Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Nursing, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Ann Palliat Med. 2021 Sep;10(9):9732-9741. doi: 10.21037/apm-21-2102.
In this study, we describe our experience regarding the implementation of early enhanced recovery after lung surgery. We achieved early ambulation within 1 hour after extubation mainly by minimally invasive surgery combined with fast-track thoracic anesthesia.
We retrospectively analyzed the clinical outcomes of early enhanced recovery in 211 patients who underwent lung resection using miniport video-assisted thoracic surgery (VATS) by a multidisciplinary team in a single institution in the period from August 2018 to August 2019.
Out of the 211 patients, 178 achieved early ambulation 1 hour after extubation. The mean age of patients in the early ambulation group was 58.6±10.8 years, and 69 men and 109 women were included. The anesthesia time (100.8±26.6 minutes), extubation time (10±2.1 minutes), and operating time (71.1±25.3 minutes) were lower in the early ambulation group (P=0.001, P<0.001, and P=0.002, respectively). Segmentectomy was performed in 48.9% of patients in the early ambulation group. The mean length of postoperative hospital stay was 4.1±3.1 days, and the 30-day morbidity was 13.7% (29/211). Prolonged air leak was the main complication, which accounted for 75.9% (22/29). No reinsertion of chest tubes, no 30-day readmissions, and no reoperations in the postoperative 30-day period occurred in any of the patients.
Early enhanced recovery after lung surgery is feasible and safe, and may facilitate early ambulation and lay the foundation for the implementation of day surgery.
本研究旨在描述我们在肺手术后早期加速康复（ERAS）实施方面的经验。我们通过微创外科手术结合快速通道胸部麻醉，使患者在拔管后 1 小时内即可早期下床活动。
我们对 2018 年 8 月至 2019 年 8 月期间，在一家机构中，由多学科团队使用微创端口电视辅助胸腔镜手术（VATS）为 211 例患者进行肺切除术后早期 ERAS 的临床结果进行了回顾性分析。
在 211 例患者中，178 例患者在拔管后 1 小时内实现了早期下床活动。早期下床活动组患者的平均年龄为 58.6±10.8 岁，包括 69 名男性和 109 名女性。该组患者的麻醉时间（100.8±26.6 分钟）、拔管时间（10±2.1 分钟）和手术时间（71.1±25.3 分钟）均低于未下床活动组（P=0.001、P＜0.001 和 P=0.002）。在早期下床活动组中，行肺段切除术的患者占 48.9%。术后住院时间的平均长度为 4.1±3.1 天，30 天发病率为 13.7%（29/211）。主要并发症是持续性肺漏气，占 75.9%（22/29）。在术后 30 天内，无患者需要重新插入胸腔引流管、再次住院或进行再次手术。
肺手术后的早期 ERAS 是可行且安全的，可促进早期下床活动，为日间手术的实施奠定基础。
