快速康复理念在创伤性肋骨骨折手术中的应用
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摘要
目的探讨快速康复理念在创伤性肋骨骨折手术中的应用。方法搜集2017年8月至2018年1月西安市红会医院胸外科收治的64例创伤性肋骨骨折患者的临床资料。按治疗方式的不同分为快速康复组(n=36)和常规治疗组(n=28)。比较两组患者的手术切口长度、手术时间、术中出血量、术后第1天视觉模拟评分(VAS评分)、拔除胸腔闭式引流管时间、术后第3天最大自由通气量(MVV)、胃肠道功能恢复时间、平均住院时间及住院费用。结果快速康复组手术切口长度短于常规治疗组,术中出血量少于常规治疗组,差异均有统计学意义(P<0.05);但两组间手术时间比较,差异无统计学意义(P>0.05)。快速康复组术后第1天VAS评分低于常规治疗组,拔除胸腔闭式引流管时间短于常规治疗组,术后第3天MVV值大于常规治疗组,胃肠道恢复时间短于常规治疗组,平均住院时间短于常规治疗组,差异均有统计学意义(P<0.05);但两组间住院费用比较差异无统计学意义(P>0.05)。结论快速康复理念应用于创伤性肋骨骨折手术中具有明显优势,应在临床中广泛推广。
Objective To explore the application of enhanced recovery idea in surgery for traumatic rib fractures. Methods 64 patients with traumatic rib fractures admitted to the Department of Thoracic Surgery, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University from August 2017 to January 2018 were randomly selected. Patients were divided into two groups according to different surgical management, 28 cases of conventional treatment group and 36 cases of enhanced recovery group.The clinical data were analyzed and compared between the two groups, including incision length,operation time, intraoperative blood loss, postoperative visual analogue scale(VAS) score on first postoperative day, time to pull out chest closed drainage tube, maximal voluntary ventilation(MVV) on 3 rd postoperative day,recovery time of gastrointestinal function, average length of hospital stay,and cost of hospitalization. Results The incision length and intraoperative blood lose of the enhanced recovery group improved significantly compared with the conventional treatment group(P < 0.05),while the two groups had no significant differences in operation time(P>0.05). Compared with the conventional treatment group, the enhanced recovery group had lower postoperative VAS score on first postoperative day; reduced time to pull out chest closed drainage tube; had greater MVV on 3 rd postoperative day; reduced the recovery time of gastrointestinal function;and as a result,also reduce the average length of hospital stay(P<0.05).However,there were no significant differences in cost of hospitalization(P>0.05). Conclusions The enhanced recovery idea has absolute advantages in operation for traumatic rib fractures,and should be widely applied in clinical treatment.
Objective To explore the application of enhanced recovery idea in surgery for traumatic rib fractures. Methods 64 patients with traumatic rib fractures admitted to the Department of Thoracic Surgery, Honghui Hospital Affiliated to School of Medicine, Xi'an Jiaotong University from August 2017 to January 2018 were randomly selected. Patients were divided into two groups according to different surgical management, 28 cases of conventional treatment group and 36 cases of enhanced recovery group.The clinical data were analyzed and compared between the two groups, including incision length,operation time, intraoperative blood loss, postoperative visual analogue scale(VAS) score on first postoperative day, time to pull out chest closed drainage tube, maximal voluntary ventilation(MVV) on 3 rd postoperative day,recovery time of gastrointestinal function, average length of hospital stay,and cost of hospitalization. Results The incision length and intraoperative blood lose of the enhanced recovery group improved significantly compared with the conventional treatment group(P < 0.05),while the two groups had no significant differences in operation time(P>0.05). Compared with the conventional treatment group, the enhanced recovery group had lower postoperative VAS score on first postoperative day; reduced time to pull out chest closed drainage tube; had greater MVV on 3 rd postoperative day; reduced the recovery time of gastrointestinal function;and as a result,also reduce the average length of hospital stay(P<0.05).However,there were no significant differences in cost of hospitalization(P>0.05). Conclusions The enhanced recovery idea has absolute advantages in operation for traumatic rib fractures,and should be widely applied in clinical treatment.
引文
1 赵润润,苏宜江.肋骨骨折诊治现状[J].创伤外科杂志,2014,16(2):173-175.
2 李扬,杨异,吴伟铭,等.肋骨骨折临床治疗研究进展[J].创伤与急危重病医学,2016,4(5):315-318.
3 沈兆亮,张仲明,徐鹏,等.快速康复理念对老年骨质疏松性压缩骨折的影响[J].创伤外科杂志,2018,20(2):135-137.
4 胡坚,马洪海.肺癌加速康复外科的发展现状及展望[J].中华胸部外科电子杂志,2017,4(3):136-139.
5 郭伟,蒋耀光.肋骨骨折的救治概况[J].创伤外科杂志,2009,11(3):272-274.
6 Slobogean GP, MacPherson CA, Sun T, et al. Surgical fixation vs nonoperative management of flail chest: a meta-analysis[J].J Am Coll Surg, 2013,216(2):302-311.
7 Leinicke JA, Elmore L, Freeman BD, et al.Operative management of rib fracturesin thesettingof flail chest: a systematic review and meta-analysis[J].Ann Surg, 2013 ,258(6):914-921.
8 王通,宋金涛,闫天生,等.电视胸腔镜辅助肋骨接骨板治疗多发肋骨骨折合并血气胸[J].中国微创外科杂志,2016,16(3):245-248.
