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

Abstract

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

CLC Number:

R765.41

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.

References 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.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Comments

Recommended 7

[1]	WANG Li, ZHANG Yu, ZHANG Hua, LIU Xueyan, SONG Xicheng. Enhanced recovery after surgery in sinus surgery[J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 23 -26 .
[2]	LIAO Libing, LIU Qiming, ZONG Ling, ZHAI Jinming, ZHANG Jianguo. Characteristics of 42 patients with tinnitus and hyperacusis[J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 31 -36 .
[3]	ZHOU Dingkun, CAI Yu,TIAN Yanhua, TENG Bo, FENG Qingjie. A case report of Grisel syndrome following adenoidectomy in Crouzon children[J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 119 -120 .
[4]	SONG Xicheng. Application value of enhanced recovery after surgery in head and neck cancer surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(5): 1 -4 .
[5]	QI Min, LI Hong, WANG Qian, TU Cuifang, YANG Qintai, XU Huiqing. Preliminary application of enhanced recovery after surgery in the perioperative nursing in functional endoscopic sinus surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(5): 13 -18 .
[6]	LIU Dawei, ZHANG Yu, LI Chenglin, CHEN Xiumei, SONG Xicheng. Use of enhanced recovery after surgery in children with obstructive sleep apnea syndrome during the perioperative period[J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 19 -22 .
[7]	WU Xifu, KONG Weifeng, WANG Weihao, XU Huiqing, QI Min, YANG Qintai. Perioperative quality of life in patients with chronic rhinosinusitis with nasal polyps under enhanced recovery after surgery using QoR-15[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(5): 5 -8 .

Enhanced recovery after surgery for the treatment of chronic rhinosinusitis with nasal polyps

PDF (PC)

Abstract

Cite this article

share this article

References 20

Related Articles 8

Metrics

Comments

Recommended 7

[1]	WANG Li, ZHANG Yu, ZHANG Hua, LIU Xueyan, SONG Xicheng. Enhanced recovery after surgery in sinus surgery [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 23-26.
[2]	SHEN Qinfeng, SHEN Xiaoyan, ZHU Rongqiang, JIANG Feifei, LANG Juntian. Role of functional middle turbinectomy in functional endoscopic sinus surgery for chronic sinusitis [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 82-85.
[3]	SONG Xicheng. Application value of enhanced recovery after surgery in head and neck cancer surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(5): 1-4.
[4]	QI Min, LI Hong, WANG Qian, TU Cuifang, YANG Qintai, XU Huiqing. Preliminary application of enhanced recovery after surgery in the perioperative nursing in functional endoscopic sinus surgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(5): 13-18.
[5]	LIU Dawei, ZHANG Yu, LI Chenglin, CHEN Xiumei, SONG Xicheng. Use of enhanced recovery after surgery in children with obstructive sleep apnea syndrome during the perioperative period [J]. J Otolaryngol Ophthalmol Shandong Univ, 2018, 32(5): 19-22.
[6]	WU Xifu, KONG Weifeng, WANG Weihao, XU Huiqing, QI Min, YANG Qintai. Perioperative quality of life in patients with chronic rhinosinusitis with nasal polyps under enhanced recovery after surgery using QoR-15 [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(5): 5-8.
[7]	PANG Yufeng, GONG Jingrong, ZOU Yang, HUANG Juan. Application of modified naso-pharyngeal tube in postoperative packing of FESS. [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2016, 30(1): 47-50.
[8]	ZHANG Wei-shi, GAO Gang, QIAN Mao-hua, JI Chao. Budesonide used after functional endoscopic sinus surgery [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2014, 28(4): 43-45.