ERAS理念下达芬奇机器人与单孔胸腔镜肺叶切除术患者术后康复和疼痛的对比研究  

Comparative study of postoperative rehabilitation and pain in patients undergoing Da Vinci robot-assisted thoracoscopic surgery and single-port video-assisted thoracoscopic surgery based on the concept of ERAS

作　　者：刘冬华[1] 林艳荣[2] 张英慧[3] 陈雪莉[4] 常宗娥[4] 冯翠翠[1] 杜可[2] 王振兴 LIU Donghua;LIN Yanrong;ZHANG Yinghui;CHEN Xueli;CHANG Zong’e;FENG Cuicui;DU Ke;WANG Zhenxing(Department of Anesthesiology,Liaocheng People’s Hospital,Liaocheng 252000,China;Department of Thoracic Surgery,Liaocheng People’s Hospital,Liaocheng 252000,China;Department of Gastrointestinal Surgery,Liaocheng People’s Hospital,Liaocheng 252000,China;Operating Room,Liaocheng People’s Hospital,Liaocheng 252000,China)

机构地区：[1]聊城市人民医院麻醉科,山东聊城252000 [2]聊城市人民医院胸外科,山东聊城252000 [3]聊城市人民医院胃肠外科,山东聊城252000 [4]聊城市人民医院手术室,山东聊城252000

出　　处：《机器人外科学杂志（中英文）》2024年第5期926-931,共6页Chinese Journal of Robotic Surgery

基　　金：中华医学会杂志社20212022年护理学科研究发展课题(CMAPH-NRD2021057)。

摘　　要：目的:对比分析加速康复外科(ERAS)理念下达芬奇机器人辅助胸腔镜手术(RATS)与单孔胸腔镜手术(VATS)患者术后康复和疼痛情况。方法:回顾性分析2021年9月—2022年8月在聊城市人民医院行RATS和单孔VATS的68例患者的临床资料,其中RATS组33例,单孔VATS组35例。两组患者均在ERAS理念下实施多模式镇痛(MMA)管理方案,椎旁神经阻滞(PVB)联合静吸复合全麻,侧卧位下实施手术,术后急性疼痛服务(APS)小组进行两次/天疼痛查房。比较两组患者的一般资料、手术时间、术中镇痛药物用量、术后入麻醉后恢复室(PACU)、术后24 h、48 h和72 h患者的镇痛药物用量、恶心呕吐发生率、术后24 h、48 h和72 h的静息和咳嗽疼痛评分,胸腔引流管的平均拔除时间、术后出院时间和首次下床活动时间。结果:两组患者均顺利完成手术,无中转开胸。RATS组手术时间和麻醉时间长于VATS组;两组患者术后24 h内的静息痛和咳嗽痛评分差异无统计学意义(P>0.05),但RATS组患者术后48 h和72 h的静息痛和咳嗽痛评分低于单孔VATS组,且差异有统计学意义(P<0.05)。RATS组患者术后48h、72h阿片类药物用量低于单孔VATS组,差异有统计学意义(P<0.05)。两组患者术后首次下床活动时间、胸腔引流管拔除时间、出院时间和术后麻醉并发症相比,差异无统计学意义(P>0.05)。结论:基于ERAS理念实施MMA,RATS和单孔VATS有相似的围术期安全性和可靠性,但RATS手术时间、麻醉时间长于单孔VATS组,RATS术后48和72 h内静息、咳嗽疼痛评分和阿片药物用量低于单孔VATS组。Objective:To compare the postoperative rehabilitation and pain of patients who underwent robot-assisted thoracoscopic surgery(RATS)and video-assisted thoracoscopic surgery(VATS)based on the concept of enhanced recovery after surgery(ERAS).Methods:Clinical data of 68 patients who underwent RATS and single-port VATS in Liaocheng People’s Hospital from September 2021 to August 2022 were retrospectively analyzed.There were 33 cases in the RATS Group and 35 cases in single-port VATS Group.Patients in the two groups were both given multimodal analgesia(MMA)management program based on the concept of ERAS,paravertebral nerve block combined with intravenous inhalation and general anesthesia.Surgeries were performed in the lateral position.Patients were visited by Acute Pain Service(APS)twice a day after surgery for pain examination.The general data,operative time,intraoperative dosage of analgesics,postoperative dosage of analgesics in post anesthesia care unit(PACU),postoperative dosage of analgesics at 24 h,48 h,72 h after surgery,incidence of nausea and vomiting,resting and cough pain scores at 24 h,48 h,72 h after surgery,removal time of thoracic drainage,off-bed time,the length of hospital stay of patients in the two groups were compared.Results:All surgeries were successfully completed without conversion to thoracotomy.The operative time and anesthesia duration of patients in the RATS group were longer than those in the single-port VATS group.There was no significant difference in the pain scores at rest and cough within 24 h after surgery(P>0.05),but the pain scores at rest and cough in the RATS group were lower than those in the single-port VATS group at 48 h and 72 h after surgery(P<0.05).The dosage of opioids in the RATS group was lower than that in the single-port VATS group at 48 h and 72 h after surgery(P<0.05).There was no significant difference between the two groups in the time of getting out of bed,removal time of thoracic drainage,the length of hospital stay,the incidence of vomiting and adverse side e

关 键 词：机器人辅助胸腔镜手术 单孔胸腔镜手术 术后疼痛 加速康复外科 

分 类 号：R655.4[医药卫生—外科学] R735.1[医药卫生—临床医学]