快速康复外科对行腹腔镜下子宫全切术的子宫腺肌症患者早期康复效果的分析
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摘要
目的探究快速康复外科对行腹腔镜下子宫全切术的子宫腺肌症患者早期康复效果的影响,分析其临床价值。方法选取本院2016年5月至2018年5月收治的162例拟行腹腔镜下子宫全切术的子宫腺肌症患者为研究对象。采用随机数表法将入选患者分为观察组和对照组,每组各81例。对照组患者给予常规围术期干预,包括术前肠道准备、术中静脉-吸入复合全身麻醉、术后给予止痛药物等;观察组患者接受快速康复外科理念指导下的综合围术期干预,包括超前镇痛、限制性补液、早期下床活动等。比较两组患者术后恢复情况、视觉模拟评分法(visual analogue scale,VAS)评分、症状自评量表(symptom checklist-90,SCL-90)评分及并发症发生率,分析两种方案对患者早期康复效果的影响。结果观察组患者气管导管拔除时间、首次排气时间及住院天数均显著短于对照组(P_均<0.05),住院费用显著少于对照组(P <0.05)。两组患者术后6、12、24 h VAS评分均显著高于术后3 h(P_均<0.05),且于术后12 h达到峰值;观察组患者术后6、12、24 h VAS评分均显著低于同期对照组(P_均<0.05)。术后3 d,除精神病性评分外,观察组患者SCL-90中其他各项评分及总分均显著低于本组术前和同期对照组(P_均<0.05)。两组患者术后并发症发生率比较无显著差异(χ~2=0.206,P=0.650)。结论基于快速康复外科理念的围术期干预能够有效减轻子宫腺肌症患者子宫全切术后疼痛,缩短恢复时间,优化心理状态,对于促进患者早期康复具有积极意义。
Objective To explore the effect of rapid rehabilitation surgery on early rehabilitation of adenomyosis patients undergoing laparoscopic hysterectomy, and to analyze its clinical value. Method 162 patients with adenomyosis undergoing laparoscopic hysterectomy from May 2016 to May 2018 in our hospital were selected as the subjects. According to the random number table method, they were divided into observation group and control group, 81 cases in each group. Control group patients received routine perioperative interventions, including preoperative bowel preparation, intraoperative general anesthesia and postoperative analgesics. Observation group patients received comprehensive perioperative interventions under the guidance of the concept of rapid rehabilitation surgery, including preemptive analgesia, restrictive ?uid replacement and early ambulation. The postoperative recovery, visual analogue scale(VAS) scores, symptom checklist-90(SCL-90) and complication rates were compared between the two groups, and the effect of the two schemes on early rehabilitation was analyzed. Result The extubation time, ?rst exhaust time and hospitalization days of patients in observation group were signi?cantly shorter than those in control group(P_(all)<0.05),and the hospitalization expenses was signi?cantly less than those in control group(P < 0.05). The VAS scores of the two groups were signi?cantly higher at 6, 12, 24 h after operation than those of before operation(P_(all)< 0.05), and reached the peak at 12 h after operation. The VAS scores of observation group were signi?cantly lower at 6, 12, 24 h after operation than those of control group(P_(all)< 0.05). On the 3~(rd) day after operation, except for psychiatric score, the other scores and total scores of SCL-90 in observation group were signi?cantly lower than those in preoperative and control group(P_(all)< 0.05). There was no signi?cant difference in the incidence of postoperative complications between the two groups(χ~2= 0.206, P = 0.650). Conclusion Perioperative management based on the concept of rapid rehabilitation surgery can effectively relieve the pain of patients with adenomyosis after total hysterectomy, shorten the recovery time, optimize the psychological state, and promote early rehabilitation of patients with positive signi?cance.
Objective To explore the effect of rapid rehabilitation surgery on early rehabilitation of adenomyosis patients undergoing laparoscopic hysterectomy, and to analyze its clinical value. Method 162 patients with adenomyosis undergoing laparoscopic hysterectomy from May 2016 to May 2018 in our hospital were selected as the subjects. According to the random number table method, they were divided into observation group and control group, 81 cases in each group. Control group patients received routine perioperative interventions, including preoperative bowel preparation, intraoperative general anesthesia and postoperative analgesics. Observation group patients received comprehensive perioperative interventions under the guidance of the concept of rapid rehabilitation surgery, including preemptive analgesia, restrictive ?uid replacement and early ambulation. The postoperative recovery, visual analogue scale(VAS) scores, symptom checklist-90(SCL-90) and complication rates were compared between the two groups, and the effect of the two schemes on early rehabilitation was analyzed. Result The extubation time, ?rst exhaust time and hospitalization days of patients in observation group were signi?cantly shorter than those in control group(P_(all)<0.05),and the hospitalization expenses was signi?cantly less than those in control group(P < 0.05). The VAS scores of the two groups were signi?cantly higher at 6, 12, 24 h after operation than those of before operation(P_(all)< 0.05), and reached the peak at 12 h after operation. The VAS scores of observation group were signi?cantly lower at 6, 12, 24 h after operation than those of control group(P_(all)< 0.05). On the 3~(rd) day after operation, except for psychiatric score, the other scores and total scores of SCL-90 in observation group were signi?cantly lower than those in preoperative and control group(P_(all)< 0.05). There was no signi?cant difference in the incidence of postoperative complications between the two groups(χ~2= 0.206, P = 0.650). Conclusion Perioperative management based on the concept of rapid rehabilitation surgery can effectively relieve the pain of patients with adenomyosis after total hysterectomy, shorten the recovery time, optimize the psychological state, and promote early rehabilitation of patients with positive signi?cance.
