加速康复外科理念下麻醉管理在腰椎手术中的应用

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摘要目的探讨在加速康复外科（ERAS）理念指导下进行的麻醉管理对腰椎手术患者的临床效果。方法选取冀中能源邢台矿业集团总医院2019年3月—8月行腰椎后路减压植骨融合内固定术的腰椎退行疾病患者80例，按照随机数字表法将其分成对照组和ERAS组，每组40例。对照组采用常规麻醉管理，ERAS组采用ERAS理念的麻醉管理。比较两组患者术中生命体征，包括平均动脉压（MAP），心率（HR），术后苏醒时间和定向力恢复时间及拔管时间，术中阿片药用量，术后不良反应（寒战，恶心、呕吐），术后不同时间点的疼痛视觉模拟评分（VAS）以及患者住院时间。结果两组患者MAP、HR组间、时间及交互作用比较，差异有统计学意义（P ＜ 0.05）。其中ERAS组MAP、HR各时间点比较，差异无统计学意义（P ＞ 0.05）。对照组MAP各时间点比较，差异有统计学意义（P ＜ 0.05）；除1、2 h外，其他各时间点HR比较，差异有统计学意义（P ＜ 0.05）。ERAS组MAP、HR各时间点低于对照组，差异有统计学意义（P ＜ 0.05）。ERAS组患者术后恶心、呕吐，寒战发生率均低于对照组，差异有统计学意义（P ＜ 0.05）。ERAS组患者舒芬太尼用量低于对照组，差异有统计学意义（P ＜ 0.05）。ERAS组术后苏醒时间、定向力恢复时间、术后拔管时间及住院时间短于对照组，差异有统计学意义（P ＜ 0.05）。ERAS组患者术后各时间点VAS低于对照组，差异有统计学意义（P ＜ 0.05）。结论 ERAS理念下指导的麻醉管理在腰椎手术中的应用，可使患者术中生命体征更平稳，缩短患者术毕苏醒时间，减少了阿片类药物的使用，降低了术后不良反应发生率，改善患者术后疼痛及缩短住院时间，值得在脊柱外科临床应用。

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	乔丽艳郝占元左灵

关键词 ：加速康复外科, 腰椎手术, 麻醉管理, 联合麻醉

Abstract：Objective To explore the clinical effects of anesthesia management under the guidance of the concept of enhanced recovery after surgery (ERAS) on patients undergoing lumbar surgery. Methods A total of 80 patients with lumbar degenerative disease who underwent posterior lumbar decompression, bone grafting, fusion and internal fixation from March to August 2019 in Jizhong Energy Xingtai Mining Group General Hospital were selected and divided into control group and ERAS group according to the random number table method, with 40 cases in each group. The control group was adopted conventional anesthesia management, and the ERAS group was adopted the ERAS concept of anesthesia management. The intraoperative vital signs of the two groups were compared, including mean arterial pressure (MAP), heart rate (HR), postoperative wake-up time, orientation recovery time and extubation time, intraoperative opioid dosage, and postoperative adverse reactions (chills, nausea and vomiting), visual analogue scale (VAS) at different time points after surgery, and the length of hospital stay. Results The comparison of MAP and HR group, time and interaction between the two groups were statistically significant (P ＜ 0.05). Among them, there was no statistically significant differences in MAP and HR in the ERAS group at each time point (P ＞ 0.05). The comparison of MAP at each time point in the control group showed statistically significant differences (P ＜ 0.05); except for 1, 2 h, the HR comparison at other time points showed statistically significant differences (P ＜ 0.05). The MAP and HR of the ERAS group were lower than those of the control group at each time point, and the differences were statistically significant (P ＜ 0.05). The incidence of postoperative adverse reactions including nausea and vomiting, chills in the ERAS group were lower than those in the control group, and the differences were statistically significant (P < 0.05). The dosage of sufentanil in the ERAS group was lower than that in the control group, and the difference was statistically significant (P < 0.05). The postoperative recovery time, orientation recovery time, extubation time after operation and hospital stay in the ERAS group were shorter than those in the control group, and the differences were statistically significant (P < 0.05). The VAS score of the ERAS group was lower than that of the control group, and the difference was statistically significant (P < 0.05). Conclusion The application of anesthesia management guided by the concept of ERAS in lumbar surgery can make the patient’s vital signs more stable during the operation, shorten the patient’s recovery time after the operation, reduce the use of opioids, and decrease the incidence of postoperative adverse reactions. It is worthy of clinical application in spinal surgery.

