 张志武 孟海[1] 白成瑞[1] 白天宇 金凤 苏楠[1] 范子寒 林吉生[1] 谢学虎 邵佳申 杨雍[1] 费琦[1] NI Guoyu;ZHANG Zhiwu;MENG Hai;BAI Chengrui;BAI Tianyu;JIN Feng;SU Nan;FAN Zihan;LIN Jisheng;XIE Xuehu;SHAO Jiashen;YANG Yong;FEI Qi(Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University,Beijing,100050,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《中华骨与关节外科杂志》2024年第9期823-830,共8页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:评价加速康复外科(ERAS)临床路径在单侧双通道脊柱内镜(UBE)腰椎间盘切除术中的应用效果。方法:回顾性分析2022年8月至2024年1月首都医科大学附属北京友谊医院因腰椎间盘突出症接受UBE腰椎间盘切除术的130例患者的临床资料。其中2022年8月至2023年4月收治的49例为传统组,2023年5月至2024年1月收治的81例为ERAS组,ERAS组核心要点包括4次患者宣教、疼痛管理、康复科参与指导围手术期功能锻炼、“术能”的应用、早期下地活动。统计学分析两组患者手术前后的下肢疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、术后首次下地时间、住院时间等。结果:与传统组相比,ERAS组患者术后4 h、24 h的VAS评分更低,差异均有统计学意义(P均<0.05);术后首次下地时间更早、平均住院时间更短、阿片类药物使用情况更少,差异均有统计学意义(P均<0.05);两组患者术前、术后48 h、出院当日VAS评分及术前、出院当日ODI评分比较,差异均无统计学意义(P均>0.05);两组患者围手术期并发症总发生率比较,差异无统计学意义(P>0.05)。结论:在ERAS临床路径管理下,UBE治疗腰椎间盘突出症可以早期减轻术后疼痛、提前术后首次下地时间、缩短住院时间、减少阿片类药物使用情况,同时未增加围手术期并发症发生率,可以获得满意的围手术期临床疗效。Objective:To evaluate the effectiveness of the enhanced recovery after surgery(ERAS)clinical pathway in unilateral biportal endoscopic(UBE)lumbar discectomy.Methods:A retrospective analysis was conducted on the clinical data of 130 patients who underwent UBE lumbar discectomy for lumbar disc herniation at Beijing Friendship Hospital,Capital Medical University,from August 2022 to January 2024.Patients were divided into two groups:49 treated from August 2022 to April 2023(the traditional group)and 81 treated from May 2023 to January 2024(the ERAS group).The core points for the ERAS group included four patient educations,pain management,the rehabilitation department in guiding perioperative functional exercises,the use of"Outfast",and early ambulation.Pre-and post-operative visual analog scale(VAS)scores for lower limb pain,the Oswestry Disability Index(ODI),the time to the first ambulation,and hospitalization days were compared between the two groups.Results:Compared to the traditional group,the ERAS group had significantly lower VAS scores at 4 and 24 hours postoperatively,earlier first ambulation,shorter average hospital stays and less opioid consumption(all P<0.05).There were no statistically significant differences in VAS scores preoperatively,48 hours postoperatively and on the day of discharge,or in ODI scores preoperatively and on the day of discharge between the two groups(all P>0.05).The overall incidence of perioperative complications was similar between the two groups(P>0.05).Conclusions:Under the management of the ERAS clinical pathway,UBE for lumbar disc herniation can effectively reduce postoperative pain,shorten the time to the first ambulation,decrease hospital stay and the use of opioids,while did not increase perioperative complication rates,resulting in satisfactory perioperative clinical outcomes.

关 键 词：加速康复外科 单侧双通道脊柱内镜 微创手术 腰椎间盘突出症 

分 类 号：R681.5[医药卫生—骨科学]