椎管内肿瘤患者围手术期的加速康复外科护理△

Enhanced recovery after surgery nursing used in perioperative period of surgical resection of intraspinal tumor

摘要:

[目的] 探讨加速康复外科 （enhanced recovery after surgery, ERAS） 护理对椎管内肿瘤切除患者围手术期的临床疗效。[方法]2020 年 3 月—2022 年 10 月在本院行椎管内肿瘤手术切除 48 例患者，随机分为两组，24 例给予围手术期 ERAS 护理，24 例给予围手术期常规护理。比较两组患者术后早期临床资料。[结果]两组患者均完成顺利手术，术中无死亡、神经损伤等严重并发症。随时间推移两组患者切口疼痛 VAS 评分均显著下降（P＜0.05）。术后 12、24、48 和 72 h ERAS 组的切口疼痛 VAS 评分均显著小于常规组 [(2.7±0.6) vs (5.2±1.2), P＜0.001; (2.9±0.4) vs (4.4±1.3), P＜0.001; (2.3±0.5) vs (3.3±1.0), P＜0.001; (1.6±0.4) vs (2.1±0.3), P＜0.001]。ERAS 组术后下地活动时间显著早于常规组 [(1.4±0.5) d vs (3.0±1.2) d, P＜0.001]；ERAS 组术后住院时间显著短于常规组 [(6.5± 1.5) d vs (10.3± 2.1) d, P＜0.001]。ERAS 组术后总体并发症发生率显著低于常规组（8.3% vs 29.2%, P=0.036）。[结论]加速康复外科护理对围手术期椎管内肿瘤患者是安全有效的，能有效缓解术后疼痛，降低术后并发症的发生。

Abstract:

[Objective] To investigate the clinical effect of enhanced recovery after surgery (ERAS) nursing in perioperative period of re- section of intraspinal tumor. [Methods] From March 2020 to October 2022, a total of 48 patients who underwent surgical resection of intra- spinal tumors in our hospital were randomly divided into two groups. Of them, 24 patients received perioperative ERAS nursing, while the other 24 patients received perioperative routine nursing. The early postoperative clinical data of the two groups were compared. [Results] All patients in both groups were successfully operated on, without death, nerve injury and other serious complications. Incision pain VAS scores in both groups were significantly decreased over time (P＜0.05). The ERAS group proved significantly lower VAS scores for incision pain than the routine group at 12 hours (h), 24 h, 48 h and 72 h postoperatively [(2.7±0.6) vs (5.2±1.2), P＜0.001; (2.9±0.4) vs (4.4±1.3), P＜0.001; (2.3±0.5) vs (3.3±1.0), P＜0.001; (1.6±0.4) vs (2.1±0.3), P＜0.001]. In addition, the ERAS group resumed ambulation postoperatively signifi- cantly earlier than the routine group [(1.4±0.5) days vs (3.0±1.2) days, P＜0.001], moreover, the former proved significantly shorter postopera- tive hospital stay than the routine group [(6.5±1.5) days vs (10.3±2.1) days, P＜0.001], furthermore, the ERAS group had significantly lower overall postoperative complication rate than the routine group (8.3% vs 29.2%, P=0.036). [Conclusion] The enhanced recovery after surgery (ERAS) nursing is safe and effective for perioperative period of resection of intraspinal tumor, and does effectively relieve postoperative pain and reduce the occurrence of postoperative complications.