1.Department of Anesthesiology,Shaoguan First People′s Hospital,Guangdong Province,Shaoguan 512000,China;2.Department of Spine,Shaoguan First People′s Hospital,Guangdong Provence,Shaoguan 512000,China
摘要目的加速康复外科（ERAS）理念改善老年腰椎间盘突出患者术后认知功能的效果。方法 选取2016年7月～2018年6月在我院行手术治疗的120例老年腰椎间盘突出患者，行腰椎后路减压植骨融合内固定术，按照随机数字表法分为试验组和对照组，每组各60例。试验组行围术期ERAS理念管理，对照组行常规围术期措施。术前12 h及术后12、24、48 h对患者行简易智力状态量表（MMSE）评分，并于术后4、8、24、48 h对患者行视觉模拟（VAS）评分和镇静（Ramsay）评分。结果 两组术前12 h MMSE评分比较，差异无统计学意义（P＞0.05）。试验组术后12、24、48 h MMSE评分高于对照组，差异有统计学意义（P＜0.05）；两组术后72 h MMSE评分比较，差异无统计学意义（P＞0.05）。试验组术后4、8、24及 48 h VAS评分均低于对照组，差异有统计学意义（P＜0.05）。结论 ERAS在改善老年腰椎间盘突出患者术后认知功能方面效果显著，其机制可能与ERAS在术前、术中及术后多个环节对患者进行全面关注有关，尤其与VAS及Ramsay评分改善有关。
Abstract：Objective To discuss the enhanced recovery after surgery(ERAS)concept in improving the cognitive function after spinal surgery in elderly patients.Methods 120 elderly patients with lumbar intervertebral disc herniation who underwent surgical treatment in our hospital from July 2016 to June 2018 were selected for this research.They were divided into the experimental group and the control group according to the random number table method,60 patients in each group.ERAS concept were administered in the experimental group and routine perioperative measures were administered in the control group.Patients were given a simple mental status scale(MMSE)score at 12 h before surgery and 12,24 and 48 after surgery,and visual analogue scale(VAS)and sedation(Ramsay)score at 4,8,24 and 48 h after surgery.Results The MMSE score of preoperative 12 h the experimental group and the control group showed no significant difference (P＞0.05).The MMSE score of 12,24 and 48 h postoperative in the experimental group were higher than those in the control group,with statistically significant differences (P＜0.05).Postoperative 72 h MMSE score in the experimental group showed no significant difference (P＞0.05).The VAS scores of postoperative 4,8,24 and 48 h in the experimental group were lower than those in the control group,and the differences were statistically significant(P＜0.05).Postoperative scores of the experimental group at 4,8,24 and 48 h VAS were lower than those of the control group,with statistically significant differences (P＜0.05).Conclusion ERAS treatment scheme can improve the postoperative cognitive function in patients with lumbar disc,but ERAS tactics in specific measures and the relationship between postoperative cognitive function remains to be further study,its specific mechanism remains to be further discussed.
Jeong O，Park YK，Mi RJ，et al.Compliance with Guidelines of enhanced recovery after surgery in elderly patients undergoing gastrectomy[J].World J Surg，2017，41（4）：1040-1044.
Yeung SE，Hilkewich L，Gillis C，et al.Protein intakes are associated with reduced length of stay：a comparison between enhanced recovery after surgery （ERAS） and conventional care after elective colorectal surgery[J].Am J Clin Nutr，2017，106（1）：44-48.
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