Dumans-Nizard Virginie, Guezennec Jeff, Parquin François, Puyo Philippe, Sage Edouard, Abdat Rachida, Vaillant Virginie, Chapelier Alain, Dreyfus Jean-François, Fischler Marc, LE Guen Morgan
Department of Anesthesiology, Foch Hospital, France and the University of Versailles Saint Quentin in Yvelines, France -
Minerva Anestesiol. 2016 Jan;82(1):15-21. Epub 2015 Mar 13.
A rehabilitation program, a multimodal strategy favoring rapid postoperative return to autonomy, has rarely been undertaken after thoracic surgery compared to colectomy. The primary outcome of this fast-track program was the length of postoperative stay. Secondary outcomes concerned the feasibility of this strategy, the incidence of postoperative complications and 3-month postoperative mortality.
Patients were included in this prospective single-center observational study if they were scheduled for lung resection (lobectomy or wedge resection) performed by posterolateral thoracotomy. The rehabilitation program, coordinated by a referent nurse, included a list of actions to be done, especially early feeding and ambulation, multimodal analgesia including epidural analgesia, early removal of chest tube.
One hundred and two patients were included in total with two exclusions (failure of epidural analgesia). The postoperative hospital stay was 8 (7-10) days (median [25-75th percentiles]); this duration was similar to that of the historical cohort which was 9 [7-13] days (P=0.06). Most actions were conducted with a high level of acceptance except for the insertion of a single chest tube (19%) and its removal later than expected in the program. Only 50% of patients left hospital shortly after exit criteria were met suggesting failure in the organization. Patients' satisfaction rate reached 77% and no postoperative death was reported during the follow-up period.
A program for early rehabilitation is feasible after thoracotomy. Chest drainage and organization to optimize the length of stay are crucial points.
与结肠切除术相比，胸部手术后很少采用康复计划，即一种有利于术后快速恢复自主能力的多模式策略。该快速康复计划的主要结果是术后住院时间。次要结果涉及该策略的可行性、术后并发症的发生率以及术后3个月的死亡率。
如果患者计划接受后外侧开胸进行肺切除术（肺叶切除术或楔形切除术），则纳入这项前瞻性单中心观察性研究。由一名责任护士协调的康复计划包括一系列要采取的措施，特别是早期进食和活动、包括硬膜外镇痛在内的多模式镇痛、早期拔除胸管。
总共纳入了102例患者，排除2例（硬膜外镇痛失败）。术后住院时间为8（7 - 10）天（中位数[第25 - 75百分位数]）；这一持续时间与历史队列的9[7 - 13]天相似（P = 0.06）。除了插入单根胸管（19%）以及在计划中比预期更晚拔除胸管外，大多数措施的接受度较高。只有50%的患者在达到出院标准后不久出院，这表明组织方面存在失败。患者满意度达到77%，随访期间未报告术后死亡。
开胸术后早期康复计划是可行的。胸腔引流和优化住院时间的组织安排是关键点。
