ERAS在肺移植患者围手术期管理中的应用

IF 1.4 Q3 SURGERY
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引用次数: 0

摘要

方法 回顾性收集27例肺移植患者围手术期接受ERAS治疗的临床资料,12例肺移植患者接受常规治疗作为对照组。收集的一般资料包括ERAS的具体实施方案、围手术期(30 d)并发症发生率和存活率、术后住院指标、术后住院时间和数字评分量表(NRS)评分。结果比较术后住院指标,ERAS组与对照组相比,在术后ICU住院时间(2.0(2.0,4.0) vs 4.5(3.0,6.0),P = 0.005)、术后住院时间(18(15,26) vs 24(19.5,32.75),p = 0.016)、鼻胃管持续时间(3(2,3) vs 4(2.25,4.75),p = 0.023)和首次下床活动时间(4(3,5) vs 5.8(4.5,7.5),p = 0.004)有显著差异。ERAS组与对照组在术后有创机械通气时间、术后进食时间、导尿时间和胸管插管时间上无明显差异(p>0.05)。ERAS组围手术期存活率为81.5%,高于对照组(66.7%),但差异无统计学意义。拔管后NRS评分比较,ERAS组在12 h(5.30±0.14 vs 6.25±0.75)、24 h(3.44±0.64 vs 5.58±0.9)、48 h(2.74±0.66 vs 4.08±0.79)和72 h(1.11±0.80 vs 2.33±0.49)的NRS评分均低于对照组,差异有统计学意义(P<0.01)。组内比较,拔管后12 h与拔管后24 h、48 h、72 h比较,NRS评分呈逐渐下降趋势,差异有统计学意义(P<0.01)。在围手术期并发症的比较中,ERAS组的术后感染发生率低于对照组,差异有统计学意义(44.4% vs 83.3%,P = 0.037)。ERAS组的术后谵妄发生率低于对照组,差异有统计学意义(11.1% vs 50%,P = 0.014)。结论 ERAS可用于肺移植患者,缓解术后疼痛,缩短术后插管时间,缩短术后住院时间。围手术期肺康复锻炼有利于减少术后肺部并发症的发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The application of ERAS in the perioperative period management of patients for lung transplantation

Objective

To explore the application of enhanced recovery after surgery (ERAS) in the perioperative period of lung transplantation.

Methods

We retrospectively collected the clinical data of 27 lung transplant patients who underwent ERAS during the perioperative period, while 12 lung transplant patients receiving routine treatment served as controls. General information was collected, including the specific implementation plan of ERAS, the incidence of complications and survival rate during the perioperative period (<30 d), postoperative hospitalization indicators, the postoperative length of stay, and numerical rating scale (NRS) scores.

Results

Comparison of postoperative hospitalization indicators, the ERAS group compared with the control group, there were significant differences in postoperative ICU stay time (2.0(2.0,4.0) vs 4.5(3.0,6.0), p = 0.005), postoperative hospital stay time (18(15,26) vs 24(19.5,32.75), p = 0.016), duration of nasogastric tube (3(2,3) vs 4(2.25,4.75), p = 0.023), and first ambulation time (4(3,5) vs 5.8(4.5,7.5), p = 0.004). There was no significant difference in postoperative invasive mechanical ventilation time, time to eat after surgery, duration of urinary catheter and duration of chest tube between the ERAS group and the control group (p>0.05). The perioperative survival of the ERAS group was 81.5%, which was higher than the control group (66.7%), but there is no statistically significant difference. Comparison of post-extubation NRS scores, the ERAS group had lower NRS scores at 12 h (5.30 ± 0.14 vs 6.25 ± 0.75), 24 h (3.44 ± 0.64 vs 5.58 ± 0.9), 48 h (2.74 ± 0.66 vs 4.08 ± 0.79) and 72 h (1.11 ± 0.80 vs 2.33 ± 0.49) than the control group, the difference was statistically significant (p<0.01). Intra-group comparison, post-extubation 12 h comparison post-extubation 24 h, 48 h, 72 h, the NRS scores showed a gradual downward trend, the difference was statistically significant (p<0.01). In the comparison of perioperative complications, the ERAS group had a lower postoperative infection incidence than the control group, the difference was statistically significant (44.4% vs 83.3%, p = 0.037). The ERAS group had lower postoperative delirium incidence than the control group, the difference was statistically significant (11.1% vs 50%, p = 0.014). There was no significant difference in the incidence of acute rejection, primary graft loss (PGD), gastrointestinal (GI) complications and airway complications between two groups (p>0.05).

Conclusion

The ERAS can be applied to lung transplant patients to relieve postoperative pain, shorten postoperative tube time, and shorten postoperative stay. Perioperative pulmonary rehabilitation exercises are beneficial to reducing the occurrence of postoperative pulmonary complications.

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