加速康复外科理念下血液管理在腰椎结核围手术期的应用  

Application of blood management in the perioperative period of lumbar tuberculosis under the concept of enhanced recovery after surgery

作　　者：刘树仁 付琳[1] 王连波[1] 赵桂松 李卓[1] 董昭良[1] Liu Shuren;Fu Lin;Wang Lianbo;Zhao Guisong;Li Zhuo;Dong Zhaoliang(Department of First Orthopedics,Hebei Province Chest Hospital,Shijiazhuang 050041,China)

机构地区：[1]河北省胸科医院骨一科,石家庄050041

出　　处：《中国防痨杂志》2024年第11期1343-1349,共7页Chinese Journal of Antituberculosis

基　　金：河北省医学科学研究课题计划(20191021)。

摘　　要：目的:探索加速康复外科(ERAS)理念下腰椎结核围手术期的血液管理情况。方法:采用回顾性研究方法,收集2020年5月至2023年5月河北省胸科医院经规范抗结核治疗后行单纯腰椎后路手术的61例腰椎结核患者资料,根据围手术期内不同的血液管理方式将患者分为ERAS血液管理组(观察组;32例)和常规血液管理组(对照组;29例)。比较两组患者手术时间、术中输血量、术后3d引流量、术后卧床时间和围手术期总失血量,记录术后并发症、血栓及刀口愈合情况,并使用疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估腰部疼痛及功能恢复情况。结果:所有患者均顺利完成手术并获得随访。观察组手术时间[(127.65±25.37)min]、术中输血量[200(100,400)ml]、术后卧床时间[(5.09±1.15)d]、围手术期总出血量[833.30(678.76,897.22)ml]均明显低于对照组[(159.10±21.02)min、450(400,800)ml、(5.86±1.03)d、1086.37(793.60,1264.00)ml],差异均有统计学意义(t=5.240,P=0.000;Z=3.469,P=0.001;t=2.748,P=0.008;Z=3.134,P=0.002)。观察组和对照组患者术后共有5例发生皮疹、3例下肢血栓形成、8例因结核感染致刀口丙级愈合,发生率分别为9.38%(3/32)和6.89%(2/29)、6.25%(2/32)和3.45%(1/29)、15.63%(5/32)和10.34%(3/29),术后6个月的ODI评分分别为(7.38±1.07)%和(7.41±1.02)%,VAS评分分别为(2.81±0.74)分和(2.97±0.68)分,差异均无统计学意义(χ^(2)=0.124,P=1.000;χ^(2)=0.255,P=1.000;χ^(2)=-0.593,P=0.553;t=0.145,P=0.885;t=0.843,P=0.403)。结论:ERAS指导下围手术期血液管理可明显降低手术时间、术后卧床时间和围手术期总失血量,有利于手术的顺利实施,降低手术失血风险,使患者尽快康复,有一定临床积极意义;但术后并发症、血栓形成、刀口愈合,以及腰部疼痛和功能恢复与常规血液管理方式并无差异,说明两种方式的术后并发症和远期疗效一致,安全性相同。Objective:To explore the blood management in the perioperative period of lumbar tuberculosis under the concept of enhanced recovery after surgery(ERAS).Methods:A retrospective study was conducted to collect the data of 61 patients with lumbar tuberculosis who underwent simple lumbar posterior surgery after standardized anti-tuberculosis treatment in Hebei Chest Hospital from May 2020 to May 2023.According to different blood management methods during the perioperative period,the patients were divided into ERAS blood management group(observation group;32 cases)and conventional blood management group(control group;29 cases).The operation time,intraoperative blood transfusion volume,postoperative 3-day drainage volume,postoperative bedridden time and total volume of perioperative blood loss were compared between two groups of patients.Lower back pain and functional recovery were assessed using the visual analogue scale(VAS)and Oswestry disability index(ODI).Results:All patients successfully completed the surgery and were followed up.The observation group showed lower operation time((127.65±25.37)min),intraoperative blood transfusion volume(200(100,400)ml),postoperative bedridden time((5.09±1.15)d),total perioperative blood loss volume(833.30(678.76,897.22)ml)compared to that of control group((159.10±21.02)min,450(400,800)ml,(5.86±1.03)d,1086.37(793.60,1264.00)ml),and the differences were statistically significant(t=5.240,P=0.000;Z=3.469,P=0.001;t=2.748,P=0.008;Z=3.134,P=0.002).There were a total of 5 cases of rash complications,3 cases of lower limbs thrombosis,and 8 cases of grade C healing due to tuberculosis infection in the two groups,with incidence rates of 9.38%(3/32)and 6.89%(2/29),6.25%(2/32)and 3.45%(1/29),15.63%(5/32)and 10.34%(3/29),respectively.The ODI scores at 6 months were(7.38±1.07)%and(7.41±1.02)%,and the VAS scores were(2.81±0.74)points and(2.97±0.68)points after 6 months of follow-up,respectively,with no significant differences(χ^(2)=0.124,P=1.000;χ^(2)=0.255,P=1.000;χ^(2)=-0.593,P=0.553

关 键 词：结核 脊柱 失血 手术 围手术期护理 对比研究 加速康复外科 

分 类 号：R529.2[医药卫生—内科学] R473.6[医药卫生—临床医学]