Tian R X, Wang J W, Yang Y J, Liu L P, Sun Y M, Tang N N, Zhang Y, Song X C
Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, Shandong Province, China.
Department of Allergy, 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):229-235. doi: 10.3760/cma.j.cn115330-20200410-00286.
To explore the effect of perioperative airway management based on the concept of enhanced recovery after surgery (ERAS) on the improvement of preoperative pulmonary function in patients with aspirin intolerance triad (AIT). Thirty patients with AIT (including 13 males and 17 females, aged from 29 to 75 years old) for sinus surgery from January 2018 to December 2019 were selected, 172 patients (including 105 males and 67 females, aged from 17 to 83 years old) with chronic rhinosinusitis with nasal polyps (CRSwNP) without lower airway disease were selected by random number table at the same period, and their clinical data and preoperative pulmonary function were analyzed and compared retrospectively. FEV%pred<80% after bronchodilation test was considered as high risk for surgery. Preoperative evaluation and standardized drug intervention were applied in patients with pulmonary function abnormalities at risk for surgery, and improvement of preoperative pulmonary function and tolerability to general anesthesia surgery in the two groups were evaluated. All the statistical analyses were conducted using SPSS 22.0. The main pulmonary function indexes (FEV%pred, FEV/FVC%pred, FEF%pred, FEF%pred, MMEF%pred) in AIT group decreased significantly than those in CRSwNP group ( values were 10.882, 10.506, 9.141, 10.182, 9.099, respectively, all <0.001). At admission 86.7% (26/30) patients in the AIT group and 11.6% (20/172) patients in CRSwNP group had high surgical risk for lung function, with significantly difference ( = 81.788, 0.05); after 3 days with individualized drug intervention, 57.7% (15/26) patients in AIT group reached the standard for surgery, which was significantly less than 90.0% (18/20) patients in CRSwNP group (4.335,<0.05); and after 6 days with drug intervention, the patients who reached the standard for surgery in pulmonary function accounted for 92.3% (24/26) in the AIT group and 100% (20/20) in the CRSwNP group. FEV%pred in the two groups before surgery were significantly improved compared with those at admission respectively ((90.00±6.32)% (64.79±13.60)%, value was 10.110 in AIT group; (91.65±11.86)% (76.40±9.35)%, value was 9.346 in CRSwNP group; all 0.05), and also FEV/FVC%pred, FEF%pred, FEF%pred and MMEF%pred were all significantly improved (all <0.05). Surgery was completed successfully in the two groups of patients with lung function meeting the surgical standard, and no intraoperative or postoperative airway adverse events occurred. AIT patients have high airway risk for sinus surgery due to poor pulmonary function. Standardized airway management based on the concept of ERAS can improve the pulmonary function of patients, and decrease the incidence of perioperative airway adverse events.
探讨基于加速康复外科（ERAS）理念的围手术期气道管理对阿司匹林不耐受三联征（AIT）患者术前肺功能改善的影响。选取2018年1月至2019年12月因鼻窦手术收治的30例AIT患者（男13例，女17例，年龄29～75岁），同期采用随机数字表法选取172例慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）且无下气道疾病的患者（男105例，女67例，年龄17～83岁），回顾性分析比较两组患者的临床资料及术前肺功能。支气管舒张试验后FEV%pred<80%视为手术高风险。对存在手术风险的肺功能异常患者进行术前评估及规范化药物干预，评估两组患者术前肺功能改善情况及对全身麻醉手术的耐受性。所有统计分析均采用SPSS 22.0软件。AIT组主要肺功能指标（FEV%pred、FEV/FVC%pred、FEF%pred、FEF%pred、MMEF%pred）均显著低于CRSwNP组（值分别为10.882、10.506、9.141、10.182、9.099，均<0.001）。入院时，AIT组86.7%（26/30）的患者及CRSwNP组11.6%（20/172）的患者存在肺功能手术高风险，差异有统计学意义（=81.788，<0.05）；个体化药物干预3天后，AIT组57.7%（15/26）的患者达到手术标准，显著低于CRSwNP组90.0%（18/20）的患者（=4.335，<0.05）；药物干预6天后，AIT组肺功能达到手术标准的患者占92.3%（24/26），CRSwNP组为100%（20/20）。两组患者术前FEV%pred较入院时均显著改善（AIT组：（90.00±6.32）% （64.79±13.60）%，值为10.110；CRSwNP组：（91.65±11.86）% （76.40±9.35）%，值为9.346；均<0.05），FEV/FVC%pred、FEF%pred、FEF%pred及MMEF%pred也均显著改善（均<0.05）。两组肺功能达手术标准的患者均成功完成手术，术中及术后均未发生气道不良事件。AIT患者因肺功能差，鼻窦手术气道风险高。基于ERAS理念的规范化气道管理可改善患者肺功能，降低围手术期气道不良事件的发生率。
