本文關(guān)鍵詞： 甲狀腺 加速康復(fù)外科 圍手術(shù)期 應(yīng)激反應(yīng) 術(shù)后康復(fù)　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：加速康復(fù)外科(enhanced recovery after surgery,ERAS)最早由丹麥哥本哈根大學(xué)學(xué)者Kehlet率先提出,并最早應(yīng)用于結(jié)直腸外科。ERAS的核心是在圍手術(shù)期采取一系列經(jīng)循證醫(yī)學(xué)證據(jù)證實(shí)有效的優(yōu)化處理措施,減輕患者心理和生理方面的創(chuàng)傷應(yīng)激反應(yīng),減少并發(fā)癥,縮短住院時(shí)間,降低再入院風(fēng)險(xiǎn)及死亡風(fēng)險(xiǎn),同時(shí)降低醫(yī)療費(fèi)用,最終目標(biāo)是促使患者快速康復(fù)。目前,ERAS已成功應(yīng)用到普通外科、胸心外科、骨科、婦科及泌尿外科等諸多領(lǐng)域,受到學(xué)術(shù)界的廣泛關(guān)注和高度重視。黎介壽教授首先將加速康復(fù)外科的概念介紹到國內(nèi)。近年來,加速康復(fù)外科理念和方法開始在我國應(yīng)用,并取得了很好效果,但在甲狀腺外科的應(yīng)用文獻(xiàn)報(bào)道較少。本研究將加速康復(fù)外科理念應(yīng)用于甲狀腺外科領(lǐng)域,通過對(duì)比研究,客觀分析和綜合評(píng)價(jià)其臨床應(yīng)用價(jià)值。目的:將加速康復(fù)外科理念應(yīng)用于甲狀腺外科領(lǐng)域,通過對(duì)比研究,客觀分析和綜合評(píng)價(jià)其臨床應(yīng)用價(jià)值,促進(jìn)加速康復(fù)外科理念在甲狀腺外科的應(yīng)用和發(fā)展。方法:2015年1月~2017年1月,在我院普外科住院,并需手術(shù)治療的甲狀腺疾病患者90例,完全隨機(jī)化分組分為試驗(yàn)組和對(duì)照組。試驗(yàn)組48例采用快速康復(fù)外科理念及方法進(jìn)行圍手術(shù)期管理,對(duì)照組42例采用常規(guī)外科理念及方法進(jìn)行圍手術(shù)期管理。試驗(yàn)組和對(duì)照組由同一手術(shù)、麻醉及護(hù)理團(tuán)隊(duì)完成。檢測(cè)兩組術(shù)前及術(shù)后第1天、第3天、第5天時(shí)C-反應(yīng)蛋白(CRP);記錄術(shù)后第1天、第3天、第5天時(shí)疼痛評(píng)分;測(cè)量術(shù)前及術(shù)后第1天、第3天、第5天時(shí)頦-頸間距(頦隆突至頸靜脈切跡的距離),記錄術(shù)后第1天、第3天、第5天時(shí)頦-頸間距縮短的距離,以此表示頸部活動(dòng)受限的程度;記錄兩組患者術(shù)后引流量及引流管拔除時(shí)間;記錄兩組患者住院天數(shù);記錄兩組患者麻醉時(shí)間、手術(shù)時(shí)間和手術(shù)出血量;記錄兩組患者手術(shù)相關(guān)并發(fā)癥。應(yīng)用SPSS 21.0進(jìn)行統(tǒng)計(jì)學(xué)分析,正態(tài)分布的計(jì)量資料比較采兩獨(dú)立樣本t檢驗(yàn);偏態(tài)分布的計(jì)量資料比較采用Wilcoxon秩和檢驗(yàn)。計(jì)數(shù)資料比較采用卡方檢驗(yàn)。重復(fù)測(cè)量數(shù)據(jù)檢驗(yàn)采用重復(fù)測(cè)量方差分析。P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1試驗(yàn)組術(shù)前及術(shù)后第1天、第3天、第5天時(shí)crp分別為1.81±0.97mg/l、18.61±0.48mg/l、16.56±0.52mg/l、8.54±0.43mg/l;對(duì)照組術(shù)前及術(shù)后第1天、第3天、第5天時(shí)crp分別為1.64±0.66mg/l、22.28±0.63mg/l、20.09±0.72mg/l、14.23±0.61mg/l。試驗(yàn)組和對(duì)照組術(shù)前c反應(yīng)蛋白比較,無顯著性差異(p0.05);試驗(yàn)組術(shù)后第1天、第3天、第5天時(shí)c反應(yīng)蛋白比對(duì)照組低,有顯著性差異(p0.05)。2試驗(yàn)組術(shù)后第1天、第3天、第5天時(shí),疼痛評(píng)分分別為4.06±0.14分、3.06±0.11分、2.02±0.11分;對(duì)照組術(shù)后第1天、第3天、第5天時(shí),疼痛評(píng)分分別為7.02±0.22分、6.04±0.12分、4.09±0.12分。試驗(yàn)組術(shù)后第1天、第3天、第5天時(shí),疼痛評(píng)分明顯低于對(duì)照組,有顯著性差異(p0.05)。3試驗(yàn)組術(shù)后第1天、第3天、第5天時(shí)頦-頸間距縮短的距離分別為4.12±0.10cm、2.76±0.13cm、1.53±0.10cm;對(duì)照組術(shù)后第1天、第3天、第5天時(shí)頦-頸間距縮短的距離分別為6.04±0.13cm、5.71±0.18cm、5.22±0.10cm。兩組比較均有顯著性差異(p0.05)。4試驗(yàn)組術(shù)后引流量及引流管拔除時(shí)間分別為35.02±1.05ml、3.02±0.11天,對(duì)照組術(shù)后引流量及引流管拔除時(shí)間分別為40.04±1.15ml、5.00±0.12天。試驗(yàn)組術(shù)后引流量與對(duì)照組比較,無顯著性差異(p0.05),試驗(yàn)組拔管時(shí)間早于對(duì)照組,兩組比較有顯著性差異(p0.05)。5試驗(yàn)組和對(duì)照組住院天數(shù)分別為5.00±0.17天和8.04±0.15天,兩組比較有顯著性差異(p0.05)。6試驗(yàn)組和對(duì)照組麻醉時(shí)間、手術(shù)時(shí)間和出血量分別為150.00±2.45分鐘、120.62±2.27分鐘、30.20±1.18ml和150.47±2.06分鐘、120.83±1.82分鐘、35.11±1.43ml,兩組比較均無顯著性差異(p0.05)。7試驗(yàn)組和對(duì)照組發(fā)生手術(shù)相關(guān)并發(fā)癥(聲音嘶啞、聲音低鈍、飲水嗆咳、手足麻木)均為2例,兩組患者手術(shù)相關(guān)并發(fā)癥發(fā)生率比較,無顯著性差異(p0.05)。結(jié)論:1加速康復(fù)外科理念及方法應(yīng)用于甲狀腺外科,能夠顯著減輕術(shù)后應(yīng)激反應(yīng)、降低疼痛評(píng)分、增加頸部活動(dòng)度和舒適度、縮短拔管時(shí)間和住院天數(shù),促進(jìn)術(shù)后康復(fù)。2加速康復(fù)外科理念及方法應(yīng)用于甲狀腺外科,并不增加麻醉時(shí)間、手術(shù)時(shí)間、手術(shù)出血量、術(shù)后引流量及手術(shù)相關(guān)并發(fā)癥發(fā)生率。
