Zhang H, Mou Y K, Liu Z L, Song X C
Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, Shandong Province, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Mar 7;56(3):221-228. doi: 10.3760/cma.j.cn115330-20200825-00694.
To explore the application value of enhanced recovery after surgery (ERAS) with the multidisciplinary team (MDT) model in laryngeal cancer surgery. Eighty patients with laryngeal cancer treated in Department of Otorhinolaryngology Head and Neck Surgery of Yantai Yuhuangding Hospital from May 2016 to June 2017 were selected, including 76 males and 4 females, aged 45 to 75 years old. By random number table method, they were divided into ERAS group (40 cases) and control group (40 cases). Visual analogue scale (VAS), general comfort questionnaire (GCQ) and self-rating Anxiety Scale (SAS) were used to evaluate the symptoms and signs and psychological state of the two groups before and after operation. Mann Whitney test was used for non-normal distribution data, and chi square test, Fisher exact probability method and covariance analysis were used for classification data. Repeated measures analysis of variance was used for the comparison of each group at different time points. Two cases in the ERAS group and six cases in the control group withdrew from the study for some reason. Finally, 38 cases in the ERAS group and 34 cases in the control group were enrolled in this study. The postoperative pain scores of the two groups were the highest at 6 h after operation, and then gradually decreased. At different time points after operation, the pain scores of ERAS group were lower than those of the control group. At 24 h after operation, the pain relief degree of ERAS group was significantly higher than that of the control group, with a statistically significant difference (<0.05). Compared to control group, ERAS group had lower preoperative thirst score [(0.15±0.36) (4.29±1.17), =-7.695, <0.001] and hunger score [(0.38±0.49) (3.44±1.13), =-7.426, <0.001]. The total number of postoperative adverse reactions (8 16), oral feeding time [(4.06±4.42) d (9.06±2.42) d] and postoperative hospital stay [(5.91±0.97) d (11.03±2.11)d] in ERAS group were lower than those in control group (statistics 5.461, -4.558, -7.347, <0.05), but there was no significant difference in postoperative catheter indwelling time and neck drainage tube indwelling time between the two groups (>0.05). Before discharge, the comfort of ERAS group was significantly higher than that of control group [(60.37±8.78) (50.38±8.08), =-4.370, <0.001]. Before discharge, the anxiety level of ERAS group decreased, while that of the control group increased significantly, which was higher than that of ERAS Group [(59.12±6.43) (52.62±6.25), =-4.179, <0.001]. The application of multidisciplinary ERAS in laryngeal cancer surgery can improve preoperative hunger and thirst, postoperative pain and mental state, shorten the length of hospital stay and reduce postoperative adverse reactions.
探讨多学科团队（MDT）模式下的术后加速康复（ERAS）在喉癌手术中的应用价值。选取2016年5月至2017年6月在烟台毓璜顶医院耳鼻咽喉头颈外科治疗的80例喉癌患者，其中男性76例，女性4例，年龄45至75岁。采用随机数字表法将其分为ERAS组（40例）和对照组（40例）。采用视觉模拟评分法（VAS）、一般舒适度问卷（GCQ）和自评焦虑量表（SAS）评估两组患者手术前后的症状体征及心理状态。非正态分布数据采用Mann Whitney检验，分类数据采用卡方检验、Fisher确切概率法和协方差分析。采用重复测量方差分析比较各组在不同时间点的情况。ERAS组有2例、对照组有6例因某种原因退出研究。最终，ERAS组纳入38例，对照组纳入34例。两组患者术后疼痛评分均在术后6小时最高，随后逐渐下降。术后不同时间点，ERAS组疼痛评分低于对照组。术后24小时，ERAS组疼痛缓解程度明显高于对照组，差异有统计学意义（<0.05）。与对照组相比，ERAS组术前口渴评分[（0.15±0.36） （4.29±1.17），=-7.695，<0.001]和饥饿评分[（0.38±0.49） （3.44±1.13），=-7.426，<0.001]更低。ERAS组术后不良反应总例数（8 16）、经口进食时间[（4.06±4.42）d （9.06±2.42）d]及术后住院时间[（5.91±0.97）d （11.03±2.11）d]均低于对照组（统计值5.461，-4.558，-7.347，<0.05），但两组术后留置尿管时间和颈部引流管留置时间差异无统计学意义（>0.05）。出院前，ERAS组舒适度明显高于对照组[（60.37±8.78） （50.38±8.08），=-4.370，<0.001]。出院前，ERAS组焦虑水平降低，而对照组焦虑水平显著升高，高于ERAS组[（59.12±6.43） （52.62±6.25），=-4.179, <0.001]。多学科ERAS在喉癌手术中的应用可改善术前饥饿和口渴状况、术后疼痛及心理状态，缩短住院时间并减少术后不良反应。
