加速康复外科理念指导腹腔镜全子宫切除术对绝经后妇女术后镇痛及胃肠功能恢复的影响

目的　探讨加速康复外科理念指导腹腔镜全子宫切除术对绝经后妇女术后镇痛及胃肠功能恢复的影响。方法　选择2016年1月1日至2020年12月31日南京医科大学附属淮安第一医院收治94例行腹腔镜全子宫切除术的绝经后妇女为研究对象，根据围术期干预方法不同分为对照组（46例）和试验组（48例）。对照组年龄（52.34±7.46）岁，试验组年龄（52.17±7.32）岁。两组均行腹腔镜全子宫切除术治疗，其中对照组接受传统围术期治疗，试验组接受加速康复外科理念的围术期治疗。比较两组患者相关康复指标、术后胃肠功能恢复情况、术后不同时刻视觉模拟评分法（VAS）评分及并发症发生情况。计量资料组间采用独立样本t检验，组内采用配对t检验，计数资料采用χ²检验。结果　两组患者术中出血量、手术时间比较，差异均无统计学意义（均P>0.05）；试验组术后住院时间为（4.38±0.62）d，低于对照组（6.97±1.04）d，差异有统计学意义（P<0.05）。试验组术后肛门首次排气时间、术后首次排便时间、术后首次进食时间分别为（21.61±4.28）h、（60.35±6.14）h、（1.34±0.36）d，均低于对照组（25.49±5.56）h、（64.28±7.32）h、（3.58±0.67）d，差异均有统计学意义（均P<0.05）。两组患者术后48 h的VAS评分均低于术后6 h，且试验组术后6 h、48 h的VAS评分分别为（3.21±0.46）分、（1.17±0.22）分，均低于对照组（5.56±0.74）分、（3.24±0.43）分，差异均有统计学意义（均P<0.05）。两组行腹腔镜全子宫切除术患者术后7 d并发症发生率比较，差异无统计学意义（P>0.05）。结论　加速康复外科理念指导腹腔镜全子宫切除术可促进绝经后妇女胃肠功能恢复，减轻术后疼痛，且安全可靠。

Influence of the concept of enhanced recovery after surgery to guide laparoscopic total hysterectomy on post-menopausal women's postoperative analgesia and gastrointestinal function recovery

Objective　To explore the influence of the concept of enhanced recovery after surgery (ERAS) to guide laparoscopic total hysterectomy on post-menopausal women's postoperative analgesia and gastrointestinal function recovery. Methods　From January 1, 2016 to December 31, 2020, a total of 94 post-menopausal women who underwent laparoscopic total hysterectomy were selected as the research subjects in Huai'an First Hospital Affiliated to Nanjing Medical University. According to different perioperative intervention methods, they were divided into a control group (46 cases) and an experimental group (48 cases). The control group was (52.34±7.46) years old, and the experimental group was (52.17±7.32) years old. Both groups of patients were treated with laparoscopic total hysterectomy. Among them, the patients in the control group received traditional perioperative treatment, and the patients in the experimental group received perioperative treatment with the concept of ERAS. Relevant rehabilitation indicators, postoperative gastrointestinal function recovery, Visual Analogue Scale (VAS) scores at different time points after surgery, and complications were compared between the two groups. Independent sample t test was used for comparison of the measurement data between groups, paired t test was used for comparison of the measurement data within groups, and χ² test was used for the count data. Results　There were no statistically significant differences in the intraoperative blood loss and operation time between the two groups (both P>0.05), and the postoperative hospital stay in the experimental group was shorter than that in the control group (4.38±0.62)d vs. (6.97±1.04)d] (P<0.05). In the experimental group, the first postoperative anal exhaust time, the first postoperative defecation time, and the first postoperative feeding time were (21.61±4.28) h, (60.35±6.14) h, and (1.34±0.36) d, respectively, which were shorter than those in the control group (25.49±5.56) h, (64.28±7.32) h, and (3.58±0.67) d], with statistically significant differences (all P<0.05). The VAS score 48 h after surgery was lower than that 6 h after surgery in both groups, and the VAS scores in the experimental group 6 h and 48 h after surgery were (3.21±0.46) points and (1.17±0.22) points, respectively, lower than those in the control group (5.56±0.74) points and (3.24±0.43) points], with statistically significant differences (all P<0.05). There was no statistically significant difference in the total complication rate between the two groups within 7 days after surgery (P>0.05). Conclusion　The concept of ERAS to guide laparoscopic total hysterectomy can promote the recovery of gastrointestinal function in postmenopausal women, reduce postoperative pain, and is safe and reliable.