The Study Of Enhanced Recovery After Surgery On Perioperative Stress Response And Clinical Value In Patients With Acoustic Neuroma

Objective:To observe the effects of enhanced recovery after surgery(ERAS)on perioperative physiological and psychological stress responses and postoperative clinical outcomes in patients with acoustic neuroma through randomized controlled design,and explore the application value of ERAS in the perioperative period of patients with acoustic neuroma,in order to provide a scientific basic for better application of ERAS concept in neurosurgery.Methods:According to the inclusion and exclusion criteria,32 eligible patients with acoustic neuroma were enrolled and randomly divided into enhanced recovery after surgery group(ERAS group)and conventional treatment group(control group),with 16 cases in each group.ERAS group used the ERAS program developed in this study for perioperative management,and control group used the conventional program for perioperative management.On the 2nd day of admission and postoperative 1d、postoperative 3d and postoperative 5d,the anterior cubital venous blood of fasting patients was taken to measure cortisol(COR),hypersensitive C-creative protein(hs-CRP)and white blood cell count(WBC)to evaluate the physiological stress level.Psychological stress response questionnaire(SRQ)and Hospital Anxiety and Depression Scale(HADS)were used to assess the patients’ psychological stress level on the day of admission and discharge.The length of hospitalization and the cost of hospitalization were recoded.The pain numerical rating scale(NRS)and the visual analogue scale of nausea and vomiting(PONV VAS)were used to assess the degree of pain,nausea and vomiting in the first 3 days after operation.The incidence of complications such as facial paralysis,headache,dizziness,incision infection,lung infection,intracranial infection,and cerebrospinal fluid leakage were recorded.Results:1.Comparison of baseline data: There was no statistically significant difference in general information(gender,age,height,weight,side of the lesion,KOOS classification,operation time,intraoperative blood loss)between two groups(P>0.05).And there was also no statistically significant difference in physiological stress level(COR concentration,hs-CRP concentration,WBC)and psychological stress level(the SRQ questionnaire total score and it’s all sub-items,including emotional reaction,physical reaction and behavior reaction,and HADS score with anxiety and depression)at admission between two groups(P>0.05).2.Comparison of physiological stress: ⑴In the control group,the WBC and hs-CRP levels increased on the postoperative 1d、postoperative 3d and postoperative 5d,and the COR levels increased on the postoperative 1d and postoperative 3d compared with pre-operation,and the differences were statistically significant(P < 0.05);⑵In the ERAS group,the WBC levels increased on the postoperative 1d and 3d,and hs-CRP levels increased on the postoperative 1d,3d and 5d compared with pre-operation,the COR levels increased on the postoperative 1d,and decreased on the postoperative 5d compared with pre-operation,and the differences were statistically significant(P<0.05).⑶Postoperative comparison between the two groups,the WBC levels of the ERAS group were significantly lower than that of the control group on the postoperative 1d、postoperative 3d and postoperative 5d(P<0.05),and the hs-CRP levels were significantly lower than that of the control group on the postoperative 3d and postoperative 5d(P<0.05),and the COR levels were significantly lower than that of the control group on the postoperative 1d and postoperative 3d(P<0.05).3.Comparison of psychological stress: Compared with the day of admission,the HADS score(anxiety,depression),the SRQ questionnaire total score and it’s all sub-items were significantly decreased in the ERAS group at discharge(P<0.05).In the control group,the SRQ questionnaire total score and its sub-items of physical reaction and behavior reaction were significantly decreased compared with admission(P<0.05),but emotional reaction score and the HADS score(anxiety,depression)were not significantly different compared with admission(P>0.05).At discharge,the HADS score(anxiety,depression),SRQ questionnaire total score and all its subitems of the ERAS group were lower than those of the control group,with statistically significance(P<0.05).4.Comparison of clinical indicators: ⑴ The length of hospitalization in the ERAS group was significantly shorter than that of the control group(P< 0.05).The cost of hospitalization was significantly lower than that of the control group(P<0.05).⑵ The NRS pain score and PONV VAS score of the ERAS group on the postoperative 1d and postoperative 2d were significantly lower than those of the control group(P<0.05).⑶ The incidence of headache and dizziness in the ERAS group were significantly lower than those of the control group(P<0.05).Conclusion:1.Compared with the traditional perioperative management program,ERAS program can more effectively decrease the postoperative the level of COR、hs-CRP and WBC,and optimize the perioperative psychological state in patients with acoustic neuroma.The ERAS has certain advantages in reducing physical and psychological stress responses.2.The application of ERAS in perioperative management of patients with acoustic neuroma can improve the rehabilitation quality of patients and accelerate the rehabilitation process in terms of reducing postoperative pain,nausea and vomiting,reducing the incidence of postoperative complication,shortening the hospitalization length,reducing medical costs.