摘要
目的探讨加速康复外科(Enhanced Recovery After Surgery,ERAS)理念在颈椎病行Mobi-C人工颈椎间盘置换的患者围手术期的应用。方法自2017年1月—2018年9月科室收治的17例(23个节段)因颈椎病行Mobi-C人工颈椎间盘置换的患者,术前保守治疗3个月无效,围手术期应用ERAS理念,术前给予全面评估及治疗相关原发病、多方式详尽的术前指导,减轻患者心理负面情绪、超前镇痛、术前6小时禁食、2小时禁饮、不常规留置尿管;术中加强体温管理、限制液体入量、不放置切口引流管;术后保证有效可行的镇痛、全麻清醒后即可漱口、饮水,术后4~6小时开始进食、术后第1天佩戴颈托,下床活动,术后第4天去除颈托等措施。比较患者术前及术后的上下肢运动、感觉、躯体感觉及膀胱功能评分。数据处理采用SPSS 17.0统计学软件,计数资料采用例(%)进行描述,计量资料采用(x±s)进行描述,计量资料两组间比较采用两独立样本t检验,P<0.05为差异有统计学意义。结果17例患者均获得连续随访,数据采集在术前、术后1个月进行。患者症状消失或明显缓解,未出现新的神经症状,脊髓功能改善,患者手术前后上下肢运动及膀胱功能JOA评分(日本骨科协会评估治疗分数)、下肢及躯干感觉JOA评分均有差异,且差异均具有统计学意义(P<0.01)。患者术后未发生护理并发症,复查X线片显示假体位置无变化,未出现偏移、下沉。结论将ERAS理念应用于颈椎病行Mobi-C人工颈椎间盘置换的患者围手术期,有利于减轻患者围手术期的焦虑,缓解术后疼痛,降低术后不适,减少术后并发症,提高成本效益。
Objective To investigate the enhanced recovery after surgery(enhanced recovery after surgery ERAS)concept in patients with cervical spondylosis row Mobi-C artificial cervical disc replacement perioperative applications.Methods From January 2017 to September 2018,17 patients(23 segments)underwent Mobi-C cervical disc replacement due to cervical spondylosis,Preoperative conservative treatment was ineffective for 3 months,perioperative application of ERAS concepts,Preoperative comprehensive evaluation and treatment of related primary diseases,multi-way detailed preoperative guidance,To alleviate the patients'psychological negative emotion,preemptive analgesia,6 hours fasting before operation,2 hours no drinking,non-conventional indwelling catheter;Strengthen body temperature management during operation,limit fluid intake,do not place incision drainage tube;After the operation to ensure effective and feasible analgesia,general anesthesia sober can gargle,drinking water,Start eating 4-6 hours after surgery,wear neck brace 1 day after surgery,Get out of bed,Removal of neck support on the 4th day after operation.The scores of upper and lower limb movement,sensation,somatosensory and bladder function were compared before and after operation.Data processing using spss17.0 statistics software,The counting data are described by example(%),Metrology is described by(x±s),Comparison of measurement data between the two groups using two independent samples t test,P<0.05 was statistically significant.Results 18 patients were followed up continuously.Data collected in the preoperative and postoperative 3 days,7 days,1 month,3 months,6 months and 12 month.Symptoms disappeared or significantly eased,new neurological symptoms did not appear,spinal cord function improved,JOA score increased from preoperative to postoperative 6-11 points 14-17 points;Odom excellent rating 16 cases,2 cases of benign;VAS score,NDI indices remain low.Nursing complications,review X-ray showed moderate prosthesis position,offset or prosthetic subsidence oc
作者
陈树军
解妍琪
王巧英
唐晓杰
王春晓
CHEN Shujun;XIE Yanqi;WANG Qiaoying;TANG Xiaojie;WANG Chunxiao(Spine Surgery Department,Yantai Affiliated Hospital,Binzhou Medical College,Yantai Shandong 264000,China)
出处
《中国继续医学教育》
2021年第9期171-175,共5页
China Continuing Medical Education
基金
山东省烟台市重点研发计划(政策引导类)项目(2019YD062)。
关键词
快速康复
颈椎病
Mobi-C人工颈椎间盘
颈椎间盘置换
围手术期
脊髓功能
rapid recovery
cervical spondylosis
mobi-c artificial cervical disc
cervical disc replacement
perioperative period
spinal cord function
