加速康复外科理念在慢性鼻-鼻窦炎伴鼻息肉手术治疗中的应用

doi:10.6040/j.issn.1673-3770.1.2018.012

摘要/Abstract

摘要： 目的探讨加速康复外科(ERAS)在慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)手术患者围手术期的应用效果。方法选取CRSwNP患者136例,随机分为ERAS组70例,对照组66例,两组均接受鼻内镜下鼻息肉切除加鼻窦开放手术,ERAS组患者行术前宣教、围手术期气道评估干预、缩短禁食时间、术中控制性低血压、按时镇痛等一系列优化措施;对照组行传统的围术期处理。比较两组术前肺功能异常可耐受手术率、术后疼痛评分、术后24 h鼻腔出血量、术后住院时间、总住院时间。结果 ERAS组、对照组术前肺功能异常患者可耐受手术率分别为93.3%、75.0%,两组比较差异无统计学意义(χ2=1.924, P=0.165); ERAS组患者术后鼻部疼痛、鼻塞、头痛、眼部胀痛、流泪、耳闷和睡眠困难的VAS评分均低于对照组(P均<0.001); ERAS组术后24 h内出血量为5.7(3.0,10.3)mL,对照组为7.2(5.0,13.2)mL,两组比较差异无统计学意义(U=-0.913, P=0.361)。平均住院日ERAS组、对照组分别为(4.6±0.8)、(7.5±1.1)d,两组比较差异有统计学意义(t=17.79, P<0.001);术后住院日ERAS组与对照组分别为(2.1±0.5)、(3.8±0.3)d,两组比较差异有统计学意义(t=23.94, P<0.001)。结论将ERAS理念贯穿于CRSwNP患者围手术期将有效减轻患者心理和生理的创伤应激反应,缩短住院时间。

关键词: 鼻窦炎, 鼻息肉, 功能性鼻内镜手术, 加速康复外科

Abstract: Objective To explore the perioperative application value of enhanced recovery after surgery(ERAS)in patients with chronic rhinosinusitis with nasal polyps(CRSwNP). Methods A total of 136 patients with CRSwNP were randomly divided into the ERAS group(n=70)and control group(n=66). Both groups underwent endoscopic nasal polypectomy and open sinus surgery. Patients in the ERAS group underwent preoperative education and perioperative airway assessment intervention and a series of optimization measures such as shortening fasting time, intraoperative controlled hypotension, and on-time analgesia, whereas those in the control group were treated with traditional perioperative treatment. The preoperative dysfunction of lung function, postoperative pain score, amount of nasal bleeding after 24 h, postoperative hospital stay, and total hospital stay between the two groups were compared. Results The preoperative tolerance rates of patients with preoperative pulmonary dysfunction in the ERAS and control groups were 93.3% and 75.0%, respectively(χ2=1.924, P=0.165). The VAS scores of nasal congestion, headache, eye pain, tearing, ear nausea, and sleep difficulties in the ERAS group were lower than those in the control group(P<0.001). The ERAS group had a blood loss of 5.7(3.0, 10.3)mL within 24 h postoperatively, whereas the control group had a blood loss of 7.2(5.0, 13.2)mL; there was no statistically significant difference in blood loss between the two groups (U=-0.913, P=0.361). The average hospitalization days in the ERAS and control groups were 4.6±0.8 and 7.5±1.1, respectively, with statistically significant difference(t=17.79, P<0.001). The postoperative hospitalization day of the ERAS and control groups were 2.1±0.5 and 3.8±0.3, respectively, with statistically significant difference(t=23.94, P<0.001). Conclusion The use of ERAS throughout the perioperative period in patients with CRSwNP can effectively reduce the psychological and physiological trauma stress response and shorten the hospitalization time.

Key words: Enhanced recovery after surgery, Chronic rhinosinusitis with nasal polyps, Functional endoscopic sinus surgery

中图分类号:

R765.41

宋晓宇, 张宇, 李成林, 宋西成. 加速康复外科理念在慢性鼻-鼻窦炎伴鼻息肉手术治疗中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 9-12.

