加速康复外科在甲状腺外科的应用研究

发布时间：2018-01-24 11:26

  本文关键词： 甲状腺 加速康复外科 围手术期 应激反应 术后康复　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：加速康复外科(enhanced recovery after surgery,ERAS)最早由丹麦哥本哈根大学学者Kehlet率先提出,并最早应用于结直肠外科。ERAS的核心是在围手术期采取一系列经循证医学证据证实有效的优化处理措施,减轻患者心理和生理方面的创伤应激反应,减少并发症,缩短住院时间,降低再入院风险及死亡风险,同时降低医疗费用,最终目标是促使患者快速康复。目前,ERAS已成功应用到普通外科、胸心外科、骨科、妇科及泌尿外科等诸多领域,受到学术界的广泛关注和高度重视。黎介寿教授首先将加速康复外科的概念介绍到国内。近年来,加速康复外科理念和方法开始在我国应用,并取得了很好效果,但在甲状腺外科的应用文献报道较少。本研究将加速康复外科理念应用于甲状腺外科领域,通过对比研究,客观分析和综合评价其临床应用价值。目的:将加速康复外科理念应用于甲状腺外科领域,通过对比研究,客观分析和综合评价其临床应用价值,促进加速康复外科理念在甲状腺外科的应用和发展。方法:2015年1月~2017年1月,在我院普外科住院,并需手术治疗的甲状腺疾病患者90例,完全随机化分组分为试验组和对照组。试验组48例采用快速康复外科理念及方法进行围手术期管理,对照组42例采用常规外科理念及方法进行围手术期管理。试验组和对照组由同一手术、麻醉及护理团队完成。检测两组术前及术后第1天、第3天、第5天时C-反应蛋白(CRP);记录术后第1天、第3天、第5天时疼痛评分;测量术前及术后第1天、第3天、第5天时颏-颈间距(颏隆突至颈静脉切迹的距离),记录术后第1天、第3天、第5天时颏-颈间距缩短的距离,以此表示颈部活动受限的程度;记录两组患者术后引流量及引流管拔除时间;记录两组患者住院天数;记录两组患者麻醉时间、手术时间和手术出血量;记录两组患者手术相关并发症。应用SPSS 21.0进行统计学分析,正态分布的计量资料比较采两独立样本t检验;偏态分布的计量资料比较采用Wilcoxon秩和检验。计数资料比较采用卡方检验。重复测量数据检验采用重复测量方差分析。P0.05为差异有统计学意义。结果:1试验组术前及术后第1天、第3天、第5天时crp分别为1.81±0.97mg/l、18.61±0.48mg/l、16.56±0.52mg/l、8.54±0.43mg/l;对照组术前及术后第1天、第3天、第5天时crp分别为1.64±0.66mg/l、22.28±0.63mg/l、20.09±0.72mg/l、14.23±0.61mg/l。试验组和对照组术前c反应蛋白比较,无显著性差异(p0.05);试验组术后第1天、第3天、第5天时c反应蛋白比对照组低,有显著性差异(p0.05)。2试验组术后第1天、第3天、第5天时,疼痛评分分别为4.06±0.14分、3.06±0.11分、2.02±0.11分;对照组术后第1天、第3天、第5天时,疼痛评分分别为7.02±0.22分、6.04±0.12分、4.09±0.12分。试验组术后第1天、第3天、第5天时,疼痛评分明显低于对照组,有显著性差异(p0.05)。3试验组术后第1天、第3天、第5天时颏-颈间距缩短的距离分别为4.12±0.10cm、2.76±0.13cm、1.53±0.10cm;对照组术后第1天、第3天、第5天时颏-颈间距缩短的距离分别为6.04±0.13cm、5.71±0.18cm、5.22±0.10cm。两组比较均有显著性差异(p0.05)。4试验组术后引流量及引流管拔除时间分别为35.02±1.05ml、3.02±0.11天,对照组术后引流量及引流管拔除时间分别为40.04±1.15ml、5.00±0.12天。试验组术后引流量与对照组比较,无显著性差异(p0.05),试验组拔管时间早于对照组,两组比较有显著性差异(p0.05)。5试验组和对照组住院天数分别为5.00±0.17天和8.04±0.15天,两组比较有显著性差异(p0.05)。6试验组和对照组麻醉时间、手术时间和出血量分别为150.00±2.45分钟、120.62±2.27分钟、30.20±1.18ml和150.47±2.06分钟、120.83±1.82分钟、35.11±1.43ml,两组比较均无显著性差异(p0.05)。7试验组和对照组发生手术相关并发症(声音嘶哑、声音低钝、饮水呛咳、手足麻木)均为2例,两组患者手术相关并发症发生率比较,无显著性差异(p0.05)。结论:1加速康复外科理念及方法应用于甲状腺外科,能够显著减轻术后应激反应、降低疼痛评分、增加颈部活动度和舒适度、缩短拔管时间和住院天数,促进术后康复。2加速康复外科理念及方法应用于甲状腺外科,并不增加麻醉时间、手术时间、手术出血量、术后引流量及手术相关并发症发生率。
[Abstract]:Accelerated rehabilitation surgery (enhanced recovery after surgery, ERAS) the earliest scholars from the University of Copenhagen in Denmark Kehlet first proposed, the core and the earliest application in colorectal surgery in the perioperative period of.ERAS is taken by a series of evidence-based effective optimization measures, reduce the stress response, patients with psychological and physiological aspects of reducing complications, shorten the hospitalization time, lower readmission risk and the risk of death at the same time, reduce medical costs, the ultimate goal is to promote the rapid recovery of patients. At present, ERAS has been successfully applied to general surgery, thoracic surgery, Department of orthopedics, Department of Urology, gynecology and other fields, attention by academic circles. Professor Li Jieshou will first the concept of accelerated rehabilitation surgery introduced to the country. In recent years, the concept of accelerated rehabilitation surgery and methods used in our country, and achieved good results, but in The application of thyroid surgery were less reported. In this study the concept of accelerated rehabilitation surgery applied in thyroid surgery, through comparative study, objective analysis and evaluation of its clinical application. Objective: the concept of accelerated rehabilitation surgery applied in thyroid surgery, through comparative study, objective analysis and evaluation of its clinical value, promote the concept of accelerated rehabilitation surgery in the application and development of thyroid surgery. Methods: January 2015 ~2017 January, hospitalized in the Department of general surgery of our hospital, and 90 patients with thyroid diseases treated with completely randomized grouping, divided into experimental group and control group. The experimental group of 48 cases using the concept of rapid rehabilitation surgery and methods of perioperative management the control group of 42 patients treated with conventional surgical method and concept of perioperative management. The test group and the control group by the same surgery, anesthesia and nursing team to complete the examination. First days, two groups were measured before and after third days, fifth days of C- reactive protein (CRP); postoperative first days, third days, fifth days of pain score; first days, were measured before and after third days, the fifth day interval (chin chin neck to neck vein carina the distance from the notch), were recorded after first days, third days, chin - collar from the distance shortened fifth days, said this degree of neck activity; records of two groups of patients with postoperative drainage and drainage tube removal time records; hospitalization days of patients in two groups; recording time of anesthesia in two groups of patients, operation time bleeding and the amount of surgery; records of two patients of surgery related complications. The application of SPSS 21 for statistical analysis, measurement data of normal distribution of two independent samples t test; skewness distribution measurement data was compared using Wilcoxon rank sum test. Enumeration data were compared by chi square test. The repeated measurement data using repeated test 娴嬮噺鏂瑰樊鍒嗘瀽.P0.05涓哄樊寮傛湁缁熻�″�︽剰涔，

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