9 张亦弛,王许安,刘颖斌.快速康复理念在外科围手术期的应用[J].上海医药,2017,38(10):3-6.
10 车国卫,吴齐飞,邱源,等.多学科围手术期气道管理中国专家共识(2018版)[J].中国胸心血管外科临床杂志,2018,25(7):545-549.
11 支修益,何建行,刘伦旭,等.多学科围手术期气道管理专家共识(2016年版)[J].中华胸部外科电子杂志,2016,3(3):129-133.
12 朱爱艳,朱淑娥.超声诊断胸部闭合伤中肋骨骨折的应用价值[J].中国超声医学杂志,2016,32(3):274-275.
13 古旸,何芳,金兰,等.高频超声与另外三种影像学检查方法诊断肋骨及肋软骨骨折的对比分析[J].创伤外科杂志,2016,18(10):630-631.
14 王飞,杨劼,古卫权,等.双孔胸腔镜肺段切除术56例[J].中国微创外科杂志,2018,18(10):902-903,907.
15 赵子聪,洪志鹏.外科胸腔镜的发展现状[J].中华肺部疾病杂志:电子版, 2018,11(5):618-620.
16 陈宇,宁光耀,夏万里,等.单孔胸腔镜在治疗孤立性肺结节中的应用[J].临床肺科杂志,2018,23(11):2038-2040
17 孙超,石维平,吕小夏,等.胸腔镜食管癌手术上纵隔缝合方法及经验总结[J].中华腔镜外科杂志:电子版,2017,10(4):226-229.
18 徐震壮,吴小波,胡斌.胸腔镜辅助镍钛记忆合金肋骨接骨板内固定术治疗多发肋骨骨折临床疗效研究[J].创伤外科杂志,2018,20(11):848-851.
19 周雁,种皓,郑媛芳,等.创伤骨科围手术期多模式疼痛管理[J].骨科临床与研究杂志,2018,3(04):249-254.
20 洪飚,罗涛,段律芳,等.不同镇痛方式在多发肋骨骨折患者疼痛管理的应用[J].中国疼痛医学杂志,2015,21(5):383-386.
2 李扬,杨异,吴伟铭,等.肋骨骨折临床治疗研究进展[J].创伤与急危重病医学,2016,4(5):315-318.
3 沈兆亮,张仲明,徐鹏,等.快速康复理念对老年骨质疏松性压缩骨折的影响[J].创伤外科杂志,2018,20(2):135-137.
4 胡坚,马洪海.肺癌加速康复外科的发展现状及展望[J].中华胸部外科电子杂志,2017,4(3):136-139.
5 郭伟,蒋耀光.肋骨骨折的救治概况[J].创伤外科杂志,2009,11(3):272-274.
6 Slobogean GP, MacPherson CA, Sun T, et al. Surgical fixation vs nonoperative management of flail chest: a meta-analysis[J].J Am Coll Surg, 2013,216(2):302-311.
7 Leinicke JA, Elmore L, Freeman BD, et al.Operative management of rib fracturesin thesettingof flail chest: a systematic review and meta-analysis[J].Ann Surg, 2013 ,258(6):914-921.
8 王通,宋金涛,闫天生,等.电视胸腔镜辅助肋骨接骨板治疗多发肋骨骨折合并血气胸[J].中国微创外科杂志,2016,16(3):245-248.
9 张亦弛,王许安,刘颖斌.快速康复理念在外科围手术期的应用[J].上海医药,2017,38(10):3-6.
10 车国卫,吴齐飞,邱源,等.多学科围手术期气道管理中国专家共识(2018版)[J].中国胸心血管外科临床杂志,2018,25(7):545-549.
11 支修益,何建行,刘伦旭,等.多学科围手术期气道管理专家共识(2016年版)[J].中华胸部外科电子杂志,2016,3(3):129-133.
12 朱爱艳,朱淑娥.超声诊断胸部闭合伤中肋骨骨折的应用价值[J].中国超声医学杂志,2016,32(3):274-275.
13 古旸,何芳,金兰,等.高频超声与另外三种影像学检查方法诊断肋骨及肋软骨骨折的对比分析[J].创伤外科杂志,2016,18(10):630-631.
14 王飞,杨劼,古卫权,等.双孔胸腔镜肺段切除术56例[J].中国微创外科杂志,2018,18(10):902-903,907.
15 赵子聪,洪志鹏.外科胸腔镜的发展现状[J].中华肺部疾病杂志:电子版, 2018,11(5):618-620.
16 陈宇,宁光耀,夏万里,等.单孔胸腔镜在治疗孤立性肺结节中的应用[J].临床肺科杂志,2018,23(11):2038-2040
17 孙超,石维平,吕小夏,等.胸腔镜食管癌手术上纵隔缝合方法及经验总结[J].中华腔镜外科杂志:电子版,2017,10(4):226-229.
18 徐震壮,吴小波,胡斌.胸腔镜辅助镍钛记忆合金肋骨接骨板内固定术治疗多发肋骨骨折临床疗效研究[J].创伤外科杂志,2018,20(11):848-851.
19 周雁,种皓,郑媛芳,等.创伤骨科围手术期多模式疼痛管理[J].骨科临床与研究杂志,2018,3(04):249-254.
20 洪飚,罗涛,段律芳,等.不同镇痛方式在多发肋骨骨折患者疼痛管理的应用[J].中国疼痛医学杂志,2015,21(5):383-386.