Effects of ERAS strategy on prevention of complications related to anesthesia in gynecological laparoscopic surgery
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摘要:
目的 探讨通过加速康复外科理念进行麻醉的实施与管理对妇科腹腔镜手术患者麻醉相关并发症发生率的防治作用。 方法 选取2015年10月~2016年10月首次接受择期腹腔镜妇科手术的患者156例随机分为对照组与加速康复外科组，对照组采用常规麻醉处理，观察组实施加速康复外科策略优化麻醉管理及围术期处理，记录观察患者术毕体温、术后气管导管拔除时间、麻醉复苏室停留时间、拔管后30 minVAS评分、术后恶心呕吐、苏醒延迟、烦躁及术后寒战发生率。 结果 加速康复外科策略能够降低术后恶心呕吐、术后寒战的发生率，并缩短气管导管拔除时间和VAS评分（P<0.05）；两组麻醉复苏室停留时间、术后烦躁及苏醒延迟发生率之间差异无统计学意义（P>0.05）。 结论 加速康复外科策略能够降低围术期麻醉相关并发症发生率，促进妇科腹腔镜手术患者术后早期恢复。 Abstract:Objective To investigate the prevention effects of ERAS strategies on anesthesia-related complications in patients with gynecologic laparoscopic surgery. Methods A total of 156 patients underwent laparoscopic gynecological surgery from October 2015 to October 2016 were included.The patients were randomly divided into control group and ERAS group. The control group was treated with conventional anesthesia. The observation group achieved ERAS strategies to optimize anaesthetic and perioperative management. The VAS scoring at 30 minutes after extubation, rate of PONV, delayed recovery, irritability and postoperative chills were observed. Results ERAS strategies decreased the incidence of PONV and postoperative chills. It shortened the time from PACU admission to extubation and reduced VAS scoring (P<0.05). The differences of PACU residence time, postoperative irritability and recovery delay were not significant (P>0.05). Conclusion ERAS strategies can decrease the incidence of perioperative anesthesia-related complications and promote the early recovery of patients underwent laparoscopic gynecological surgery. -
表 1 患者一般资料比较（Mean±SD）
组别 年龄（岁） BMI（kg/m2） 手术时间（min） 麻醉时间（min） Tpre（℃） 对照组 38.5±6.4 23.7±3.6 76.3±21.0 108.2±19.9 37.1±0.9 ERAS组 39.4±5.6 23.3±3.3 73.5±19.8 105.3±22.1 37.0±0.7 t 0.934 0.723 0.857 0.861 0.775 P 0.351 0.47 0.392 0.39 0.44 BMI: 体质量指数; ERAS: 加速康复外科; Tpre: 诱导后鼻咽腔温度. 
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表 2 患者术后情况比较（Mean±SD）
组别 拔管时间（min） PACU停留时间（min） VAS Tpost（℃） 对照组 10.4±5.3 41.5±7.6 4.6±3.2 35.7±0.4 ERAS组 8.3±5.9a 40.5±8.4 3.3±1.5* 36.3±0.6* t 2.339 0.78 3.249 7.348 P 0.021 0.437 0.001 <0.0001 *P<0.05vs对照组; ERAS: 加速康复外科; Tpost: 手术结束时患者鼻咽腔温度; PACU: 麻醉复苏室.
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表 3 患者麻醉相关并发症发生率比较（n/%）
组别 苏醒延迟 术后寒战 苏醒后躁动 PONV 对照组 2/2.6 13/16.6 11/11.53 25/32.1 ERAS组 0/0 5/6.4* 6/7.7 13/16.7* χ2 - 4.019 0.664 5.01 P 0.497 0.045 0.415 0.025 *P<0.05vs 对照组; ERAS: 加速康复外科; PONV: 术后恶心呕吐.
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