加速康复外科在微创经椎间孔腰椎椎体间融合术围术期的应用价值

Value of enhanced recovery after surgery in patients undergoing minimally invasive transforaminal lumbar interbody fusion during perioperative period

  • 摘要:
      目的  探讨加速康复外科(ERAS)在腰椎管狭窄症患者微创经椎间孔腰椎椎体间融合术(MIS-TLIF)围术期的应用价值。
      方法  选取在脊柱外科住院接受MIS-TLIF治疗的120例腰椎管狭窄症患者为研究对象,随机分为观察组和对照组,每组60例。观察组实施ERAS管理,对照组实施常规管理。比较2组患者围术期镇痛药物使用情况(药物品种及用量)、住院时间、术中出血量,并比较术前、术后1 d疼痛评分和术后进食时间、术后下地时间、住院时间、术后恢复情况、满意度情况。
      结果  观察组术中出血量为(66.02±32.04) mL, 少于对照组的(94.04±37.02) mL, 差异有统计学意义(P < 0.001); 观察组住院时间为(2.42±1.13)d,短于对照组的(4.01±1.98)d,差异有统计学意义(P < 0.001)。观察组术后1 d焦虑评分、疼痛评分分别为(8.46±6.31)、(1.88±0.24)分,均低于术前,差异有统计学意义(P < 0.05)。观察组阿片类药物围术期用量、术后1 d疼痛评分低于对照组,术后下地时间、术后进食时间早于对照组,差异有统计学意义(P < 0.05)。观察组患者术后日常生活活动能力(ADL)评分、满意度高于对照组,差异有统计学意义(P < 0.05)。
      结论  将ERAS应用于接受MIS-TLIF治疗的腰椎管狭窄症患者,可降低患者焦虑评分、疼痛评分和镇痛药物使用量,加快术后康复,改善康复效果,提高患者满意度。

     

    Abstract:
      Objective  To investigate the application value of enhanced recovery after surgery (ERAS) in patients with lumbar spinal stenosis under minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in perioperation.
      Methods  A total of 120 hospitalized patients with lumbar spinal stenosis who underwent MIS-TLI treatment in the spinal surgery department were selected, and were divided into observation group(n=60) and control group(n=60). The observation group underwent ERAS management and the control group underwent ordinary management. The use of analgesics during the perioperative period of the two groups (varieties of drugs and amount of drugs), the length of hospital stay, and intraoperative blood loss were recorded. Preoperative and postoperative pain scores, postoperative feeding time, postoperative ground time, postoperative length of hospital stay, postoperative recovery and satisfaction were compared.
      Results  The intraoperative blood loss of patients in the observation group was(66.02±32.04) mL, which was significantly less than (94.04±37.02) mL of the control group (P < 0.001). The length of hospitalization in the observation group was (2.42±1.13) d, which was shorter than (4.01±1.98) d in the control group (P < 0.001). The anxiety score and pain score of the observation group 1 day after surgery were (8.46±6.31) and (1.88±0.24), respectively, which were lower than those before surgery (P < 0.05). The perioperative dosage of opioids and postoperative pain score one day after surgery in the observation group were lower than those in the control group, and the postoperative ground time and postoperative eating time were earlier than those in the control group (P < 0.05). The activities of daily living (ADL) score and satisfaction of patients in the observation group were higher than those in the control group (P < 0.05).
      Conclusion  ERAS for patients with lumbar spinal stenosis undergoing minimally invasive transformational lumbar inter body fusion can reduce the patient's anxiety and pain scores, decrease the use of analgesics, further promote postoperative recovery, improve the rehabilitation effect and patients'satisfaction.

     

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