胸腰椎骨折围手术期加速康复外科护理的运用价值

Significance of enhanced recovery after surgery protocol in perioperative period of pedicle screw fixation of thoracolumbar fractures

摘要:

[目的]探讨术后加速恢复路径（enhanced recovery after surgery, ERAS）在胸腰椎骨折椎弓钉固定围手术期的运用价值。[方法]2019 年 4 月—2023 年 6 月行椎弓钉固定的胸腰椎骨折 80 例患者纳入本研究，抛硬币法随机分为两组。40 例采用 ERAS 护理，另外 40 例采用常规护理。比较围术期资料和术后疼痛情况。[结果]两组患者均顺利手术，无严重并发症。两组在手术时间、术中出血量差异无统计学意义（P＞0.05），但是，EARS 组排气时间 [(19.4±5.6) h vs (24.2±6.7) h, P＜0.001]、下床时间 [(22.5±6.2) h vs (27.1±7.8) h, P=0.005]、住院时间 [(6.6±2.0) d vs (7.8±2.5) d, P=0.020]、总并发症发生率 （5.0% vs 22.5%, P= 0.023）均显著低于常规组。疼痛方面，ERAS 组术后 2 h、1、3 d 的 VAS 评分显著低于常规组（P＜0.05），术后 5 d 两组间 VAS 评分差异无统计学意义（P＞0.05）。此外，ERAS 组首次补救镇痛时间 [(7.4±2.8) h vs (10.6±3.3) h, P＜0.001]、PCA 按压次数 [(4.6± 1.4) 次 vs (6.0±1.8) 次, P＜0.001] 均显著低于常规组。[结论] ERAS 护理用于胸腰椎骨折围手术期能够促进早期康复，降低术后早期疼痛症状。

关键词:胸腰椎骨折;椎弓钉固定;术后加速恢复路径;疼痛

Abstract:

[Objective] To investigate the value of enhanced recovery after surgery (ERAS) protocol used in the perioperative period of pedicle screw fixation of thoracolumbar fractures. [Methods] From April 2019 to June 2023, 80 patients who received pedicle screw fixation of thoracolumbar fractures were included in this study and randomly divided into two groups by coin tossing. Of them, 40 patients received ERAS care, while the other 40 received conventional care. The documents regarding perioperative period and postoperative pain were compared between them. [Results] All patients in both groups had fracture fixed with pedicle screw successfully without serious complications. There was no significant difference in operation time and intraoperative blood loss between the two groups (P＜0.05), however, the ERAS group was significantly superior to the conventional groups in terms of the exhaust time [(19.4±5.6) hours vs (24.2±6.7) hours, P＜ 0.001], bed rest time [(22.5±6.2) hours vs (27.1±7.8) hours, P=0.005], hospital stay [(6.6±2.0) days vs (7.8±2.5) days, P=0.020], and the total incidence of complications (5.0% vs 22.5%, P=0.023). Regarding pain, the ERAS group was marked significantly lower VAS scores 2 hours, 1 day and 3 days postoperatively than the conventional group (P＜0.05), whereas which became not significantly different between the two groups 5 days after surgery (P＞0.05). In addition, the ERAS group was also significantly better than the conventional group in terms of time of first analgesia given [(7.4±2.8) hours vs (10.6±3.3) hours, P＜0.001] and the number of PCA compressed [(4.6±1.4) times vs (6.0±1.8) times, P＜0.001]. [Conclusion] ERAS care in the perioperative period of pedicle screw fixation of thoracolumbar fractures can promote early recovery and reduce early postoperative pain.

Key words:thoracolumbar fracture; pedicle screw fixation; enhanced recovery after surgery; pain