加速康复外科理念应用于剖宫产产妇围术期管理

Application of enhanced recovery after surgery in the perioperative management of parturient undergoing cesarean section

中文关键词: 加速康复外科  剖宫产  围术期管理

英文关键词: Enhanced recovery after surgery  Cesarean section  Perioperative management

中文摘要:

      
目的 探讨加速康复外科（ERAS）理念指导剖宫产产妇围术期管理的有效性。
方法 选择2020年1—5月择期行剖宫产术的单胎足月产妇100例，年龄22~45岁，BMI≤35 kg/m²，孕37~42周，ASA Ⅱ级。采用随机数字表法将产妇分为两组：ERAS理念指导围术期管理组（E组）和传统围术期管理组（C组），每组50例。所有产妇均采用腰-硬联合麻醉，L_3-4椎间隙行腰-硬联合麻醉，于蛛网膜下腔注入1%罗哌卡因1.5 ml+生理盐水1.5 ml的混合液。记录术中寒战发生例数、术后6、12、24 h时静息和运动时VAS疼痛评分、术后24 h内布托啡诺用量、补救镇痛情况、术后首次排气时间、术后首次下床时间、术后住院时间（手术结束到出院）和术后住院期间恶心呕吐、切口感染及尿潴留等并发症的发生情况。
结果 与C组比较，E组术中寒战发生率明显降低（P<0.05），术后6 h静息和运动时VAS疼痛评分明显降低（P<0.05），术后24 h内阿片类镇痛药用量明显减少（P<0.05），术后首次排气时间、术后首次下床时间、术后住院时间明显缩短（P<0.05），术后恶心呕吐发生率明显降低（P<0.05）。
结论 ERAS理念指导剖宫产产妇围术期管理可以加速产妇术后康复。

英文摘要:

      
Objective To evaluate the efficacy of enhanced recovery after surgery (ERAS) in perioperative management of parturient undergoing cesarean section.
Methods A total of 100 parturient undergoing elective cesarean section from January 2020 to May 2020, aged 22-45 years, BMI≤ 35 kg/m², gestational aged 37-42 weeks, ASA physical status Ⅱ, were randomly divided into two groups: received ERAS group (group E) and received conventional perioperative management group (group C), each group enrolled 50 patients. The occurrence of intraoperative shivering, the visual analogue scale (VAS) scores during the rest and exercise 6, 12, and 24 hours after operation, the dose of butorphanol and the requirement for rescue analgesia within 24 hours after operation, the time of anal exhaust, the time of leaving bed, the length of hospital stay, and the occurrence of adverse reactions such as nausea and vomiting， infection of incision and urinary retention after operation were recorded.
Results Compared with group C, the incidence of intraoperative shivering was significantly reduced in group E (P < 0.05), the VAS scores during the rest and exercise 6 hours after operation, and the consumption of opioid within 24 hours after operation were significantly lower in group E (P < 0.05), the time of anal exhaust, the time of leaving bed, and the length of hospital stay were significantly shorter in group E (P < 0.05), and the incidence of postoperative nausea and vomiting were significantly reduced in group E (P < 0.05).
Conclusion ERAS can accelerate postoperative recovery of parturient when applied in perioperative management of cesarean section．