快速康复外科理念在脊柱后凸畸形矫形术麻醉管理中的应用

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摘要目的观察快速康复外科（ERAS）理念在脊柱后凸畸形矫形手术麻醉管理中的应用效果。方法选择2014年1月~2018年11月在安徽省阜阳市人民医院行脊柱截骨矫形术的患者50例，采用随机数字表法分为两组，ERAS组（E组，n = 25）和对照组（C组，n = 25）。C组采用传统围术期管理方式；E组采用ERAS理念下的围术期管理模式：术前进行功能锻炼，术中采用肺保护、目标导向液体治疗、血液保护、体温保护等措施，术后多模式镇痛。测定两组患者麻醉前（T0）、拔管后（T1）、术后24 h（T2）、术后48 h（T3）的血糖（Glu）、皮质醇（Cor）浓度和C-反应蛋白（CRP）水平；记录两组患者麻醉清醒时间、术中出血量、48 h内视觉模拟评分（VAS）；比较两组患者肠道恢复时间、首次进食时间、住院时间；观察术后不良反应发生情况。结果与C组比较，E组患者T1~T3时点的Glu、Cor浓度和CRP水平均明显降低（P < 0.05），麻醉清醒时间、术中出血量、48 h内VAS评分均降低（P < 0.05），肠道恢复时间、首次进食时间、住院时间均明显缩短（P < 0.05），术后球结膜水肿及恶心呕吐等不良反应发生率人数明显减少（P < 0.05）。结论在脊柱后凸畸形矫形手术中应用ERAS理念下的麻醉管理策略，可明显抑制患者应激反应，提供完善的镇痛效果，术后不良反应少，促进早期康复。

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	蔡宁1 代晨旭1 于海洋2 张旭2

关键词 ：快速康复外科, 脊柱畸形, 截骨矫形术, 围术期麻醉管理, 应激反应

Abstract：Objective To observe the clinical effect of anesthesia management strategy under the concept of enhanced recovery after surgery (ERAS) in kyphosis deformity surgery. Methods A total of 50 patients with moderate or severe kyphosis deformity who underwent elective spinal osteotomy in the People′s Hospital of Fuyang in Anhui Province from January 2014 to November 2018 were enrolled, they were divided into two groups according to random number table method: ERAS group (group C, n = 25) and control group (group E, n = 25). Group C was given the traditional perioperative management method and group E was given the perioperative management mode under the concept of ERAS, such as preoperative functional exercise, intraoperative lung protection, goal-oriented fluid therapy, blood protection, temperature protection and other measures, postoperative multi-mode analgesia. The concentrations of blood glucose (Glu), cortisol (Cor) and level of C-reactive protein (CRP) were measured before anesthesia (T0), after extubation (T1), 24 h (T2) and 48 h after surgery (T3), respectively. The recovery time, intraoperative blood loss, and VAS score within 48 h were recorded. The recovery time of the intestines, the time of eating, and the number of hospital stays were recorded. And the occurrence of postoperative adverse reactions were observed. Results Compared with group C, the concentrations of Glu, Cor and level of CRP at the timepoint of T1-T3 were significantly lower in group E (P < 0.05). The recovery time, intraoperative blood loss and VAS score within 48 h were lower (P < 0.05). The intestinal recovery time, eating time and hospitalization time of patients were significantly shorter (P < 0.05). The number of patients with adverse reactions such as conjunctival edema and nausea and vomiting decreased after operation (P < 0.05). Conclusion The anesthesia management strategy under the concept of ERAS in kyphosis deformity surgery can significantly inhibit the patient′s stress response and provide a good analgesic effect. It can reduce fewer postoperative adverse reactions, and promote patients early recovery.

Key words： Enhanced recovery after surgery Kyphosis Spinal osteotomy Perioperative anesthesia management Stress response

基金资助:安徽省科技厅重点研究与开发计划立项项目（1704a0802159）。

作者简介: 蔡宁（1975.4-），男，副主任医师，主要从事老年患者麻醉研究。

引用本文:

蔡宁1 代晨旭1 于海洋2 张旭2. 快速康复外科理念在脊柱后凸畸形矫形术麻醉管理中的应用[J]. 中国医药导报, 2019, 16(22): 98-102.
CAI Ning1 DAI Chenxu1 YU Haiyang2 ZHANG Xu2. Application of the enhanced recovery after surgery concept of anesthesia management in kyphosis deformity surgery. 中国医药导报, 2019, 16(22): 98-102.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2019/V16/I22/98

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