Lu Dan, Zhou Chao, Zhang Yiwen, Yang Xiaoping, Xia Faming, Pan Xiaofeng, Li Mingxing, Wang Rurong, Li Wentao
Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
J Thorac Dis. 2024 Sep 30;16(9):5792-5801. doi: 10.21037/jtd-24-685. Epub 2024 Sep 26.
The clinical effectiveness of enhanced recovery after surgery (ERAS) strategy, which emphasizes a comprehensive intervention without highlighting key points, seems to have reached a bottleneck. This study focuses on surgery, anesthesia and postoperative analgesia as the three key factors, to observe the related manifestations of ERAS in patients undergoing lung surgery with minimal intervention throughout the perioperative period.
All patients who underwent lung surgery by micro-invasive video-assisted thoracoscopic surgery (VATS) at Taizhou Municipal Hospital from August 2018 to August 2019 were consecutively enrolled in the study. The clinical data of patients were collected to observe the results of ERAS. The patients were divided into intravenous analgesia group and intercostal nerve block group according to different analgesic methods, and the ERAS results of the two analgesic methods were compared.
A total of 242 patients were included in the study. The time from cessation of anesthesia to extubation was 10 [interquartile range (IQR), 9, 12] minutes (min), the time from extubation to limb activity according to instructions was 18 (IQR, 14, 23) min, time to sit up was 18 (IQR, 14, 23) min, time to stand up was 40 (IQR, 35, 46) min, and time to walk was 48 (IQR, 45, 55) min. No patient had any anesthesia complications. Compared with the intravenous analgesia group, the intercostal nerve block group had shorter time to limb activity according to instructions, time to sit up and time to walk after extubation, and lower postoperative pain scores (P<0.05).
For patients undergoing thoracic surgery, focusing on surgery, anesthesia and analgesia the three key factors, using micro-invasive VATS to reduce surgical trauma and shorten operation time, precise individualized anesthesia program and effective postoperative analgesia can achieve early autonomous activity of patients after surgery.
强调全面干预但未突出关键点的加速康复外科（ERAS）策略的临床效果似乎已达到瓶颈。本研究聚焦于手术、麻醉和术后镇痛这三个关键因素，在围手术期以最小干预观察ERAS在肺手术患者中的相关表现。
连续纳入2018年8月至2019年8月在台州市立医院接受微创电视辅助胸腔镜手术（VATS）进行肺手术的所有患者。收集患者的临床资料以观察ERAS结果。根据不同镇痛方法将患者分为静脉镇痛组和肋间神经阻滞组，比较两种镇痛方法的ERAS结果。
本研究共纳入242例患者。麻醉停止至拔管时间为10[四分位间距（IQR），9，12]分钟（min），拔管至按指令肢体活动时间为18（IQR，14，23）min，坐起时间为18（IQR，14，23）min，站立时间为40（IQR，35，46）min，行走时间为48（IQR，45，55）min。无患者出现任何麻醉并发症。与静脉镇痛组相比，肋间神经阻滞组拔管后按指令肢体活动时间、坐起时间和行走时间更短，术后疼痛评分更低（P<0.05）。
对于胸科手术患者，聚焦于手术、麻醉和镇痛这三个关键因素，采用微创VATS减少手术创伤并缩短手术时间，精准个体化麻醉方案及有效的术后镇痛可实现患者术后早期自主活动。
