中老年患者腰椎融合术后影响加速康复的因素分析

doi:10.3760/cma.j.issn.1007-1245.2023.17.031

摘要/Abstract

摘要：

目的　探讨腰椎融合术后影响患者加速康复（ERAS）的相关因素。方法　本文为前瞻性研究。以2021年1月至2022年12月在揭阳市人民医院进行诊治的腰椎退行性病变患者147例为研究对象，使用区组随机化的随机分组方法分为ERAS组70例和非ERAS组77例。ERAS组男32例、女38例，年龄（69.45±6.25）岁；非ERAS组男35例、女42例，年龄（69.27±6.35）岁。所有患者均接受后路腰椎融合术治疗。对两组患者人口特征、合并症、手术数据和术后恢复参数进行统计；临床结果包括住院时间、术后并发症和术后疼痛［视觉模拟评分法（VAS）评分］。采用t检验、χ²检验，使用多变量logistic回归分析住院时间、术后并发症的危险因素。结果　ERAS组患者住院时间［（13.6±4.0）d］短于非ERAS组［（15.6±3.9）d］，差异有统计学意义（t=3.068，P=0.003）；ERAS组并发症发生率［7.1%（5/70）］低于非ERAS组［18.2%（14/77）］，早期下地行走［70.0%（49/70）］、早期经口进食［88.6%（62/70）］、早期拔除膀胱导管［80.0%（56/70）］、营养支持比例［45.7%（32/70）］均高于非ERAS组［11.7%（9/77）、7.8%（6/77）、16.9%（13/77）、20.8%（16/77）］，差异均有统计学意义（χ²=3.970、52.191、96.243、58.648、10.367，均P<0.05）。术后第1天、第2天、第3天，ERAS组VAS评分（腰痛和腿痛）均低于非ERAS组［（3.8±1.7）分比（5.7±2.3）分、（3.6±1.9）分比（4.5±2.2）分、（3.1±1.2）分比（3.8±1.7）分、（3.2±1.5）分比（3.8±1.7）分、（2.5±1.6）分比（3.5±1.2）分、（2.0±1.3）分比（2.5±0.9）分］，差异均有统计学意义（t=5.649、2.642、2.858、2.260、4.311、2.731，均P<0.05）；术后第4天，ERAS组VAS评分（腰痛）低于非ERAS组［（2.7±0.5）分比（3.2±0.9）分］，差异有统计学意义（t=4.107，P<0.05），而ERAS组的VAS评分（腿痛）与非ERAS组相比［（1.8±0.8）分比（2.0±1.0）分］差异无统计学意义（t=1.330，P>0.05）。多变量logistic回归分析，住院时间的延长与ERAS计划、术前Oswestry功能障碍指数（ODI）相关（均P<0.05），但与年龄、体质量指数（BMI）、手术节段≥3节段、美国麻醉师协会（ASA）分级≥3级、手术时间无关（均P>0.05）；ERAS计划的实施与并发症减少相关（P<0.05）。结论　腰椎融合术后患者ERAS可能与早期进行正常活动（包括早期行走、早期移除膀胱导管、早期口服喂养）、使用多模式镇痛等相关因素有关。

关键词:

腰椎融合术, 加速康复, 中老年患者, 影响因素

Abstract:

Objective　To investigate the factors influencing enhanced recovery after lumbar fusion surgery. Methods　Using the method of prospective cohort study, 147 patients with lumbar degenerative diseases who were diagnosed and treated in Jieyang People's Hospital from January 2021 to December 2022 were selected as the research objects. Using the randomized grouping method of block randomization, they were divided into 70 patients in the ERAS (enhanced recovery after surgery) group and 77 patients in the non-ERAS group. There were 32 males and 38 females in the ERAS group, aged (69.45±6.25) years; there were 35 males and 42 females in the non-ERAS group, aged (69.27±6.35) years. All patients received lumbar fusion surgery. The demographic characteristics, complications, surgical data, and postoperative recovery parameters of the two groups were analyzed. Clinical outcomes included the length of hospital stay, postoperative complications, and postoperative pain [Visual Analogue Scale (VAS) score]. t test and χ² test were used, and multivariate logistic regression analysis was used to analyze the risk factors of hospital stay and postoperative complications. Results　The length of hospital stay in the ERAS group [(13.6±4.0) d] was shorter than that in the non-ERAS group [(15.6±3.9) d], with a statistically significant difference (t=3.068, P=0.003). The incidence of complications in the ERAS group [7.1% (5/70)] was lower than that in the non-ERAS group [18.2% (14/77)], and the proportions of early ground walking [70.0% (49/70)], early oral feeding [88.6% (62/70)], early removal of bladder catheter [80.0% (56/70)], and nutritional support [45.7% (32/70)] were higher than those in the non-ERAS group [11.7% (9/77), 7.8% (6/77), 16.9% (13/77), and 20.8% (16/77)], with statistically significant differences (χ²=3.970, 52.191, 96.243, 58.648, and 10.367; all P<0.05). On day 1, day 2, and day 3 after surgery, the VAS scores (low back pain and leg pain) in the ERAS group were lower than those in the non-ERAS group [(3.8±1.7) points vs. (5.7±2.3) points, (3.6±1.9) points vs. (4.5±2.2) points, (3.1±1.2) points vs. (3.8±1.7) points, (3.2±1.5) points vs. (3.8±1.7) points, (2.5±1.6) points vs. (3.5±1.2) points, (2.0±1.3) points vs. (2.5±0.9) points], with statistically significant differences (t=5.649, 2.642, 2.858, 2.260, 4.311, and 2.731; all P<0.05). On day 4 after surgery, the VAS score (low back pain) in the ERAS group was lower than that in the non-ERAS group [(2.7±0.5) points vs. (3.2±0.9) points], with a statistically significant difference (t=4.107, P<0.05); there was no statistically significant difference in the VAS score (leg pain) between the ERAS group and the non-ERAS group [(1.8±0.8) points vs. (2.0±1.0) points] (t=1.330, P>0.05). Multivariate logistic regression analysis showed that the length of hospital stay was correlated with ERAS program and preoperative Oswestry Disability Index (ODI) (both P<0.05), but was not related to age, body mass index (BMI), operative segments ≥3, American Society of Anesthesiologists (ASA) grade ≥3, or operative time (all P>0.05); implementation of ERAS program was associated with a decrease in complications (P<0.05). Conclusion　ERAS after lumbar fusion may be related to early normal activities (including early walking, early removal of bladder catheter, and early oral feeding), multimodal analgesia, and other factors.

Key words:

Lumbar fusion, Enhanced recovery, Middle aged and elderly patients, Influencing factors

李钿洪全林加阳林可新李晓红.

中老年患者腰椎融合术后影响加速康复的因素分析 [J]. 国际医药卫生导报, 2023, 29(17): 2507-2512.

Li Tian, Hong Quan, Lin Jiayang, Lin Kexin, Li Xiaohong.

Analysis of factors influencing enhanced recovery after lumbar fusion surgery in middle-aged and elderly patients [J]. International Medicine and Health Guidance News, 2023, 29(17): 2507-2512.

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