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Enhanced Recovery after Surgery Program in the Perioperation of Adolescent Idiopathic Scoliosis and Its Effect Evaluation
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摘要:
目的 总结青少年特发性脊柱侧凸术后快速康复(enhanced recovery after surgery, ERAS)综合措施, 评价其对术后康复的影响。 方法 2007年1月至2017年1月在北京协和医院骨科住院接受外科矫形治疗的青少年特发性脊柱侧凸患者连续队列中最初100例(第1~100例, 传统组)和最后100例(第1193~1292例, ERAS组)患者入选本研究。ERAS组围手术期采用包括术前、术中及术后的快速康复诊疗方案, 回顾性比较两组术后康复情况, 包括总住院日、术后住院日、异体输血量、出院时疼痛评分、30 d内并发症发生率及1年内非计划再手术发生率。 结果 两组患者一般临床资料及1年内非计划再手术率无统计学差异, 传统组患者的总住院日及术后住院日均显著长于ERAS组[总住院日:传统组(17.18±2.67)d, ERAS组(11.35±1.49)d, P < 0.05;术后住院日:传统组(9.34±0.52)d, ERAS组(7.19±0.71)d, P < 0.05];传统组异体输血人数及异体红细胞输血量均多于ERAS组[异体输血人数:传统组41%(41/100), ERAS组20%(20/100), P < 0.05;异体红细胞输血量:传统组(1.43±0.39)U, ERAS组(0.59±0.12)U, P < 0.05];传统组出院时疼痛评分[(3.40±0.63)分]略高于ERAS组[(3.00±0.47)分], 但差异无统计学意义。 结论 青少年特发性脊柱侧凸围手术期实施加速康复诊疗方案, 可在不增加患者并发症和非计划再手术发生率的情况下, 减少住院时间及输血量, 加快患者康复。 -
关键词:
- 术后快速康复 /
- 青少年特发性脊柱侧凸 /
- 住院日 /
- 输血量
Abstract:Objective The aim of this study was to summarize the integrated program of enhanced recovery after surgery (ERAS) in the perioperation of adolescent idiopathic scoliosis (AIS) and to evaluate its impact on the recovery. Methods Among the continuous cohort of AIS patients who underwent the orthopedic surgery in Peking Union Medical College Hospital from January 2007 to January 2017, the initial 100(Cases 1-100, traditional group) and the last 100 cases (Cases 1193-1292, ERAS group) were enrolled in this study. The preoperative, intraoperative, and postoperative enhanced recovery managements were performed in the ERAS group. The related recovery indicators were compared between the two groups, including the length of stay, the postoperative length of stay, allogeneic blood transfusion, pain scores at the discharge, the incidence of complications within 30 days, and the incidence of unplanned reoperation within 1 year. Results There was no statistical difference in gender, age, body mass index, surgical segment, and the incidence of unplanned reoperation within 1 year between the two groups. The length of stay and the postoperative length of stay in the traditional group were significantly longer than those in the ERAS group[Length of stay:traditional group (17.18±2.67)days, ERAS group (11.35±1.49)days, P < 0.05; Postoperative length of stay:traditional group (9.34±0.52)days, ERAS group (7.19±0.71)days, P < 0.05]. The percentage and volume of allogeneic blood transfusion in the traditional group were both higher than those in the ERAS group[Percentage:traditional group 41%(41/100), ERAS group 20%(20/100), P < 0.05; Volume:traditional group (1.43±0.39)U, ERAS group (0.59±0.12)U, P < 0.05]. The pain scores at the discharge of the traditional group[(3.40±0.63) points] was slightly higher than that of the ERAS group[(3.00±0.47) points] without the statistical significance. Conclusion Proposal formulation of ERAS program for the surgical treatment of AIS might reduce hospital stay and blood transfusion, and accelerate recovery without increasing complications and reoperation. 利益冲突 无 -
表 1 青少年特发性脊柱侧凸患者传统组和ERAS组一般临床资料
组别 女性(%) 年龄(x±s，岁) BMI(x±s，kg/m2) 手术节段(x±s，个) 传统组(n=100) 88 14.5±2.1 18.13±4.31 10.69±3.20 ERAS组(n=100) 87 14.1±3.1 19.15±3.49 10.28±2.84 P值 0.14 0.83 0.11 0.51 ERAS:加速康复外科; BMI:体质量指数 
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表 2 青少年特发性脊柱侧凸患者传统组和ERAS组临床结局比较
组别 总住院日(x±s，d) 术后住院日(x±s，d) 术后输血人数(n) 输血量(x±s，U) 30 d内并发症发生率(%) 非计划再手术发生率(%) 出院时疼痛评分(x±s，分) 出院满意度(x±s，分) 传统组(n=100) 17.18±2.67 9.34±0.52 41 1.43±0.39 6 3 3.40±0.63 95.14±6.87 ERAS组(n=100) 11.35±1.49 7.19±0.71 20 0.59±0.12 9 2 3.00±0.47 94.86±7.92 P值 0.00 0.00 0.001 0.0008 0.42 0.65 0.69 0.27 ERAS:同表 1
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