[Abstract]:Accelerated rehabilitation surgery (enhanced recovery after surgery, ERAS) the earliest scholars from the University of Copenhagen in Denmark Kehlet first proposed, the core and the earliest application in colorectal surgery in the perioperative period of.ERAS is taken by a series of evidence-based effective optimization measures, reduce the stress response, patients with psychological and physiological aspects of reducing complications, shorten the hospitalization time, lower readmission risk and the risk of death at the same time, reduce medical costs, the ultimate goal is to promote the rapid recovery of patients. At present, ERAS has been successfully applied to general surgery, thoracic surgery, Department of orthopedics, Department of Urology, gynecology and other fields, attention by academic circles. Professor Li Jieshou will first the concept of accelerated rehabilitation surgery introduced to the country. In recent years, the concept of accelerated rehabilitation surgery and methods used in our country, and achieved good results, but in The application of thyroid surgery were less reported. In this study the concept of accelerated rehabilitation surgery applied in thyroid surgery, through comparative study, objective analysis and evaluation of its clinical application. Objective: the concept of accelerated rehabilitation surgery applied in thyroid surgery, through comparative study, objective analysis and evaluation of its clinical value, promote the concept of accelerated rehabilitation surgery in the application and development of thyroid surgery. Methods: January 2015 ~2017 January, hospitalized in the Department of general surgery of our hospital, and 90 patients with thyroid diseases treated with completely randomized grouping, divided into experimental group and control group. The experimental group of 48 cases using the concept of rapid rehabilitation surgery and methods of perioperative management the control group of 42 patients treated with conventional surgical method and concept of perioperative management. The test group and the control group by the same surgery, anesthesia and nursing team to complete the examination. First days, two groups were measured before and after third days, fifth days of C- reactive protein (CRP); postoperative first days, third days, fifth days of pain score; first days, were measured before and after third days, the fifth day interval (chin chin neck to neck vein carina the distance from the notch), were recorded after first days, third days, chin - collar from the distance shortened fifth days, said this degree of neck activity; records of two groups of patients with postoperative drainage and drainage tube removal time records; hospitalization days of patients in two groups; recording time of anesthesia in two groups of patients, operation time bleeding and the amount of surgery; records of two patients of surgery related complications. The application of SPSS 21 for statistical analysis, measurement data of normal distribution of two independent samples t test; skewness distribution measurement data was compared using Wilcoxon rank sum test. Enumeration data were compared by chi square test. The repeated measurement data using repeated test 嫻嬮噺鏂瑰樊鍒嗘瀽.P0.05涓哄樊寮傛湁緇熻瀛︽剰涔，

本文編號(hào)：1459934