加速康复外科理念在游离皮瓣修复口腔癌患者中的应用

目的 探讨加速康复外科理念在游离皮瓣修复口腔癌患者中的有效性及安全性。 方法 选取蚌埠医学院第一附属医院口腔颌面外科加速康复外科(enhanced recovery after surgery,ERAS)方案实施前(2018年8月—2019年3月)接受满意度调查的32例口腔癌患者作为对照组,ERAS方案实施后(2019年4月—2020年1月)32例口腔癌患者作为ERAS组,对照组给予常规护理,ERAS组实施ERAS护理干预方案,术前干预包括多元化健康宣教、营养筛查、适应性训练、缩短禁食水时间,术后康复促进包括多模式预镇痛、早期进食、早期活动、尽早拔除尿管、气道管理、吞咽训练等。 结果 术后6、24、48、72 h的疼痛评分采用重复测量方差分析,时间效应和组别效应的差异有统计学意义(均P<0.01),时间和组别无交互作用(F=1.157,P>0.05),组间各时间点疼痛评分比较差异均有统计学意义(均P<0.01);ERAS组术后住院时间为(16.72±2.13)d,对照组为(13.75±2.50)d,平均缩短3 d,差异有统计学意义(t=5.113,P<0.01);胃管留置时间平均减少2 d,总体并发症的发生率明显降低,肺部感染、胃肠道反应、压疮的发生率比较差异有统计学意义(均P<0.05),皮瓣危象发生率差异无统计学意义(P>0.05);ERAS组患者满意度明显提高,差异有统计学意义(P<0.05)。 结论 口腔癌患者围手术期ERAS护理方案能减轻术后疼痛,降低并发症发生率、缩短住院时间,提高患者满意度,在临床中的应用是安全、有效的。 

Application of the concept of enhanced recovery after surgery in free flap repair of oral cancer patients

Objective To evaluate efficacy and safety of enhanced recovery after surgery in free flap repair of oral cancer patients. Methods In the Department of Oral and Maxillofacial Surgery of our hospital, 32 patients who received satisfaction survey before the implementation of ERAS scheme(from August 2018 to March 2019) were selected as the control group, and 32 patients after the implementation of ERAS scheme(from April 2019 to January 2020) were selected as the ERAS group. The control group was used conventional nursing care, and ERAS group was used perioperative nursing scheme for patients under enhanced recovery after surgery. The preoperative interventions include diversified health mission, nutritional screening, fitness training, and shortening the time of water fasting. Postoperative rehabilitation promotion includes multi-mode pre-analgesia, early feeding, early activity, early removal of urinary catheter, airway management, swallowing training, etc. Results The repeated measures ANOVA was used for the pain scores at 6, 24, 48 and 72 h after surgery. The difference between the time effect and the group effect was statistically significant(all P<0.01), and there was no interaction between the time effect and the group effect(F=1.157, P>0.05). The score of pain in the postoperative 6, 12, 48 and 72 h were compared between the two groups, there were statistically significant(all P<0.05). In ERAS group, the postoperative hospital stay was(16.72±2.13) days, the control group was(13.75±2.50) days, the average time was shortened by 3 days, the difference had statistical significance(t=5.113, P<0.01). The gastric tube indwelling time reduced by 2 days on average. The overall incidences of complications were significantly reduced, and the incidences of pulmonary infection, gastrointestinal reaction and pressure ulcer were statistically significant(all P<0.05). The incidence of skin flap crisis had no statistically significant difference(P>0.05). The satisfaction rate of patients in ERAS group was significantly improved, and the difference was statistically significant(P<0.05). Conclusion The perioperative ERAS nursing scheme for patients with oral cancer can reduce postoperative pain, reduce the incidence of complications, shorten the length of stay, and improve patient satisfaction. It is safe and effective in clinical application.