胸腰段脊柱骨折的加速康复外科护理

Early recovery after surgery nursing for thoracolumbar fractures

摘要:

[目的] 评价加速康复外科 （early recovery after surgery, ERAS） 护理在胸腰段脊柱骨折患者中的应用价值。[方法] 2020 年 5 月—2022 年 5 月骨科收治的胸腰段脊柱骨折 92 例患者作为观察对象，按随机数字表法分为两组。所有患者均行手术复位、减压和椎弓钉内固定术；47 例围手术期采用 ERAS 护理，45 例采用常规护理。比较两组围手术期资料。[结果]两组患者均顺利手术，术中无严重并发症。术后早期并发症，ERAS 组为 6.4%；常规组为 22.2%，两组间差异有统计学意义 （P= 0.001）。ERAS 组在肠功能恢复时间 [(7.2±1.1) h vs (10.4±2.3) h, P＜0.001]、首次肛门排气时间 [(9.5±2.2) h vs (16.4±2.6) h, P＜ 0.001]、首次排便时间 [(25.6±4.9) h vs (43.2±5.6) h, P＜0.001]、术后下床活动时间 [(3.1±0.6) d vs (5.3±1.1) d, P＜0.001] 和住院时间 [(8.4±1.0) d vs (12.0±1.3) d, P＜0.001] 均显著优于常规组。随术后时间推移，两组患者疼痛 VAS 评分和 GCQ 评分均显著改善（P＜ 0.05）；术前两组间上述评分的差异无统计学意义（P＞0.05），术后 1~7 d，ERAS 组的 VAS 和 GCQ 评分均显著优于常规组（P＜ 0.05）。[结论]对胸腰段脊柱骨折患者实施 ERAS 护理，能促进患者肠功能恢复，缓解术后疼痛，提高舒适度。

Abstract:

[Objective] To evaluate the clinical significances of early recovery after surgery (ERAS) nursing in surgical treatment of tho- racolumbar fractures. [Methods] From May 2020 to May 2022, a total of 96 patients with thoracolumbar spine fracture admitted to our de- partment were divided into two groups according to random number table method. All patients in both group underwent surgical reduction, decompression and pedicle screw fixation. Of them, 47 patients received ERAS nursing, while other 45 patients received conventional nurs- ing. The perioperative data of the two groups were compared. [Results] All patients in both groups were operated on successfully without se- rious complications. Early postoperative complications were of 6.4% in the ERAS group, while 22.2% in the conventional group, which was statistically significant (P=0.001). The ERAS group proved significantly superior to the conventional group in terms of bowel function recov- ery time [(7.2±1.1) hours vs (10.4±2.3) hours, P＜0.001], time of the first fart [(9.5±2.2) hours vs (16.4±2.6) hours, P＜0.001], time of the first defecation [(25.6±4.9) hours vs (43.2±5.6) hours, P＜0.001], postoperative ambulation time [(3.1±0.6) days vs (5.3±1.1) days, P＜0.001] and hospital stay [(8.4±1.0) days vs (12.0±1.3) days, P＜0.001]. The VAS score for pain and general comfort questionnaire (GCQ) score were sig- nificantly improved in both groups over time (P＜0.05), which were not statistically significant between the two groups before operation (P＞ 0.05), whereas in the ERAS group were significantly better than those in the conventional group 1 to 7 days postoperatively (P＜0.05). [Con- clusion] ERAS nursing used in the perioperative period for thoracolumbar fractures does promote the recovery of intestinal function, re- lieve postoperative pain and improve comfort of the patients.