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快速康复外科理念在长期口服阿司匹林甲状腺癌患者围术期的应用效果

The effect of enhanced recovery after surgery during the perioperative period in thyriod cancer patients treated with long-term oral aspirin

作者：于晓霞;李晶明;刘晓彤;王建宏

英文作者：Yu Xiaoxia Li Jingming Liu Xiaotong Wang Jianhong

单位：首都医科大学附属北京安贞医院耳鼻咽喉头颈外科100029

英文单位：Department of Otolaryngology-Head and Neck Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：甲状腺癌；快速康复外科；阿司匹林；围术期

英文关键词：Thyroidcancer;Enhancedrecoveryaftersurgery;Aspirin;Perioperativeperiod

• 摘要：

• 目的 探讨快速康复外科（ERAS）理念在长期口服阿司匹林甲状腺癌患者围术期的应用效果。方法 选取2013年6月至2018年5月入住首都医科大学附属北京安贞医院耳鼻咽喉头颈外科的46例甲状腺癌患者为研究对象。按随机数字表法分为常规护理组与ERAS组，各23例。2组均给予常规护理，ERAS组在此基础上采用ERAS理念加强围术期护理，包括术前加强入院宣教、评估其颈椎的活动度、缩短禁食禁饮时间、增加体位训练，术中加强低体温的预防，术后多模式镇痛、鼓励早期下床活动。比较2组患者术后下床时间、住院时间、疼痛视觉模拟量表评分、并发症的发生率、患者满意度和生活质量。结果 ERAS组术后下床时间、住院时间、疼痛视觉模拟量表评分短于/低于常规护理组［（1.00±0.13）d比（3.08±0.18）d、（6.6±0.8）d比（9.6±0.9）d、（3.3±1.0）分比（5.9±1.0）分］，并发症发生率低于常规护理组［4.3%（1/23）比30.4%（7/23）］，患者生活质量评分各个维度均明显高于常规护理组，差异均有统计学意义（均P＜0.05）。ERAS组总体满意度高于常规护理组［95.7%（22/23）比82.6%（19/23）］，但差异无统计学意义（χ2=2.020,P=0.160）。结论ERAS护理能够促进长期口服阿司匹林甲状腺癌患者术后康复，增加患者的满意度，提高患者生活质量。

• Objective To investigate the application effect of enhancing recovery after surgery（ERAS） in perioperative period of thyroid cancer patients with long-term oral aspirin. Methods From June 2013 to May 2018, 46 thyroid cancer patients with long-term oral aspirin admitted in Beijing Anzhen Hospital, Capital Medical University were randomly divided into the routine nursing group(23 cases) and ERAS group(23 cases). The two groups both received routine care. The ERAS group were given ERAS procedures on the basis of routine nursing group, including strengthening the education before operation, evaluating the activity of cervical vertebra, shortening the time of fasting and drinking prohibition, increasing the position training, strengthening the prevention of hypothermia during operation, multi-mode analgesia after operation, and encouraging the early out of bed activities. The time of out of bed, hospitalization, the score of pain visual analogue scale/score, the incidence of complications, the satisfaction of patients and the quality of life were compared between the two groups. Results The time of out of bed, hospitalization, visual analogue scale/score in the ERAS group were significantly shorter/lower than those in the routine nursing group［（1.00±0.13）d vs （3.08±0.18）d, （6.6±0.8）d vs （9.6±0.9）d, （3.3±1.0） vs （5.9±1.0）］; the incidence of complications was lower than that of the routine nursing group［4.3%（1/23） vs 30.4%（7/23）］. The scores of quality of life were significantly higher than those in the routine nursing group(all P＜0.05). The overall satisfaction of ERAS group was higher than that of the routine nursing group ［95.7%（22/23） vs 82.6%（19/23）］, but the difference was not statistically significant （χ2=2.020, P=0.160）. ConclusionERAS nursing can promote postoperative rehabilitation of patients with long-term oral aspirin thyroid cancer, increase patient satisfaction, and improve quality of life for patients.