实施加速康复外科麻醉管理对甲状腺手术应激水平的影响

发布时间：2018-09-06 20:34

【摘要】：目的比较加速康复外科(enhanced recovery after surgery,ERAS)与传统围术期的麻醉管理对甲状腺手术围术期应激水平的影响。方法选择2016年5~8月择期行甲状腺手术的患者62例,男13例,女49例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为ERAS组(n=29)和对照组(C组,n=33)。ERAS组按照ERAS围术期流程操作,记录苏醒期和术后第1天VAS疼痛评分以及术后镇痛满意度评分,记录术前、术后当日和术后1d的C反应蛋白(CRP)、血皮质醇、IL-6、IL-8和TNF-α浓度。记录术后并发症的发生情况。结果苏醒期ERAS组VAS疼痛评分明显低于C组[(0.42±0.83)分vs(0.95±1.16)分,P0.05],术后1dERAS组VAS疼痛评分明显低于C组[(1.90±1.21)分vs(2.73±1.40)分,P0.05]。ERAS组术后第1天镇痛满意度评分明显高于C组(P0.05)。术后当日和术后1dERAS组CRP浓度明显低于C组;C组CRP浓度明显高于术前(P0.05)。两组术后咽痛、声嘶和饮水呛咳等并发症的发生率差异无统计学意义。结论 ERAS围术期操作系统在甲状腺手术中的应用安全、可靠,有效提高患者的满意度,提升舒适化围术期体验,同时减轻术后疼痛,促进患者快速康复。
[Abstract]:Objective to compare the effect of (enhanced recovery after surgery,ERAS (accelerated Rehabilitation surgery) and traditional perioperative anesthesia management on perioperative stress in thyroid surgery. Methods Sixty-two patients (13 males and 49 females) who underwent thyroid surgery from May to August 2016 were randomly divided into ERAS group (n = 29) and control group (n = 33). ERAS group was operated according to ERAS perioperative procedure. The VAS pain score and the postoperative analgesia satisfaction score were recorded during the recovery period and the first day after operation. The concentrations of IL-6 IL-8 and TNF- 伪 in serum of C-reactive protein (CRP), were recorded before, on the day of operation and 1 day after operation. Postoperative complications were recorded. Results the VAS pain score in ERAS group was significantly lower than that in C group [(0.42 卤0.83) vs (0.95 卤1.16), P0.05], and the VAS pain score in 1dERAS group was significantly lower than that in C group [(1.90 卤1.21) score, vs (2.73 卤1.40) score, P0.05]. The score of analgesic satisfaction in ERAS group was significantly higher than that in C group on the first day after operation (P0.05). The concentration of CRP in 1dERAS group was significantly lower than that in group C (P0.05). There was no significant difference in the incidence of postoperative pharynx, hoarseness and drinking cough between the two groups. Conclusion the application of ERAS perioperative operating system in thyroid surgery is safe and reliable. It can effectively improve patients' satisfaction and comfort perioperative experience, at the same time, reduce postoperative pain and promote patients' rapid recovery.
【作者单位】：上海交通大学医学院附属瑞金医院麻醉科;上海交通大学医学院附属瑞金医院甲状腺血管外科;
【基金】：上海交通大学医学院科技基金项目(Jyh1610)
【分类号】：R614

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