Lung Cancer Center, West China Hospital, Sichuan University/West China School of Nursing, Chengdu, 610000, Sichuan, China.
Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610000, Sichuan, China.
J Cardiothorac Surg. 2024 Apr 20;19(1):253. doi: 10.1186/s13019-024-02762-3.
Chest drainage is a standard procedure in thoracoscopic surgery for lung cancer. However, chest tube placement may deteriorate the ventilation capacity and increase difficulty of postoperative management of patients. The study investigated on the effects of enhanced recovery after surgery (ERAS) program focusing on chest tube management on surgical recovery of lung cancer patients.
The study population consisted of 60 patients undergoing video-assisted thoracoscopic surgery (VATS) after implementation of ERAS program and another group of 60 patients undergoing VATS before implementation of ERAS program.
The mean time of first food intake was 12.9 h required for the ERAS group, which was significantly shorter than 18.4 h required for the control group (p < 0.0001). The mean time of out-of-bed activity was 14.2 h taken for the ERAS group, which was notably shorter than 22.8 h taken for the control group (p < 0.0001). The duration of chest tube placement was 68.6 h in the ERAS group, which was remarkably shorter than 92.8 h in the control group (p < 0.0001). The rate overall postoperative complications were notably lower in the ERAS group than in the control group (p = 0.018). The visual analogue score (VAS) scores on the second postoperative day exhibited significant differences between the ERAS group and the control group (p = 0.017). The patients in the ERAS group had a shorter hospitalization stay than those in the control group (p < 0.0001).
The study suggests the ERAS program focusing on chest tube management could improve surgical recovery, remove patient chest tube earlier, and relieve patient pain after VATS.
胸腔引流是肺癌胸腔镜手术的标准程序。然而，放置胸腔引流管可能会降低患者的通气能力，并增加术后管理的难度。本研究探讨了以胸腔引流管管理为重点的术后快速康复（ERAS）方案对肺癌患者手术康复的影响。
研究人群包括 60 例接受电视辅助胸腔镜手术（VATS）的患者，这些患者在实施 ERAS 方案后分为一组，另有 60 例接受 VATS 的患者在实施 ERAS 方案前分为一组。
ERAS 组首次进食的平均时间为 12.9 小时，显著短于对照组的 18.4 小时（p<0.0001）。ERAS 组下床活动的平均时间为 14.2 小时，明显短于对照组的 22.8 小时（p<0.0001）。ERAS 组胸腔引流管放置时间为 68.6 小时，明显短于对照组的 92.8 小时（p<0.0001）。ERAS 组术后总体并发症发生率明显低于对照组（p=0.018）。ERAS 组和对照组术后第 2 天的视觉模拟评分（VAS）差异有统计学意义（p=0.017）。ERAS 组患者的住院时间短于对照组（p<0.0001）。
该研究表明，以胸腔引流管管理为重点的 ERAS 方案可改善手术康复，更早地为患者去除胸腔引流管，并减轻 VATS 后的疼痛。
