Department of Otolaryngology Head and Neck Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China.
Department of Scientific Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China.
Chin Med J (Engl). 2019 Feb 5;132(3):253-258. doi: 10.1097/CM9.0000000000000060.
Enhanced recovery after surgery (ERAS) protocols are a series of perioperative care to optimize preoperative preparation, prevent postoperative complications, minimize stress, and speed up recovery. This study aimed to assess the impact of ERAS protocols for functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).
One hundred and two patients with CRSwNP undergoing FESS were randomly divided into the ERAS group and the control group. The outcomes of the Self-Rating Anxiety Scale (SAS), Visual Analogue Scale (VAS), Medical Outcomes Study Sleep Scale (MOS-SS) and Kolcaba Comfort Scale Questionnaire (GCQ) were determined in both groups. The serum levels of C-reactive protein (CRP) were compared preoperatively and 24 hours postoperatively.
The ERAS group had a significantly better SAS scores than did the control group (28 [24, 35] vs. 43 [42, 47], Z = 5.968, P < 0.001). The rhinalgia and headache scores at 2, 24 and 48 hours postoperatively were lower in the ERAS group than that in the control group (all P < 0.001). The outcomes of the MOS-SS (43 [42, 39] vs. 28 [22, 35], Z = 7.071, P < 0.001) and GCQ (76 [68, 87] vs. 64 [50, 75], Z = 4.806, P < 0.001) were significantly different between the two groups. No significant difference was found in the preoperative CRP levels between the two groups (1.3 [0.6, 2.8] vs. 0.5 [0.5, 1.2], Z = 3.049, P > 0.05); However, the CRP level in 24 hours postoperatively was significantly lower in the ERAS group than that in the control group (2.5 [1.4, 3.9] vs. 6.6 [3.8, 9.0], Z = 5.027, P < 0.001). The incidence rates of complications, such as nausea/emesis (χ = 0.343, P > 0.05), hemorrhage, aspiration and tumble, were not increased in the ERAS group compared with those in the control group. The ERAS group had a significantly shorter length of hospital stay (5 [4, 5] days vs. 8 [8,9] days, Z = 8.939, P < 0.001) and hospitalization expenses ($ 2670 [2375, 2740] vs. $3129 [3116, 3456], Z = 8.514, P < 0.001).
ERAS protocols might optimize FESS for patients with CRSwNP by reducing psychological and physical stress, shortening the length of hospital stay and lowering hospitalization expenses without increasing postoperative complications.
Chinese Clinical Trial Registry, No. ChiCTR1800015791; http://www.chictr.org.cn/showproj.aspx?proj=26872.
加速康复外科（ERAS）方案是一系列围手术期护理措施，旨在优化术前准备，预防术后并发症，减轻应激，加速康复。本研究旨在评估 ERAS 方案对慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）患者功能性内镜鼻窦手术（FESS）的影响。
将 102 例接受 FESS 的 CRSwNP 患者随机分为 ERAS 组和对照组。采用焦虑自评量表（SAS）、视觉模拟评分（VAS）、医学结局研究睡眠量表（MOS-SS）和 Kolcaba 舒适状况量表问卷（GCQ）评估两组患者的结局。比较两组患者术前和术后 24 小时血清 C 反应蛋白（CRP）水平。
与对照组相比，ERAS 组的 SAS 评分明显更低（28[24，35] vs. 43[42，47]，Z=5.968，P<0.001）。ERAS 组术后 2、24 和 48 小时的鼻痛和头痛评分均低于对照组（均 P<0.001）。MOS-SS（43[42，39] vs. 28[22，35]，Z=7.071，P<0.001）和 GCQ（76[68，87] vs. 64[50，75]，Z=4.806，P<0.001）的结果在两组之间也有显著差异。两组患者术前 CRP 水平无显著差异（1.3[0.6，2.8] vs. 0.5[0.5，1.2]，Z=3.049，P>0.05）；然而，术后 24 小时的 CRP 水平在 ERAS 组明显低于对照组（2.5[1.4，3.9] vs. 6.6[3.8，9.0]，Z=5.027，P<0.001）。恶心/呕吐（χ=0.343，P>0.05）、出血、吸入和跌倒等并发症的发生率在 ERAS 组与对照组之间无增加。ERAS 组的住院时间（5[4，5]天 vs. 8[8，9]天，Z=8.939，P<0.001）和住院费用（$2670[2375，2740] vs. $3129[3116，3456]，Z=8.514，P<0.001）均明显缩短。
ERAS 方案通过减轻心理和生理应激，缩短住院时间和降低住院费用，而不增加术后并发症，可能优化 CRSwNP 患者的 FESS。
中国临床试验注册中心，编号 ChiCTR1800015791；http://www.chictr.org.cn/showproj.aspx?proj=26872。
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