MASS及WFTSS在腹腔镜胆囊切除患者ERAS中的比较研究  

Comparative study of MASS and WFTSS in ERAS for patients undergoing laparoscopic cholecystectomy

作　　者：梁国晋 陈益君 黄长顺 LIANG Guojin;CHEN Yijun;HUANG Changshun(Department of Anesthesiology,the First Affiliated Hospital of Ningbo University,Ningbo 315010,Zhejiang,China)

机构地区：[1]宁波大学附属第一医院麻醉科,浙江宁波3150101

出　　处：《中国现代医生》2024年第29期15-18,32,共5页China Modern Doctor

基　　金：浙江省医学会项目(2017ZYC-A50;202003N4272)。

摘　　要：目的对改良的Aldrete评分系统(modified Aldrete scoring system,MASS)及White快速通道评分系统(White’s fast-track scoring system,WFTSS)在术后快速康复(enhanced recovery after surgery,ERAS)方面做出评价,比较七氟醚与丙泊酚维持麻醉对ERAS的影响。方法选取2021年1月至2023年10月于宁波大学附属第一医院接受腹腔镜胆囊切除手术的患者160例作为研究对象,采用随机数字表法将患者分为七氟醚组和丙泊酚组,每组80例。七氟醚组采用七氟醚-瑞芬太尼维持麻醉,丙泊酚组给予丙泊酚-瑞芬太尼维持麻醉。通过WFTSS和MASS对患者进行ERAS评估。记录麻醉恢复时间、符合ERAS的患者例数、不符合ERAS的相关因素与围手术期并发症。结果与MASS比较,WFTSS对ERAS的出手术室评估更加有效(P=0.031)。拔管时间方面,七氟醚组明显慢于丙泊酚组(P=0.030);在符合ERAS方面,丙泊酚组患者例数明显多于七氟醚组(P=0.026),入复苏室的患者例数明显少于七氟醚组,差异有统计学意义(P=0.025)。结论WFTSS可作为ERAS的出室标准之一。与七氟醚联合瑞芬太尼维持麻醉比较,丙泊酚联合瑞芬太尼维持麻醉能更快达到ERAS手术室内的拔管要求,且不良反应更小。Objective To evaluate the modified Aldrete scoring system(MASS)and the White’s fast-track scoring system(WFTSS)in the context of enhanced recovery after surgery(ERAS)and to compare the effects of sevoflurane anesthesia maintenance with propofol intravenous anesthesia maintenance in the ERAS of patients undergoing laparoscopic cholecystectomy;to evaluate the MASS and WFTSS in the context of ERAS.Methods A total of 160 patients undergoing laparoscopic cholecystectomy from January 2021 to October 2023 in the First Affiliated Hospital of Ningbo University were randomly divided into sevoflurane group and propofol group,80 cases in each group.The sevoflurane group maintained on sevoflurane-remifentanil and propofol group on propofol-remifentanil.Patients ERAS were evaluated by WFTSS and MASS.Time to the recovery from anesthesia,number of patients meeting the ERAS,factors associated with non-ERAS compliance,and perioperative complications were recorded.Results The proportion of patients entering ERAS in both groups was higher in the MASS than in the WFTSS(P=0.031).In terms of extubation time,the sevoflurane group was significantly slower than propofol group(P=0.030).In terms of meeting ERAS criteria,the propofol group had significantly more patients than sevoflurane group(P=0.026),and the number of patients entering the recovery room was significantly less than in sevoflurane group(P=0.025).Regarding the factors affecting entry into ERAS,the number of cases in sevoflurane group was higher than in propofol group,with postoperative nausea being the only factor with statistical significance while others were not significantly different.Conclusion WFTSS provides a more comprehensive and effective assessment for ERAS at the time of leaving the operating room and can be considered as one of the discharge criteria for ERAS.It also concludes that compared with sevoflurane combined with remifentanil for anesthesia maintenance,the propofol combined with remifentanil maintenance can achieve the extubation requirements in the ope

关 键 词：全凭静脉麻醉 吸入麻醉 腹腔镜胆囊切除术 MASS评分 

分 类 号：R614[医药卫生—麻醉学]