Key words： Enhanced recovery after surgery Lumbar surgery Anesthetic management Combined anesthesia

基金资助:河北省邢台市科技局项目（2019ZC339）。

作者简介: 乔丽艳（1982.8-），女，硕士；研究方向：医院管理。

引用本文:

乔丽艳郝占元左灵. 加速康复外科理念下麻醉管理在腰椎手术中的应用[J]. 中国医药导报, 2021, 18(4): 107-110,138.
QIAO Liyan HAO Zhanyuan ZUO Ling. Application of anesthesia management in lumbar spine surgery under the concept of enhanced recovery after surgery. 中国医药导报, 2021, 18(4): 107-110,138.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2021/V18/I4/107

[1] Joliat GR，Labgaa I，Hübner M，et al. Cost-benefit analysis of the implementation of an Enhanced Recovery Program in liver surgery [J]. World J Surg，2016，40：2441-2450.
[2] Ljungqvist Q. ERAS-enhanced recovery after surgery：moving evidence-based perioperative care to practice [J]. J Parenter ENteral Nutr，2014，38：559-566.
[3] Thorell A，MacCormick AD，Awad S，et al. Guidelines for perioperative care in bariatric surgery：Enhanced Recovery After Eurgery （ERAS） Society recommendations [J]. World J Surg，2016，40：2065-2083.
[4] 孙旭，李庭，杨明辉，等.加速康复外科的发展与在骨科的应用[J].骨科临床与研究杂志，2017，2（2）：114-116.
[5] 黄文起，黄宇光.多学科合力促进ERAS的发展[J].广东医学，2016，37（18）：2689-2691.
[6] 叶芳，黄文起.加速康复外科发展与完善麻醉管理[J].广东医学，2016，36（18）：2692-2694.
[7] Pogatschnik C，Steiger E. Review of Preoperative Carbohydrate Loading [J]. Nutr Clin Pract，2015，30（5）：660-664.
[8] 程忠才.术前疼痛干预对全麻患者术后疼痛认知度的影响[J].当代医学，2012，18（22）：156-157.
[9] 陈彩曼，黎剑云.快速康复外科理念联合超前镇痛在腹部手术患者围术期中的应用[J].现代中西医结合杂志，2016，25（22）：2494-2496.
[10] 宗行万之助.疼痛的估价-用特殊的视觉模拟评分法作参考（VAS）[J].实用疼痛学，1994（4）：153.
[11] Shida D，Tagawa K，Inada K，et al. Enhanced recovery after surgery （ERAS） protocols for colorectal cancer in Japan [J]. BMC surgery，2015，15：90-96.
[12] Carli F，Clemente A. Regional anesthesia and enhanced recoveryafter surgery [J]. Minerva Anestesiol，2014，80（11）：1228-1233.
[13] 倪慧玉.快速康复外科理念在老年胸腰椎压缩性骨折围手术期的应用观察[J].中外医学研究，2017，15（34）：127-128.
[14] 赵晶，许涛，江伟.胸段硬膜外麻醉的非镇痛作用[J].国际麻醉学与复苏杂志，2010，31（1）：56-59.
[15] Mcevoy MD，Scott MJ，Gordon DB，et al. American Society for Enhanced Recovery （ASER） and Perioperative Quality Initiative （POQI） joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery：part 1 from the preoperative period to PACU [J]. Perioper Med （Lond），2017，6：8
[16] Long DR，Lihn AL，Friedrich S，et al. Association between intraoperative opioid administration and 30-day readmission：a pre-specified analysis of registry data from a healthcare network in New England [J]. Br J Ansesth，2018，120：1090-1102.
[17] Du KN，Feng L，Newhouse A，et al. Effects of Intraoperative Opioid Use on Recurrence-Free and Overall Survival in Patients With Esophageal Adenocarcinoma and Squamous Cell Carcinoma [J]. Anesth Analg，2018，127：210-216.
[18] Austin PN. Forced-Air Warmers and Surgical Site Infection in patients Undergoing Knee or Hip Arthroplasty [J]. Annu Rev Nurs Res，2017，35（1）：179-199.
[19] Frank SM，Fleisher LA，Breslow MJ，et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial [J]. JAMA，1997，277（14）：1127-1134.
[20] 潘志明.快速康复外科理念在腹腔镜胆囊切除术中的研究[J].河北医药，2015，37（4）：553.
[21] Hausel J，Nygren J，Lagerkranser M，et al. A carbo Hydrate-rich drink reduces preoperative discomfort inelective surgery patients [J]. Anesth Analg，2001，93（5）：1344-1350.
[22] Nygren J，Soop M，Thorell A，et al. Preoperative oralcarbohydrates and postoperative insulin resistance [J]. Clin Nutr，1999，18（2）：117-120.
[23] Svanfeldt M，Thorell A，Hausel J，et al. Randomizedclinical trial of the effect of preoperative oral carbo-hydrate teeatment on postoperative whole-body protein and glucose kinetics [J]. Br J Surg，2007，94（11）：1342-1350.
[24] 陆小川，俞瑞东，宋晓华，等.围手术期限制性液体治疗对巨大切口疝术后并发症和预后的影响[J].临床外科杂志，2012，20（10）：721-723.
[25] 朱晗月，李晶晶，邓立琴，等.麻醉因素与代谢综合征老年病人术后认知功能障碍的关系：异丙酚复合麻醉与七氟醚复合麻醉的比较[J].中华麻醉学杂志，2017，37（8）：910-913.