SONG Xiaoyu, ZHANG Yu, LI Chenglin, SONG Xicheng. Enhanced recovery after surgery for the treatment of chronic rhinosinusitis with nasal polyps[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(5): 9-12.

参考文献 20

[1]	Cotton P. Fast-track improves CABG outcomes[J]. JAMA, 1993, 270(17):2023.
[2]	Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78(5):606-617.
[3]	Kehlet H. Enhanced Recovery After Surgery(ERAS): good for now, but what about the future[J]. Can J Anaesth, 2015, 62(2):99.
[4]	陈俊强,刘金禄,王震,等.胃外科开展加速康复外科有关问题思考[J].消化肿瘤杂志(电子版),2016,8(4):226-229.
[5]	余继海,荚卫东,马金良,等.加速康复外科治疗手术切除肝癌患者的价值探讨[J].实用肝脏病杂志,2010,13(5):357-358. YU Jihai, JIA Weidong, MA Jinliang, et al. Study of fast track surgery in primary liver cancer pafienU undergoing lobular resection[J]. J Clin Hepatol, 2010, 13(5):357-358.
[6]	Grass F, Pache B, Martin D, et al. Feasibility of early postoperative mobilisation after colorectal surgery: a retrospective cohort study[J]. Int J Surg, 2018, 56:161-166. DOI: 10.1016/j.ijsu.2018.06.024.
[7]	李中信.结直肠手术围手术期加速康复外科治疗的细化[J].中华结直肠疾病电子杂志, 2013,2(4):158-161. LI Zhongxin.The refinement offast-track pathways in colorectal surgery[J]. Chin J Colorect Dis(Electronic Ed), 2013, 2(4):158-161.
[8]	Bertani A, Ferrari P, Terzo D, et al. A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video-assisted thoracoscopic surgery lobectomy[J]. J Thorac Dis, 2018, 10(S4):S499-S511.
[9]	中华医学会呼吸病学分会肺功能专业组.肺功能检查指南(第二部分)——肺量计检查[J].中华结核和呼吸杂志,2014,37(7):481-486.
[10]	陈晓栋,石照辉,李晓媛,等.经鼻内镜鼻窦手术后鼻腔填塞或不填塞膨胀海绵的比较研究[J].中华耳鼻咽喉头颈外科杂志,2015,50(10):854-857. CHEN Xiaodong, SHI Zhaohui, LI Xiaoyuan, et al. Comparative study on packing with or without Merocel after endoscopic sinus surgery[J]. Chin J Otorhinolaryngol Head Neck Surg, 2015, 50(10):854-857.
[11]	Håkansson K, Bachert C, Konge L, et al. Airway Inflammation in Chronic Rhinosinusitis with Nasal Polyps and Asthma: The United Airways Concept Further Supported[J]. PLoS One, 2015, 10(7):e0127228.
[12]	Zhang L, Zhang L, Zhang C H, et al. The Lung Function Impairment in Non-Atopic Patients With Chronic Rhinosinusitis and Its Correlation Analysis[J]. Clin Exp Otorhinolaryngol, 2016, 9(4):339-345.
[13]	Kariya S, Okano M, Higaki T, et al. Chronic rhinosinusitis patients have decreased lung function[J]. Int Forum Allergy Rhinol, 2015, 4(10):828-833.
[14]	Barham H P, Osborn J L, Snidvongs K, et al. Remodeling changes of the upper airway with chronic rhinosinusitis[J]. Int Forum Allergy Rhinol, 2015, 5(7):565-572.
[15]	Shaw CL, Dymock RB, Cowin A, et al. Effect of packing on nasal mucosa of sheep[J]. J Laryngol Otol, 2000, 114(7):506.
[16]	Weber R, Keerl R, Hochapfel F, et al. Packing in endonasal surgery[J]. Am J Otolaryngol, 2001, 22(5):306-320.
[17]	江一鸣,张淳,周佳青,等.普米克令舒鼻雾化吸入在功能性鼻窦内镜手术围术期的疗效分析[J]. 临床耳鼻咽喉头颈外科杂志, 2007, 21(20):939-941. JIANG Yiming, ZHANG Chun, ZHOU Jiaqing, et al. A clinical analysis of nebulized Pulmicore respules around FESS period[J]. J Clin Otorhinolaryngol Head Neck Surg, 2007, 21(20):939-941.
[18]	Vaughan WC, Carvalho G. Use of nebulized antibiotics for acute infections in chronic sinusitis[J]. Otolaryngol Head Neck Surg, 2002, 127(6):558-568.
[19]	张宇,宋西成.加速康复外科理念在耳鼻咽喉头颈外科中的应用价值[J].中国耳鼻咽喉头颈外科, 2018,25(5):275-278. ZHANG Yu, SONG Xicheng. Application and prospect of enhanced recovery after surgery in otolaryngology[J]. Chin Arch Otolaryngol Head Neck Surg, 2018, 25(5):275-278.
[20]	陈枫虹,史剑波.鼻科医生为什么要关注慢性鼻-鼻窦炎患者的下呼吸道[J].临床耳鼻咽喉头颈外科杂志,2015(5):478-482. CHEN Fenghong, SHI Jianbo. Why should rhinologic doctor pay attention to the lower respiratory tract of chronic rhinosinusitis patients?[J]. J Clin Otorhinolaryngol Head Neck Surg(China), 2015(5):478-482.