引文
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[9]陈芙蓉,徐雅祯.FTS对阴式全子宫切除术患者免疫功能和生活质量的影响[J].西南国防医药,2016,26(8):931-933.
[10]Miralpeix E,Nick AM,Meyer LA,et al.A call for new standard of care in perioperative gynecologic oncology practice:impact of enhanced recovery after surgery(ERAS)programs[J].Gynecol Oncol,2016,141(2):371-378.
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[12]张娜,肖珊珊,温娜,等.加速康复管理在腹腔镜全子宫切除术患者中的应用研究[J].国际妇产科学杂志,2017,44(6):659-662.
[13]Bernard S,Moffet H,Plante M,et al.Pelvic-Floor Properties in Women Reporting Urinary Incontinence After Surgery and Radiotherapy for Endometrial Cancer[J].Phys Ther,2017,97(4):438-448.
[14]张盛苗.加速康复外科对腹腔镜宫颈癌根治术患者术后康复影响的研究[D].青岛:青岛大学,2016.
[15]葛伟平,楚蔚昕,刘红,等.腹腔镜全子宫切除术后盆底康复治疗的疗效评价[J].中国微创外科杂志,2017,17(4):302-306.
[16]Kim JS,Ward KK,Shah NR,et al.Effects of obesity and hysterectomy approach on the surgical management of uterine malignancy[J].Am J Clin Exp Obstet Gynecol,2015,2(3):96-101.
[17]Altiparmak B,Güzel?,Gümü?Demirbilek S.Comparison of Preoperative Administration of Pregabalin and Duloxetine on Cognitive Functions and Pain Management After Spinal Surgery[J].Clin J Pain,2018,34(12):1114-1120.
[18]Torng PL,Pan SP,Hwang JS,et al.Learning curve in conc u rrent application of laparoscopic and robotic-assisted hyste r ectomy with lymphadenectomy in endometrial cancer[J].Taiwan JObstet Gynecol,2017,56(6):781-787.
[2]Choi YS,Lee SH,Cho HJ,et al.Outcomes of ureteroscopic double-J ureteral stenting for distal ureteral injury after gynecologic surgery[J].Int J Urogynecol,2018,29(9):1397-1402.
[3]廖婧.两种心理干预方法对子宫腺肌症切除患者术前焦虑及术后恢复的影响[J].中国继续医学教育,2017,9(13):247-249.
[4]乐杰.妇产科学[M].5版.北京:人民卫生出版社,2004:219-223.
[5]韩旭东,李怡林,吴珍珍,等.快速康复外科技术用于腹腔镜子宫全切术围术期的临床研究[J].中国妇产科临床杂志,2016,17(1):21.
[6]Derogatis LR,Lipman RS,Covi L.SCL-90:an outpa tient psychiatric rating scale--preliminary report[J].Psychop harmacol Bull,1973,9(1):13-28.
[7]曾人宏,赵晓玲,朱莉.快速康复外科技术配合腹腔镜对子宫肌瘤患者疗效及恢复效率的影响[J].中国医学创新,2017,14(10):74-77.
[8]饶雪萍,仲勇.快速康复对腹腔镜辅助阴式全子宫切除术患者的临床探讨[J].吉林医学,2016,37(4):973-975.
[9]陈芙蓉,徐雅祯.FTS对阴式全子宫切除术患者免疫功能和生活质量的影响[J].西南国防医药,2016,26(8):931-933.
[10]Miralpeix E,Nick AM,Meyer LA,et al.A call for new standard of care in perioperative gynecologic oncology practice:impact of enhanced recovery after surgery(ERAS)programs[J].Gynecol Oncol,2016,141(2):371-378.
[11]Trowbridge ER,Dreisbach CN,Sarosiek BM,et al.Review of enhanced recovery programs in benign gynecologic surgery[J].Int Urogynecol J,2018,29(1):3-11.
[12]张娜,肖珊珊,温娜,等.加速康复管理在腹腔镜全子宫切除术患者中的应用研究[J].国际妇产科学杂志,2017,44(6):659-662.
[13]Bernard S,Moffet H,Plante M,et al.Pelvic-Floor Properties in Women Reporting Urinary Incontinence After Surgery and Radiotherapy for Endometrial Cancer[J].Phys Ther,2017,97(4):438-448.
[14]张盛苗.加速康复外科对腹腔镜宫颈癌根治术患者术后康复影响的研究[D].青岛:青岛大学,2016.
[15]葛伟平,楚蔚昕,刘红,等.腹腔镜全子宫切除术后盆底康复治疗的疗效评价[J].中国微创外科杂志,2017,17(4):302-306.
[16]Kim JS,Ward KK,Shah NR,et al.Effects of obesity and hysterectomy approach on the surgical management of uterine malignancy[J].Am J Clin Exp Obstet Gynecol,2015,2(3):96-101.
[17]Altiparmak B,Güzel?,Gümü?Demirbilek S.Comparison of Preoperative Administration of Pregabalin and Duloxetine on Cognitive Functions and Pain Management After Spinal Surgery[J].Clin J Pain,2018,34(12):1114-1120.
[18]Torng PL,Pan SP,Hwang JS,et al.Learning curve in conc u rrent application of laparoscopic and robotic-assisted hyste r ectomy with lymphadenectomy in endometrial cancer[J].Taiwan JObstet Gynecol,2017,56(6):781-787.