多学科合作快速康复外科理念在腹腔镜腹股沟疝修补术围手术期的应用

目的:探讨以多学科团队(MDT)合作为基础的快速康复外科(ERAS)在腹腔镜腹股沟疝修补术围手术期应用的可行性及有效性。方法:将782例行择期腹腔镜腹股沟疝修补术的患者按入院顺序随机分为ERAS组(392例)和对照组(390例)。对照组接受常规治疗护理;ERAS组接受MDT合作ERAS理念的治疗护理,主要干预措施包括住院模式选择,医护一体化健康教育,饮食要求,胃肠道准备,尿潴留预防,术后早期活动,伤口疼痛预防,麻醉前给药,防止术中低温,围手术期补液管理,术后恶心、呕吐预防及1个月患者舒适度评价等。比较两组患者术后疼痛、恢复情况、并发症与应激反应发生率、术后舒适度等。结果:与对照组比较,ERAS组术后次日清晨NRS疼痛评分降低,恢复正常饮食时间、下床活动时间、住院时间均减少,术后满意率增加,血清肿、尿潴留、伤口感染等并发症与不适感、恶心反应的发生率降低,术后1个月中位腹股沟疼痛调查表评分降低(均P0.05)。结论:在腹腔镜腹股沟疝修补术患者围手术期中采用MDT合作ERAS理念可以减轻患者不适,加速康复,缩短住院时间,提高患者满意度及舒适度。

Application of multidisciplinary enhanced recovery after surgery in perioperative period of laparoscopic inguinal hernia repair

Objective: To evaluate the feasibility and effectiveness of using enhanced recovery after surgery (ERAS) protocols based on multidisciplinary team (MDT) cooperation in perioperative period of laparoscopic inguinal hernia repair. Methods: A total of 782 patients scheduled to undergo laparoscopic inguinal hernia repair were randomly assigned to ERAS group (392 cases) and control group (390 cases) according to hospital admission orders. Patients in control group underwent conventional treatment and nursing, while those in ERAS group received treatment and nursing under the concept of MDT-based ERAS, where the main interventions included the selection of hospitalization mode, health education based on integrative medicine and nursing, dietary requirements, bowel preparation, urinary retention prevention, early postoperative ambulation, wound pain treatment, preanesthetic medication, avoidance of perioperative hypothermia, perioperative fluid management, prophylaxis of postoperative nausea and vomiting, and patient comfort assessment at one month after surgery. The scenarios such as postoperative pain, patient recovery, incidence of complications and stress responses, and degree of comfort were compared between the two groups. Results: In the ERAS group compared with control group, the NRS pain score on the morning of postoperative day 1 was decreased, the time to normal diet and ambulation as well as length of hospital stay was shortened, the postoperative satisfaction rate was increased, the incidence of complications such as seroma, urinary retention and wound infection and incidence of discomfort and nausea reaction were reduced, and median score from inguinal pain questionnaire at one month after surgery was decreased (all P<0.05). Conclusion: In perioperative period of laparoscopic inguinal hernia repair, using MDT-based ERAS protocols can alleviate patient discomfort, accelerate rehabilitation, shorten hospital stay, and increase patient satisfaction and comfort.