基于加速康复外科理念的多学科合作管理对二次剖宫产产妇术后恢复及早期转归的影响  

Effect of the multidisciplinary cooperative management based on enhanced recovery after surgery concept on postoperative recovery and early outcomes in pregnant women undergoing secondary cesarean section

作　　者：孔德华 朱朋[1] 孔宪刚[2] KONG Dehua;ZHU Peng;KONG Xiangang(Department of Obstetrics,Jining First People′s Hospital,Jining 272011,China;Department of Anesthesiology,Jining First People′s Hospital,Jining 272011,China)

机构地区：[1]济宁市第一人民医院产科,济宁272011 [2]济宁市第一人民医院麻醉科,济宁272011

出　　处：《济宁医学院学报》2024年第5期402-405,共4页Journal of Jining Medical University

基　　金：济宁市重点研发计划项目(2021YXNS112)。

摘　　要：目的探讨基于加速康复外科(ERAS)理念的多学科合作管理对二次剖宫产产妇术后恢复及早期转归的影响。方法选择2022年12月至2024年3月于济宁市第一人民医院行二次剖宫产手术的产妇60例,采用随机数字表法分为常规组和ERAS组,各30例。常规组给予传统管理方案,ERAS组给予基于ERAS理念的多学科合作管理方案。比较两组产妇术后恢复情况、术后镇痛情况及术后并发症发生情况。结果ERAS组产妇术后24h 11项产科恢复质量(ObsQoR-11)评分为(92.90±7.16)分高于常规组(85.20±11.86)分,术后首次排气时间为(25.17±4.91)h、初始泌乳时间为(21.20±1.67)h分别短于常规组(29.80±5.11)h和(25.67±3.04)h,子宫复旧程度为(2.26±0.71)cm大于常规组(1.67±0.42)cm,术后48h舒芬太尼用量为[50.00(48.00,52.00)]μg少于常规组[52.00(48.00,56.00)]μg,差异有统计学意义(t=3.044、-3.583、-7.048、3.908,Z=-2.354,均P<0.05)。ERAS组术后静息及咳嗽时中重度疼痛发生率、镇痛补救率、术后并发症总发生率分别为6.67%、10.00%、6.67%、26.67%,均明显低于常规组的26.67%、33.33%、30.00%、73.33%,差异有统计学意义(χ^(2)=4.320、4.812、5.455、13.067,均P<0.05)。结论基于ERAS理念的多学科合作管理有利于促进二次剖宫产产妇术后恢复,降低并发症,改善术后早期转归。Objective To investigate the effect of the multidisciplinary cooperative management based on enhanced recovery after surgery(ERAS)concept on postoperative recovery and early outcomes in pregnant women undergoing secondary cesarean section.Methods A total of 60 pregnant women who underwent secondary cesarean section in Jining No.1 people′s Hospital from December 2022 to March 2024 were selected and randomly divided into conventional group and ERAS group,with 30 cases in each group.Conventional group received traditional management,and ERAS group took multidisciplinary cooperative management based on ERAS.The postoperative recovery,postoperative analgesia,postoperative complications in two groups were compared.Results The obstetric quality of recovery-11(ObsQoR-11)score at 24 hours after surgery in ERAS group 92.90±7.16 points was higher than that in common group 85.20±11.86 points,the time of first exhaust after surgery was 25.17±4.91h and the initial lactation time 21.20±1.67h,shorter than those in common group 29.80±5.11h,25.67±3.04h,the uterine involution degree 2.26±0.71cm was greater than that in common group 1.67±0.42cm,sufentanil consumption in 48 hours after surgery[50.00(48.00,52.00)]μg was less than that in common group[52.00(48.00,56.00)]μg,and the differences were statistically significant(t=3.044,-3.583,-7.048,3.908,Z=-2.354,all P<0.05).The incidence of moderate to severe pain during rest or cough,the analgesia remedy rate and the total incidence of postoperative complications in observation group were 6.67%,10.00%,6.67%and 26.67%respectively,which were significantly lower than 26.67%,33.33%,30.0%,and 73.33%in common group,and the differences were statistically significant(χ^(2)=4.320,4.812,5.455,13.067,all P<0.05).Conclusion The multidisciplinary cooperative management based on ERAS concept can help to promote postoperative recovery of pregnant women undergoing secondary cesarean section,reduce complications and improve early postoperative outcomes.

关 键 词：多学科合作 加速康复外科 二次剖宫产 术后恢复 术后转归 

分 类 号：R714[医药卫生—妇产科学]