Chen Y Q, Qi Y S, Zhang Z Q, Zhu L, Wang S Z, Wu A S
Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Yi Xue Za Zhi. 2021 May 25;101(19):1427-1432. doi: 10.3760/cma.j.cn112137-20210128-00272.
To investigate the impact of perioperative anesthesia management with enhanced recovery after surgery (ERAS) strategy on postoperative recovery in patients undergoing laparoscopic surgery for gynecologic malignancy. Ninety patients undergoing laparoscopic surgery for gynecologic malignancies from April 2018 to April 2019,aged 18-65 years,with American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, were recruited and randomly divided into two groups (=45) using a random number table:ERAS group (group E) and control group (group C). Patients in group E received general anesthesia combined with transverses abdominis plane block and a series of interventions to optimize anesthetic and perioperative management, while patients in group C were treated with routine anesthesia management. Quality of Recovery-40 questionnaire (QoR-40) was administered to assess the early postoperative quality of recovery on 1 day before surgery, and at 24 and 48h after surgery. C-reactive protein (CRP) before and after the operation were evaluated. The incidence of nausea, vomiting and shivering, the time of first exhaust, ambulation, resumption of normal diet, postoperative hospital stay and complications were recorded. The scores of QoR-40 [(, )] in Group E were 175(171, 179) and 185(183, 189) at 24 h and 48 h after operation, which were higher than those in group C [162(160, 167) and 180(179, 183)] (both <0.01). The levels of CRP in both group E and group C increased at 24 h and 72 h after operation. Moreover, the extent of increasing level of CRP in group C was much higher than that in group E [(39.8±18.0) mg/L vs (13.4±6.3) mg/L, (16.6±8.6) mg/L vs (6.7±2.5) mg/L] at 24 h and 48 h after operation (both <0.01). Compared with group C, the numerical rating scale (NRS) for nausea decreased significantly in group E [0(0, 2) vs 3 (0, 5), <0.01]. Meanwhile, the incidence of vomiting and shivering in group E was lower than that in group C [8.9% (4/45) vs 26.7% (12/45); 11.1% (5/45) vs 31.1% (14/45); both <0.05]. The time of first exhaust, ambulation and resumption of normal diet in group E was (14±6) h, 6(6, 13) h and 1(1, 2) d, respectively, which was markedly shorter than that in group C [(25±10) h, 21(19, 27) h and 3(2, 3) d] (all <0.01). Overall, the postoperative length of hospital stay reduced significantly for patients who followed the ERAS protocol [7(5, 11) d vs 10(7, 14) d, <0.01]. The incidence of postoperative complications was 17.8% (8/45) and 37.8% (17/45) in group E and group C, respectively, with a significant difference (<0.05). Implementation of ERAS anesthesia management in gynecologic oncology patients undergoing minimally invasive surgery alleviates perioperative discomfort, decreases surgical stress response, and improves the early postoperative quality of recovery.
探讨围手术期采用加速康复外科（ERAS）策略进行麻醉管理对妇科恶性肿瘤腹腔镜手术患者术后恢复的影响。选取2018年4月至2019年4月行腹腔镜妇科恶性肿瘤手术的90例患者，年龄18 - 65岁，美国麻醉医师协会（ASA）身体状况分级为Ⅰ或Ⅱ级，采用随机数字表法将其随机分为两组（每组 = 45例）：ERAS组（E组）和对照组（C组）。E组患者接受全身麻醉联合腹横肌平面阻滞及一系列优化麻醉和围手术期管理的干预措施，而C组患者采用常规麻醉管理。在手术前1天、术后24小时和48小时采用术后恢复质量-40问卷（QoR - 40）评估术后早期恢复质量。评估手术前后的C反应蛋白（CRP）水平。记录恶心、呕吐和寒战的发生率、首次排气时间、下床活动时间、恢复正常饮食时间、术后住院时间及并发症情况。E组术后24小时和48小时的QoR - 40评分[（均值，范围）]分别为175（171，179）和185（183，189），高于C组[162（160，167）和180（179，183）]（均P < 0.01）。E组和C组术后24小时和72小时CRP水平均升高。此外，术后24小时和48小时C组CRP升高幅度远高于E组[（39.8±18.0）mg/L对（13.4±6.3）mg/L，（16.6±8.6）mg/L对（6.7±2.5）mg/L]（均P < 0.01）。与C组相比，E组恶心的数字评定量表（NRS）评分显著降低[0（0，2）对3（0，5），P < 0.01]。同时，E组呕吐和寒战的发生率低于C组[8.9%（4/45）对26.7%（12/45）；11.1%（5/45）对31.1%（14/45）；均P < 0.05]。E组首次排气时间、下床活动时间和恢复正常饮食时间分别为（14±6）小时、6（6，13）小时和1（1，2）天，明显短于C组[（25±10）小时、21（19，27）小时和3（2，3）天]（均P < 0.01）。总体而言，遵循ERAS方案的患者术后住院时间显著缩短[7（5，11）天对10（7，14）天，P < 0.01]。E组和C组术后并发症发生率分别为17.8%（8/45）和37.8%（17/45），差异有统计学意义（P < 0.05）。对接受微创手术的妇科肿瘤患者实施ERAS麻醉管理可减轻围手术期不适，降低手术应激反应，并改善术后早期恢复质量。
