摘要
目的 分析加速康复外科(enhanced recovery after surgery,ERAS)在单侧双通道脊柱内镜技术治疗腰椎间盘突出症的围手术期疗效。方法 选取2020年1月-12月在天津医院接受单侧双通道脊柱内镜治疗腰椎间盘突出症患者共55例,按照随机数字表法将患者随机分为传统组及ERAS组,传统组采用常规住院护理管理,ERAS组根据加速康复方案多学科协作制定全程一体化护理方案。比较两组患者术后首次排气时间、术后首次下床时间、住院时间、住院费用,术前及术后1、3 d视觉模拟评分法(Visual Analogue Scale,VAS)评分,术前、术后1个月Oswestry功能障碍指数(Oswestry Disability Index,ODI)评分,以及术后1个月改良MacNab疗效优良率。结果 传统组28例,ERAS组27例。ERAS组术后首次排气时间[(2.31±1.02)vs.(3.19±0.87)h]、术后首次下床时间[(1.06±0.40)vs.(2.00±0.53) d]均早于传统组,住院时间[(3.8±0.8)vs.(4.6±0.8) d]、住院费用[(3.218±0.910)万元vs.(3.981±1.110)万元]均少于传统组,差异有统计学意义(P<0.05)。ERAS组VAS评分在术后1 d时[(3.2±0.8)vs.(4.1±0.8)分]和术后3 d时[(1.4±0.5)vs.(1.7±0.5)分]均低于传统组(P<0.05),术后1个月的ODI评分低于传统组[(13.3±4.0)vs.(16.6±4.8)分,P<0.05]。术后1个月的改良MacNab疗效评价中,ERAS组与传统组优良率差异无统计学意义(96.3%vs. 96.4%,P>0.05)。结论 ERAS方案可显著加快患者康复,包括缩短首次排气时间,利于早期下床活动,减少住院时间和住院花费,同时,ERAS方案可有效减轻患者术后疼痛,促使患者尽早恢复功能。
Objective To analyze the perioperative efficacy of enhanced recovery after surgery(ERAS) in the treatment of lumbar disc herniation using unilateral biportal endoscopy technique. Methods A total of 55 patients who received unilateral biportal endoscopy technique for the treatment of lumbar disc herniation in Tianjin Hospital between January and December 2020 were selected and randomly divided into the traditional group and the ERAS group according to random number table method. The routine inpatient care management was adopted in the traditional group, while the holistic integrated care plan was formulated in the ERAS group according to the multidisciplinary collaboration of the accelerated rehabilitation plan. The first postoperative exhaust time, the first time out of bed, length of hospital stay,hospital costs, Visual Analogue Scale(VAS) scores before operation, one day and three days after operation, Oswestry Disability Index(ODI) scores before operation and one month after operation, and the excellent and good rate of modified MacNab efficacy one month after operation were compared between the two groups. Results There were 28cases in the traditional group and 27 cases in the ERAS group. The first postoperative exhaust time [(2.31±1.02) vs.(3.19±0.87) h], the first postoperative ambulation time [(1.06±0.40) vs.(2.00±0.53) d], length of hospital stay [(3.8±0.8) vs.(4.6±0.8) d], and hospital cost [(32.18±9.10) thousand yuan vs.(39.81±11.10) thousand yuan] in the ERAS group were all less than those in the traditional group, and the differences were statistically significant(P<0.05). The VAS scores of the ERAS group one day after operation(3.2±0.8 vs. 4.1±0.8) and three days after operation(1.4±0.5 vs. 1.7±0.5) were lower than those of the traditional group(P<0.05). The ODI scores of the ERAS group one month after operation was lower than that of the traditional group(13.3±4.0 vs. 16.6±4.8, P<0.05). In the modified MacNab efficacy evaluation one month after surgery, there was no significant difference in the excellent and good rate between the ERAS group and the traditional group(96.3% vs. 96.4%, P>0.05). Conclusions ERAS regimen can significantly accelerate the patients’ recovery,including shortening the first exhaust time, facilitating early ambulation, and reducing the hospital stay and hospitalization expenses. Meanwhile, ERAS regimen can effectively reduce the postoperative pain of the patients, and promote early functional recovery.
作者
张春虹
宋国敏
ZHANG Chunhongl;SONG Guomin(Department of Minimally Invasive Spine Surgery,Tianjin Hospital,Tianjin 300211,P.R.China;Nursing Department,Tianjin Hospital,Tianjin 300211,P.R.China)
出处
《华西医学》
CAS
2022年第10期1512-1516,共5页
West China Medical Journal
关键词
加速康复外科
单侧双通道脊柱内镜技术
围手术期管理
功能康复
Enhanced recovery after surgery
unilateral biportal endoscopy technique
perioperative management
functional rehabilitation
