摘要
目的:探讨加速康复外科(ERAS)策略在腹腔镜全子宫切除术患者中的应用效果及对细胞及体液免疫功能的影响。方法:选择在医院行腹腔镜全子宫切除术的189例患者,根据手术预后方法的不同,将其中采用ERAS策略的102例患者纳入观察组,采用传统临床路径的87例患者纳入对照组。比较两组手术及康复情况、术后并发症发生率、术后不同时间点疼痛视觉模拟评分(VAS)、术前1 d及术后第1 d和第3 d的T淋巴细胞及亚群CD3+、CD4+以及CD4+/CD8+、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)水平,以及出院时患者满意度。结果:观察组患者的首次排气时间、排便时间、下地活动时间、留置尿管时间和住院时长均较对照组短,且住院费用较对照组少,其差异有统计学意义(t=0.862,t=1.923,t=2.773,t=0.429,t=1.736,t=5.539;P<0.05);观察组术后并发症发生率低于对照组,其差异有统计学意义(x2=4.648,P<0.05);观察组术后6 h、24 h和48 h的VAS评分均明显低于对照组,其差异有统计学意义(t=1.753,t=2.697,t=1.860;P<0.05)。术后第1 d两组CD3+T细胞、CD4+T细胞以及CD4+/CD8+、IgA、IgM水平均较术前降低,且对照组降低更为显著,术后第3 d两组各指标均有回升;两组间IgG在各时间点均无明显差异。观察组患者出院时的满意度高于对照组,其差异有统计学意义(x2=2.726,P<0.05)。结论:ERAS策略对腹腔镜全子宫切除术患者的康复有促进作用,有助于缩短住院时间,减少并发症发生率及术后疼痛,保护免疫功能,提高患者满意度。
Objective:To explore the application effect of enhanced recovery after surgery(ERAS)in panhysterectomy with laparoscope and its effect on the functions of cellular and humoral immunity.Methods:A total of 189 patients who underwent panhysterectomy with laparoscope in hospital were selected as the study subjects.According to the different prognosis methods of surgery,102 patients who adopted ERAS strategy were included in observation group and 87 patients who adopted traditional clinical pathway were included in control group.And the situation of operation and rehabilitation,the incidence of complication post operation,visual analogue scale(VAS)of different point-in-time post operation,T lymphocyte and subpopulation CD3+,CD4+and CD4+/CD8+,IgA,IgG and IgM levels at 1d pre-operation and at the 1st d and the 3rd d post-operation,and the satisfaction of patients at hospital discharge between the two groups were compared.Results:The evacuation time at the first time,defecation time,activity time,the time of indwelling catheter and length of hospitalization of observation group were significantly shorter than those of control group,and the cost of hospitalization of observation group was significantly less than that of control group(t=0.862,t=1.923,t=2.773,t=0.429,t=1.736,t=5.539,P<0.05).And the incidence of postoperative complications of observation group was significantly lower than that of control group(x2=4.648,P<0.05).And the VAS scores at 6th,24th and 48th hours post operation of observation group were significantly lower than those of control group(t=1.753,t=2.697,t=1.860,P<0.05).The CD3+T cells,CD4+T cells,CD4+/CD8+,IgA and IgM at the 1st day post operation of two groups were lower than those pre operation,and the decrease of control group was more significant.Each index of two groups increased at the 3rd day post operation.But the levels of IgG between two groups were not significant at each point-in-time.Besides,the satisfaction of patients of observation group was significantly higher than that of control group(x2=2.726,P<0.05).Conclusion:ERAS strategy can promote the rehabilitation of patients who undergoes panhysterectomy with laparoscope,and it can contribute to shorten the length of hospital stay,and can reduce the incidence of complications and postoperative pain,and can protect immune function,and can improve satisfaction of patients.
作者
黄萍
曾健
田芸
邵琳
范雪
王滨
HUANG Ping;ZENG Jian;TIAN Yun(Department of Obstetrics and Gynecology,The 983th Hospital of the PLA Joint Service Support Force,Tianjin 300142,China)
出处
《中国医学装备》
2019年第12期42-46,共5页
China Medical Equipment
作者简介
黄萍,女,(1965-),本科学历,副主任护师。从事妇产科护理管理工作;通信作者:王滨,272865046@qq.com。
