基于快速康复外科理念的麻醉管理方案在胸腔镜手术中的应用效果

Application of anesthesia management plan based on ERAS concept in thoracoscopic surgery

摘要:

目的 探讨基于快速康复外科（ERAS）理念的麻醉管理方案在胸腔镜手术中的应用效果。方法 选取2021年12月－2022年12月在该院行胸腔镜手术的患者100例，随机分为对照组和观察组，各50例。对照组予以常规麻醉管理，观察组采用基于ERAS理念的麻醉管理方案。比较两组患者临床指标，术后1、3、5和7 d切口疼痛程度，术后1和3 d炎症因子水平，术后肺部并发症，以及恶心、呕吐和呼吸抑制发生率。结果 观察组苏醒拔管时间和住院时间短于对照组，治疗费用少于对照组，观察组术后各时点疼痛视觉模拟评分（VAS）明显低于对照组，术后1和3 d C反应蛋白（CRP）和肿瘤坏死因子-α（TNF-α）水平低于对照组，差异均有统计学意义（P < 0.05）。观察组肺部并发症总发生率为6.00%，明显低于对照组的22.22%，差异有统计学意义（P < 0.05）。观察组恶心、呕吐和呼吸抑制发生率分别为2.00%和0.00%，对照组恶心、呕吐和呼吸抑制发生率分别为6.00%和4.00%，两组患者其他并发症总发生率比较，差异无统计学意义（P > 0.05）。结论 基于ERAS理念下的麻醉管理方案，在胸腔镜手术中具有较好的应用效果，能加快术后恢复进程，减轻疼痛，减少术后肺部并发症，节省治疗费用。值得临床推广应用。

Abstract:

Objective To investigate the application of anesthesia management plan based on the concept of enhanced recovery after surgery (ERAS) in thoracoscopic surgery.Methods From December 2021 to December 2022, 100 patients underwent thoracoscopic surgery were randomly divided into control group and observation group with 50 patients in each. The control group received routine anesthesia management, and the observation group received anesthesia management based on ERAS concept. The two groups were compared in terms of clinical indicators, the degree of incision pain on day 1, 3, 5 and 7 after surgery, the levels of inflammatory factors on day 1 and 3 after surgery. The incidence rates of pulmonary complications, nausea and vomiting, and respiratory depression in the two groups were calculated.Results Awakening and extubation time and hospital stay of observation group were shorter than those of control group, the treatment costs of observation group was less than that of control group, the visual analogue scale (VAS) of observation group at each time point after surgery were lower than those of control group, the levels of C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) of observation group on day 1 and 3 after surgery were lower than those of control group, the differences were statistically significant (P < 0.05). The total incidence of pulmonary complications of observation group was lower than that of control group (6.00% vs 22.22%), the difference was statistically significant (P < 0.05). The incidence rates of respiratory depression and nausea and vomiting in the observation group were 0.00% and 2.00%, respectively, while the incidence rates of respiratory depression and nausea and vomiting in the control group were 4.00% and 6.00%, respectively. There was no statistically significant difference in the total incidence rates of other complications between the two groups of patients (P > 0.05).Conclusion Applying the anesthesia management plan based on ERAS concept in thoracoscopic surgery can promote postoperative recovery, reduce pain and pulmonary complications, and save treatment costs. It is worthy of clinical application.