加速康复外科方案依从性对急诊剖宫产术后恢复的影响OA
Effect of enhanced recovery after surgery protocol adherence on postoperative recovery in patients undergoing emergency cesarean section
目的 探讨加速康复外科(ERAS)方案依从性对急诊剖宫产患者术后恢复的影响.方法 纳入2023年1月至2024年9月在我院行急诊剖宫产术的576例患者,所有患者均遵循产科ERAS方案,根据依从率将患者分为高依从性组(依从率>80%,n=242)和低依从性组(依从率≤80%,n=334).比较2组患者一般临床资料,ERAS要素依从性,术后30 d内Clavien-Dindo分级并发症,术后住院时间,30 d内再入院率,术后6 h、24 h、48 h、72 h静态及动态视觉模拟量表(VAS)评分,术后使用镇痛泵情况,术后功能恢复情况及阴道出血量.结果 2组患者麻醉方式、术前血红蛋白、术中出血量、输血及术后血红蛋白比较,差异均具有统计学意义(P<0.05).高依从性组患者整体ERAS依从率高于低依从性组(P<0.001).高依从性组患者术后首次进饮、进食、排气、下床活动及拔除尿管时间均早于低依从性组(P<0.001);与低依从性组相比,高依从性组患者术后6 h、24 h、48 h、72 h静态和动态VAS评分均降低(P<0.05),术后使用镇痛泵比例降低(P<0.05),术后24 h阴道出血量减少(P<0.05).低依从性组患者术后发热、肠梗阻、术后输血比例及并发症总发生率高于高依从性组(P<0.05),术后住院时间长于高依从性组(P<0.05).2组患者术后30 d再入院率比较,差异无统计学意义(P>0.05).结论 提高ERAS方案依从性可以减少急诊剖宫产患者术后并发症,缩短术后住院时间,减轻疼痛,促进术后康复.
Objective To evaluate the effect of adherence to enhanced recovery after surgery(ERAS)protocol on postoperative recovery in patients undergoing emergency cesarean section.Methods A total of 576 patients who underwent emergency cesarean section at our hospital from January 2023 to September 2024 were included.All patients followed the obstetric ERAS protocol,and were divided into the high-adherence group(adherence rate>80%,n=242)and the low-adherence group(adherence rate≤80%,n=334)based on the adherence rate.The following parameters were compared between the two groups:general clinical data,adherence to ERAS elements,Clavien-Dindo graded complications within 30 days after operation,postoperative hospital stay,30-day readmission rate,static and dynamic visual analogue scale(VAS)scores 6 hours,24 hours,48 hours,and 72 hours after operation,postoperative use of analgesic pump,postoperative functional recovery,and volume of vaginal bleeding.Results There were statistically significant differences between the two groups in terms of anesthesia method,preoperative hemoglobin,intraoperative blood loss,blood transfusion,and postoperative hemoglobin(P<0.05).Patients in the high-adherence group had a higher overall ERAS adherence rate than those in the low-adherence group(P<0.001).The times to first fluid intake,diet intake,ambulation,flatus,and urinary catheter removal in the high-adherence group were all earlier than those in the low-adherence group(P<0.001).Compared with the low-adherence group,the high-adherence group showed lower static and dynamic VAS scores 6 hours,24 hours,48 hours,and 72 hours after operation(P<0.05),a lower rate of postoperative use of analgesic pump(P<0.05),and reduced volume of vaginal bleeding 24 hours after operation(P<0.05).The low-adherence group exhibited higher proportions of postoperative fever,intestinal obstruction,and postoperative blood transfusion,and a higher total incidence of complications(P<0.05),as well as a longer postoperative hospital stay than those in the high-adherence group(P<0.05).There was no statistically significant difference in the 30-day readmission rate between the two groups(P>0.05).Conclusion Improving adherence to the ERAS protocol can reduce postoperative complications,shorten the postoperative hospital stay,alleviate pain and promote postoperative recovery in patients undergoing emergency cesarean section.
王丹;方开云
贵州医科大学麻醉学院,贵州 贵阳 550002||贵州省人民医院麻醉科,贵州 贵阳 550002贵州医科大学麻醉学院,贵州 贵阳 550002||贵州省人民医院麻醉科,贵州 贵阳 550002
医药卫生
加速康复外科急诊剖宫产依从性并发症术后恢复
enhanced recovery after surgeryemergency cesarean sectionadherencecomplicationspostoperative recovery
《局解手术学杂志》 2026 (3)
232-236,5
贵州省科技计划项目(黔科合支撑[2019]2815)
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