摘要
目的 观察加速术后康复(ERAS)方案对单操作孔全胸腔镜肺叶切除术后康复效果的影响.方法 前瞻性选取2021年3月至2023年11月在秦皇岛市第一医院接受单操作孔全胸腔镜肺叶切除术的80例非小细胞肺癌患者,按照简单随机法将其分为两组,单组40例.对照组给予常规方案干预,观察组给予ERAS方案干预.比较两组手术一般情况、并发症情况及手术前后机体应激反应指标[皮质醇、前列腺素2(PGE2)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]变化.结果 两组的手术时间、淋巴结清扫个数比较,差异均无统计学意义(P＞0.05);观察组术后进食时间、术后下床时间、引流管放置时间、住院时间分别为(4.77±1.21)h、(19.85±4.74)h、(3.97±1.21)d、(6.78±2.07)d,均短于对照组[(6.85±1.41)h、(24.42±5.85)h、(4.58±1.44)d、(8.25±2.12)d],差异均有统计学意义(P＜0.05).术后 1、2、3、4、5 d 的VAS评分分别为(3.01±0.59)、(2.35±0.43)、(2.26±0.41)、(1.87±0.36)、(1.65±0.32)分,均低于对照组[(4.15±0.74)、(3.54±0.55)、(2.98±0.49)、(2.49±0.42)、(2.07±0.34)分],差异均有统计学意义(P＜0.05).术后24、72 h,两组皮质醇、PGE2、CRP、IL-6水平均较术前升高,但观察组术后24 h的皮质醇、PGE2、CRP、IL-6 水平分别为(87.25±18.56)ng/mL、(161.25±25.71)pg/mL、(19.78±4.02)mg/L、(40.17±5.23)pg/mL,术后 72 h的皮质醇、PGE2、CRP、IL-6 水平分别为(66.52±10.49)ng/mL、(121.28±18.53)pg/mL、(9.08±2.04)mg/L、(18.23±3.76)pg/mL,均低于对照组,差异均有统计学意义(P＜0.05).观察组与对照组的肺部并发症发生率(5.00％vs.15.00％)、非肺部并发症发生率(2.5％vs.10.00％)比较,差异均无统计学意义(P＞0.05).观察组累计并发症发生率为7.50％,低于对照组(25.00％),差异有统计学意义(P＜0.05).结论 ERAS方案用于单操作孔全胸腔镜肺叶切除术可减轻机体应激反应程度,降低并发症的发生,促进术后康复.
Abstract
Objective To observe the effect of enhanced recovery after surgery(ERAS)programme on rehabilitation after total thoraco-scopic lobectomy with a single operating hole.Methods Eighty patients who underwent single operating hole total thoracoscopic lobectomy in Qin-huangdao First Hospital from March 2021 to November 2023 were prospectively selected,and were divided into two groups of 40 cases by the sim-ple randomisation method.The control group was given conventional programme intervention,and the observation group was given ERAS pro-gramme intervention.The two groups were compared in terms of general surgical conditions,complications,and changes in organismal stress re-sponse indexes[cortisol,prostaglandin 2(PGE2),C-reactive protein(CRP),and interleukin-6(IL-6)]before and after surgery.Results There was no statistically significant difference in the operation time and the number of lymph node dissection between the two groups(P＞0.05);the postoperative feeding time,postoperative ambulation time,drainage tube placement time and hospitalization time in the observation group were(4.77±1.21)h,(19.85±4.74)h,(3.97±1.21)d and(6.78±2.07)d,respectively,which were shorter than those in the control group[(6.85±1.41)h,(24.42±5.85)h,(4.58±1.44)d and(8.25±2.12)d],and the differences were statistically significant(P＜0.05).The VAS scores at 1,2,3,4 and 5 days after operation were(3.01±0.59),(2.35±0.43),(2.26±0.41),(1.87±0.36)and(1.65±0.32)points,respectively,which were lower than those in the control group[(4.15±0.74),(3.54±0.55),(2.98±0.49),(2.49±0.42)and(2.07±0.34)points],and the differences were statistically significant(P＜0.05).At 24 and 72 h after operation,the levels of cortisol,PGE2,CRP and IL-6 in the two groups were higher than those before operation,but the levels of cortisol,PGE2,CRP and IL-6 in the observation group were(87.25±18.56)ng/mL,(161.25±25.71)pg/mL,(19.78±4.02)mg/L and(40.17±5.23)pg/mL,respectively.The levels of cortisol,PGE2,CRP and IL-6 at 72 h after operation were(66.52±10.49)ng/mL,(121.28±18.53)pg/mL,(9.08±2.04)mg/L and(18.23±3.76)pg/mL,respectively,which were lower than those in the control group,and the differences were statis-tically significant(P＜0.05).There were no statistically significant differences in the incidence of pulmonary complications(5.00％vs.15.00％)and non-pulmonary complications(2.5％vs.10.00％)between the observation group and the control group(P＞0.05).The cumulative complication rate in the observation group was 7.50％,which was lower than that in the control group(25.00％),and the difference was statisti-cally significant(P＜0.05).Conclusion The ERAS protocol for single operating total thoracoscopic lobectomy reduces the degree of stress,de-creases the incidence of complications,and promotes postoperative recovery.
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