摘要
目的探讨加速康复外科(ERAS)理念在妇科盆底重建术围术期中的应用价值。方法将因盆底器官脱垂行盆底重建手术治疗的80例女性患者分为ERAS组(39例)和对照组(38例)。对照组采用常规围术期管理,ERAS组采用ERAS理念进行围术期管理。比较两组患者术前主观舒适度、术中及术后相关指标情况。结果术前30 min,ERAS组口渴感、饥饿感、恶心感的VAS评分均低于对照组,且口渴感及饥饿感的VAS评分均低于术前3 h;对照组口渴感、焦虑感、恶心感的VAS评分均高于术前3 h(均P <0. 05)。两组患者手术时间、麻醉时间、术中失血量、术中补液量、术中肠胀气、切口愈合不良、术后腹胀、腹泻发生率比较差异均无统计学意义(均P> 0. 05)。ERAS组术中大便失禁、术后恶心呕吐、水电解质紊乱发生率均低于对照组,术后首次排气时间、首次排便时间、首次进普食时间、术后住院时间均短于对照组(均P <0. 05)。两组患者术后1 d胰岛素抵抗指数、C反应蛋白及FBG水平均高于术前1 d,但ERAS组上述指标水平低于对照组(均P <0.05)。结论 ERAS应用于盆底重建术围术期管理可以增加患者的舒适度,有利于患者术后消化功能的恢复,减轻术后应激反应,并改善胰岛素抵抗。
Objective To explore the application value of the concept of enhanced recovery after surgery(ERAS)in the perioperative management for pelvic floor reconstruction.Methods Eighty female patients who underwent pelvic floor reconstruction surgery for pelvic organ prolapse were divided into ERAS group(n=39)and control group(n=38).The control group accepted the conventional perioperative management,while the ERAS group used ERAS concept in the perioperative management.The preoperative subjective comfort,intraoperative and postoperative related indicators were compared between the two groups.Results In the ERAS group,the VAS scores for sense of thirst,sense of hunger and sense of nausea at 30 minutes before operation were lower than those in the control group,the VAS scores for sense of thirst and sense of hunger at 30 minutes before operation were lower than the scores at 3 hours before operation;in the control group,the VAS scores for sense of thirst,sense of anxiety and sense of nausea at 30 minutes before operation were higher than the scores at 3 hours before operation(all P<0.05).There were no significant differences between the two groups in the operation duration,anesthesia duration,intraoperative blood loss,volume of intraoperative fluid input,incidence rate of intraoperative flatulence,poor incision healing,postoperative nausea or vomiting(all P>0.05).The incidence rates of intraoperative fecal incontinence,postoperative nausea and vomiting,and water-electrolyte disturbance were lower,and the durations for first exhaust,first defecation and first normal diet after operation as well as the postoperative hospital stay were shorter in the ERAS group compared with the controls(all P<0.05).The levels of Homeostasis Model Assessment-insulin resistance,C-reactive protein and FBG after one day of operation were higher than those before one day of operation,however,the levels of indicators above in the ERAS group were lower than those in the control group(all P<0.05).Conclusion ERAS applied to perioperative management
作者
李承秋
刘成
张洁
黄志欣
洪佳
洪莉
LI Cheng-qiu;LIU Chen;ZHANG Jie;HUANG Zhi-xin;HONG Jia;HONG Li(The Second Department of Gynecology,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Gynecology,East Division,Renmin Hospital of Wuhan University,Wuhan 430060,China)
出处
《广西医学》
CAS
2018年第19期2299-2303,共5页
Guangxi Medical Journal
基金
国家自然科学基金(81701424)
关键词
盆底器官脱垂
加速康复外科
女性
盆底重建术
围术期
Pelvic organ prolapse
Enhanced recovery after surgery
Woman
Pelvic floor reconstruction
Perioperative period
