加速康复外科在腰椎融合手术中的应用研究

摘要

目的 研究加速康复外科(enhanced recovery after surgery,ERAS)在脊柱外科腰椎融合手术中的应用效果.方法 对2015年1~8月于我科行腰椎融合手术且融合节段≤3个的236例病人进行前瞻性研究,根据病人意愿分为对照组(117例)及加速康复组(ERAS组,119例),分别对两组病人围手术期采取常规干预和ERAS干预.对比分析两组病人手术前后不同时间点的疼痛视觉模拟量表(visual ana-logue scale,VAS)评分、Oswestry功能障碍指数(Oswestry disfunction index,ODI)评分,以及阿片类药物使用情况、术后并发症、术后住院时间、术后1个月内再次住院率、病人治疗满意度等情况.结果 ERAS组在术后3 d内、出院时及术后1个月VAS评分均优于对照组(P<0.05),术后恶心呕吐的发生率显著小于对照组(P<0.05),阿片类药物在术后第1天和第2天使用量小于对照组(P<0.05),术后平均住院时间(4.9 d)与对照组(6.2 d)比较,差异有统计学意义(P<0.05).两组病例在术后1个月内再次住院率比较,差异无统计学意义(P=0.339).病人平均随访时间为(13.4±0.9)个月.两组末次随访的VAS评分(P=0.368)和ODI评分(P=0.251)比较,差异均无统计学意义.结论 实施ERAS可以在不影响腰椎融合手术病人再次住院率的情况下,缩短了病人术后住院时间、改善了病人术后疼痛、降低了术后并发症发生率及减少了阿片类药物的使用,值得在脊柱外科临床推广.%Objective To study the effect of enhanced recovery after surgery (ERAS) on patients with lumbar fusion surgery in spine surgery. Methods There were 236 patients receiving lumbar fusion surgery whose fusion segments were no more than 3 from January 2015 to August 2015. The patients were divided into control group (117 cases) and ERAS group (119 cases) according to their decisions. Routine intervention and ERAS intervention were adopted in the 2 groups of patients during perioperative period, respectively. We comparatively analyzed postoperative visual analogue scale (VAS), the Oswestry disfunction index score (ODI), the application of opioids, postoperative complications, average length of postoperation stay, readmission rates during 1 month after surgery, satisfaction degree for the treatment, pain scores and dysfunction at follow up. Results The ERAS group patients had milder pain than the control group during 3 days after surgery, at discharge and 1 month after surgery (P<0.05). As compared with control group, the incidence of nausea and vomiting was significantly reduced (P<0.05), and opioids consumption was significantly decreased in 1st day and 2nd day after surgery in ERAS group (all P<0.05). In addition, the length of postoperation stay in ERAS group (4.9 days) was shorter than that in control group (6.2 days) (P<0.05). However, the readmission rate showed no statistically significant difference between the two groups (P=0.339). Average follow-up time was (13.4±0.9) months. There were no statistical differences in VAS (P=0.368) and ODI scores (P=0.251) between the two groups during the follow-up period. Conclusion ERAS can reduce the length of hospital stay, alleviate postoperative pain, and decrease the incidence of postoperative complications and the consumption of opioids in patients subject to lumbar fusion surgery without a concomitant increase in readmission rate. As a result, ERAS is worthy of clinical promotion in spine surgery.