加速康復外科在卵巢囊腫剝除術后康復中的應用

解春紅 趙恩鋒 張寧寧

[摘要] 目的 探索加速康復外科在腹腔鏡卵巢囊腫手術患者中的應用價值。 方法 選取2016年1月～2017年12月石家莊市第一醫(yī)院婦產(chǎn)科診治的卵巢囊腫患者110例，按收入治療的次序?qū)颊哌M行編號，采用隨機數(shù)字表中三位數(shù)隨機數(shù)，根據(jù)秩序大小分為兩組，每組各55例。觀察組采用引入“加速康復外科”理念的圍術期管理方法，對照組采用常規(guī)圍術期管理方法。記錄比較兩組術后排氣時間、留置尿管時間、下地活動時間、疼痛等級評分、術后住院日和住院費用等術后康復相關指標，以及圍術期管理滿意度。 結(jié)果 與對照組比較，觀察組術后排氣時間更少、術后留置尿管時間更短、下地活動時間更早、疼痛等級評分更低（P < 0.01）；觀察組術后住院日及住院費用均少于對照組（P < 0.01）；觀察組圍術期管理滿意率為92.7%，高于對照組的78.2%（P < 0.05）。 結(jié)論 引入“加速康復外科”理念的圍術期管理方法能夠加速腹腔鏡卵巢囊腫手術患者康復進程，改善就醫(yī)體驗，值得普及推廣。

[關鍵詞] 卵巢囊腫；腹腔鏡；加速康復外科；圍術期管理

[中圖分類號] R713 [文獻標識碼] A [文章編號] 1673-7210（2018）08（c）-0099-04

[Abstract] Objective To explore the application of enhanced recovery after surgery （ERAS） in patients with laparoscopic ovarian cysts. Methods A total of 110 patients of ovarian cyst in the First Hospital of Shijiazhuang from January 2016 to December 2017 were selected. According to the order of diagnosis， all cases were numbered corresponding to the number in the random number table， and divided into two groups according to the sequence， with 55 cases in each group. Observation group was given the perioperative management of ERAS and control group was given the routine perioperative management. The postoperative rehabilitation related indicators such as postoperative exhaust time， indwelling catheter， activity time， the pain level score， postoperative hospital stay and the cost of hospitalization of two groups， and the satisfaction rate of perioperative management were recorded and compared. Results Compared with the control group， the postoperative exhaust time and the time of indwelling catheter after operation in the observation group were shorter， the activity time was earlier， and the pain level score was lower （P < 0.01）. The postoperative hospital stay and the cost of hospitalization in the observation group were less than those in the control group （P < 0.01）. The satisfaction rate of perioperative management of the observation group was 92.7%， which was higher than that of the control group （78.2%） （P < 0.05）. Conclusion The methods of ERAS can accelerate the rehabilitation process and improve the medical experience of patients with laparoscopic ovarian cysts， worthy of popularization.

[Key words] Ovarian cysts； Laparoscopy； Enhanced recovery after surgery； Perioperative management

隨著腔鏡微創(chuàng)技術的發(fā)展成熟，腹腔鏡卵巢囊腫剝除術作為“標準化”術式已被廣泛接受[1]，為進一步改善手術效果，需要向優(yōu)化圍術期管理和縮短術后康復時間等方面努力[2]。加速康復外科（enhanced recovery after surgery，ERAS）是近年來在世界范圍廣泛應用的術后康復理念，通過借鑒循證醫(yī)學積累的臨床證據(jù)，不斷改進圍術期管理方法，以提高患者術后的康復進程，目前已應用于多個臨床學科領域[3]。本研究將加速康復外科理念應用于卵巢囊腫剝除手術患者的術后康復管理中，效果滿意，現(xiàn)總結(jié)報道如下：