相关文章 15

[1]	宋西成. 加速康复外科理念在头颈肿瘤手术的应用价值[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 1-4.
[2]	戚敏, 李红, 王倩, 涂翠芳, 杨钦泰, 徐惠清. 加速康复外科理念在功能性内镜鼻窦手术围手术期护理的初步应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 13-18.
[3]	刘大炜,张宇,李成林,陈秀梅,宋西成. 加速康复外科在儿童OSAS围手术期中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 19-22.
[4]	吴喜福, 孔维封, 王玮豪, 徐惠清, 戚敏, 杨钦泰. QoR-15在加速康复外科改善慢性鼻-鼻窦炎伴鼻息肉围手术期生活质量评估中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 5-8.
[5]	王丽,张宇,张华,刘雪艳,宋西成. 加速康复外科理念在鼻窦外科手术的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 23-26.
[6]	张汝祥,田昊,马有祥. 鼻内镜鼻窦手术前筛窦颅底高度的CT评估价值[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 75-77.
[7]	王驰,刘星,孔磊,洪兴和,宁博. 鼻内镜下等离子射频消融术对合并鼻窦炎的小儿腺样体肥大患者疗效及鼻腔黏膜纤毛清除功能的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 78-81.
[8]	沈勤峰,沈小燕,朱荣强,蒋斐斐,郎军添. 鼻内镜下中鼻甲功能性部分切除治疗慢性鼻窦炎76例分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(5): 82-85.
[9]	乔叔芬,杨飞轮,王臻妮,李学忠. YKL-40与慢性鼻-鼻窦炎组织重构的相关性探讨[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 95-99.
[10]	黄远,巴罗,李波,余文兴,杨芳丽,杜进涛. 慢性鼻窦炎鼻息肉中转录因子NKX2-1调控嗜酸性炎症反应的作用[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 17-23.
[11]	陈望兴,赵雪,刘岩,刘悦,金春顺. 鼻中隔偏曲及慢性鼻窦炎鼻息肉患者的精神心理状态调查[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 24-27.
[12]	黄凯丰. 糖皮质激素短疗程雾化吸入对嗜酸粒细胞性鼻窦炎伴鼻息肉患者鼻部症状及肾上腺皮质功能的影响[J]. 山东大学耳鼻喉眼学报, 2018, 32(4): 28-31.
[13]	陈鸣,俞雪飞. 浅谈伴有变应性鼻炎的慢性鼻窦炎的治疗[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 18-22.
[14]	娄鸿飞,王成硕. 慢性鼻窦炎分型研究进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 10-13.
[15]	李华斌, 赖玉婷. 慢性鼻-鼻窦炎的发病机制及诊疗进展[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 4-9.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed