加速康复外科方案在成人退行性脊柱侧弯围手术期的临床应用

Clinical Application of Enhanced Recovery after Surgical Protocol in the Perioperative Period of Adult Degenerative Scoliosis

摘要: 目的：探讨加速康复外科(enhanced recovery after surgery, ERAS)方案在成人退行性脊柱侧弯(adult degenerative scoliosis, ADS)矫形围手术期临床应用可行性及优势。方法：回顾性研究2017年8月~2019年11月在西安交通大学附属红会医院脊柱病院接受矫形手术的ADS患者68例，其中应用常规围手术期方案(对照组) 34例，围手术期采用ERAS方案(ERAS组) 34例。记录并比较两组患者术后Cobb角、术后疼痛视觉模拟评分(visual analogue scale, VAS)、术后进食时间、术后下床时间、术后输液时间、手术时间、出血量、输血率、术后住院日、术后并发症发生率、患者满意度。结果：两组患者术前Cobb角、术前VAS评分、骨质疏松症(osteoporosis, OP)、美国麻醉医师协会(ASA)分级、固定节段数、手术时间、出血量和术后Cobb角比较，差异均无统计学意义(P > 0.05)。但较对照组，ERAS组病人术后VAS评分更低(P < 0.01)，术后下床时间、术后进食时间、术后住院日和术后输液时间均显著减少(P < 0.01)，ERAS组患者输血率明显低于对照组(17.65% vs. 44.12%, χ² = 5.581, P = 0.018)，术后并发症发生率显著低于对照组(5.88% vs. 26.47%, χ² = 5.314, P = 0.021)，患者满意度显著高于对照组(94.12% vs. 76.47%, χ² = −2.198, P = 0.028)。结论：ERAS方案可显著改善ADS患者围手术期状况，提高患者早期康复锻炼效率，减轻患者术后疼痛，降低术后并发症发生率，提高患者满意度，促进患者术后康复。

Abstract: Objective: To explore the feasibility and advantages of an accelerated rehabilitation surgical pro-gram for the perioperative clinical application of adult degenerative scoliosis orthopedics. Methods: Retrospective analysis of 68 patients with ADS who underwent orthopedic surgery at the Depart-ment of Spine Surgery of the Xi’an Jiaotong University Affiliated Honghui Hospital from August 2017 to September 2019, including 34 patients who applied the conventional perioperative protocol (control group) and 34 patients who applied the ERAS protocol during the perioperative period (ERAS group). The postoperative Cobb angle, postoperative visual analogue scale, postoperative feeding time, postoperative bedtime, postoperative infusion time, operative time, bleeding volume, blood transfusion rate, postoperative hospital days, postoperative complication rate, and patient satisfaction were recorded and compared between the two groups. Results: There was no statistical difference in the preoperative Cobb angle, preoperative VAS score, osteoporosis rate (OP), number of fixed segments, operative time, bleeding and postoperative Cobb angle between the two groups (P > 0.05). However, compared with the control group, patients in the ERAS group had lower post-operative VAS scores (P < 0.01), significantly lower postoperative bedtime, postoperative feeding time, postoperative hospital days and postoperative fluid infusion time (P < 0.01), significantly lower transfusion rate in patients in the ERAS group than in the control group (17.65% vs. 44.12%, χ² = 5.581, P = 0.018), and significantly lower postoperative complication incidence was significant-ly lower than that of the control group (5.88% vs. 26.47%, χ² = 5.314, P = 0.021), and patient satis-faction was significantly higher than that of the control group (94.12% vs. 76.47%, χ² = −2.198, P = 0.028).Conclusion: The ERAS program can significantly improve the perioperative condition of ADS patients, increase the efficiency of early rehabilitation exercises for patients, reduce postoperative pain, decrease the occurrence of postoperative complications, improve patient satisfaction, and promote postoperative rehabilitation of patients.