加速康复外科方案在青少年特发性脊柱侧凸围手术期的应用实践

Design and implementation of an enhanced recovery after surgery(ERAS) pathway for adolescent idiopathic scoliosis surgery perioperative management

中文关键词:  加速康复外科方案  青少年特发性脊柱侧凸  围术期管理  矫形手术

英文关键词:Enhanced recovery after surgery  Adolescent idiopathic scoliosis  Perioperative management  Scoliosis correction surgery

中文摘要:

  【摘要】目的：探讨加速康复外科（enhanced recovery after surgery，ERAS）方案在青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）矫形围手术期临床应用的效果。方法：回顾性分析2010年9月~2016年8月在我院骨科接受矫形手术的AIS患者（未进行三柱截骨）91例，其中应用常规围手术期方案（对照组）51例；围手术期应用ERAS方案（ERAS组）40例，观察并记录两组患者年龄、性别、体质指数（body mass index，BMI）、术前血红蛋白、麻醉风险分级、侧凸分型（Lenke）、术前冠状位Cobb角、手术时间、融合节段、椎弓根螺钉置入数量、冠状面矫形率、出血量、输同种异体血比例、术后血红蛋白、术后疼痛视觉模拟评分（visual analogue scale，VAS）、引流量、引流管移除时间、术后住院日、患者满意度、术后并发症。组间数据采用独立样本t检验比较连续变量，采用卡方检验或Fisher′s精确检验比较分类变量。结果：两组患者年龄、性别、BMI、术前血红蛋白、麻醉风险分级、侧凸分型与术前冠状位Cobb角无统计学差异（P＞0.05）。ERAS组术中出血量515.0±14.9ml明显低于对照组865.7±309.8ml（t=5.830，P＜0.001）；ERAS组输同种异体血比例为25.0%（10/40），显著低于对照组64.7%（33/51）（χ2=14.1，P＜0.001）；ERAS组术后血红蛋白为108.3±14.8g/L，显著高于对照组100.0±14.9g/L（t=2.629，P=0.010）；ERAS组术后48h VAS评分显著低于对照组（P=0.035）；ERAS组术后引流量为30.0±25.6ml，显著少于对照组662.4±294.4ml（t=13.532，P＜0.001）；ERAS组引流管移除时间为22.7±10.6h，显著少于对照组58.7±13.3h（t=13.942，P＜0.001）；ERAS组术后住院日6.5±2.1d，较对照组7.6±1.6d（t=2.843，P=0.006）明显缩短；ERAS组患者满意率为92.5%（37/40），较对照组74.5%（38/51）明显增高（χ2=5.01，P=0.025）；ERAS组术后并发术后恶心呕吐比例为10.0%（4/40），显著低于对照组27.5%（14/51）（χ2=4.302，P=0.038）。结论：ERAS方案可显著改善青少年特发性脊柱侧凸患者围手术期状况，提高患者早期康复锻炼效率，提升患者的满意度。

英文摘要:

  【Abstract】 Objectives: To evaluate the effect of enhanced recovery after surgery(ERAS) on perioperative management in patients with adolescent idiopathic scoliosis. Methods: Ninety-one adolescent idiopathic scoliosis patients who received correction surgery without 3-column osteotomy were retrospectively analyzed from September 2010 to August 2016 in our hospital. Of these patients, 51 cases were treated by traditional programs(control group) and 40 cases were treated with ERAS programs (ERAS group). The following data of the two groups were collected and analyzed: age, gender, body mass index(BMI), preoperative hemoglobin, ASA grade, curve type(Lenke classification), Cobb angle, operating time, fusion levels, the number of pedicle screws placed, coronal correct rate, estimated blood loss, allogenic blood transfusion rate, postoperative hemoglobin, postoperative visual analogue scale(VAS) score, hemovac drainage, extubation time, postoperative length of hospital stay(LOS), satisfactory rate, postoperative complications. An independent samples t test was used to compare continuous variables between control group and ERAS group. A chi-square test, or Fisher′s exact test if more appropriate, was used to compare categorical variables between control group and ERAS group. Results: There was no significant difference in preoperative data between the two groups. Intraoperative blood loss in ERAS group was 515.0±14.9ml, which was significantly lower than that in control group 865.7±309.8ml(t=5.830, P＜0.001). Allogenic blood transfusion rate in ERAS group was 25.0% (10/40), which was significantly lower than that in control group of [64.7%(33/51)] (χ2=14.1, P＜0.001). The postoperative hemoglobin of ERAS group was 108.3±14.8g/L, which was significantly higher than that in control group of 100.0±14.9g/L(t=2.629, P=0.010). The postoperative VAS scores 48 hours after surgery in ERAS group was significantly lower than that in control group(P=0.035). The hemovac drainage in ERAS was 30.0±25.6ml, which was significantly lower than that in control group of 662.4±294.4ml (t=13.532, P＜0.001). The extubation time of ERAS group was 22.7±10.6h, which was significantly lower than that of control group of 58.7±13.3h (t=13.942, P＜0.001). Postoperative LOS of ERAS group was 6.5±2.1d, which was significantly lower than that in control group of 7.6±1.6d(t=2.843, P=0.006) The satisfaction rate of ERAS group was 92.5%(37/40), which was significantly higher than that in control group of 74.5%(38/51) (χ2=4.302, P=0.038). The rate of PONV in ERAS group was 10.0%(4/40), which was significantly lower than that in control group of 27.5%(14/51)(χ2=4.302, P=0.038). Conclusions: ERAS is capable of improving the perioperative status of AIS patients, with earlier rehabilitation and better satisfaction.