肺叶切除术后患者的早期康复:拔管1小时后早期下床活动

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肺叶切除术后患者的早期康复:拔管1小时后早期下床活动

      贵州医科大学    麻醉与心脏电生理课题组 

                翻译：安丽  编辑：马艳燕  审校：曹莹

背景

在这项研究中，描述了在实施肺叶切除手术后患者早期康复方面的经验。主要通过微创手术结合快速胸腔麻醉，在拔管后1小时内实施早期下床活动。

方法

该研究回顾性分析了2018年8月至2019年8月期间211例患者的术后早期康复临床结局指标，所有患者通过单一机构的多学科团队使用小端口视频辅助胸外科(VATS)行肺叶切除术。

结果

在211例患者中，178例在拔管后1小时实施了早期下床活动。早期下床组患者的平均年龄为58.6±10.8岁，其中男性69例，女性109例。早期下床组的麻醉时间（100.8±26.6分钟）、拔管时间（10±2.1分钟）和手术时间（71.1±25.3分钟）较未实施早期下床活动组低（分别为P=0.001、P<0.001和P=0.002）。早期下床组48.9%的患者行肺叶节段切除术。术后平均住院时间为4.1±3.1天，30天发病率为13.7%（29/211）。胸引管漏气时间延长为该类手术患者的主要并发症，占75.9%(22/29)。所有患者均未再次插入胸引管，无30天再次入院，且术后30天内无再次手术。

结论  

肺叶切除术后患者早期下床活动，是安全可行的，可为日间手术的实施奠定基础。

原始文献来源：

Chao Zhou, Yiqing Luo, Xiaofeng Pan, Faming Xia, Mingxing Li, Wentao Li.Early enhanced recovery after lung surgery: early ambulation 1 hour after extubation.Ann Palliat Med. 2021;10(9):9732-9741.

英文原文

Early enhanced recovery after lung surgery: early ambulation 1 hour after extubation

Abstract

Background:In this study, we describe our experience regarding the implementation of early enhanced recovery after lung surgery. We achieved early ambulation within 1 hour after extubation mainly by minimally invasive surgery combined with fast-track thoracic anesthesia.

Methods:We retrospectively analyzed the clinical outcomes of early enhanced recovery in 211 patients who underwent lung resection using miniport video-assisted thoracic surgery (VATS) by a multidisciplinary team in a single institution in the period from August 2018 to August 2019.

Results:Out of the 211 patients, 178 achieved early ambulation 1 hour after extubation. The mean age of patients in the early ambulation group was 58.6±10.8 years, and 69 men and 109 women were included. The anesthesia time (100.8±26.6 minutes), extubation time (10±2.1 minutes), and operating time (71.1±25.3 minutes) were lower in the early ambulation group (P=0.001, P<0.001, and P=0.002, respectively). Segmentectomy was performed in 48.9% of patients in the early ambulation group. The mean length of postoperative hospital stay was 4.1±3.1 days, and the 30-day morbidity was 13.7% (29/211). Prolonged air leak was the main complication, which accounted for 75.9% (22/29). No reinsertion of chest tubes, no 30-day readmissions, and no reoperations in the postoperative 30-day period occurred in any of the patients.

Conclusion:Early enhanced recovery after lung surgery is feasible and safe, and may facilitate early ambulation and lay the foundation for the implementation of day surgery.