Study On Application Of Fast Track Surgery Concept In Perioperative Care Of Caesarean Section

ObjectiveTo analysis the application of FTS in caesarean section patients at perioperative period.MethodsIn this study, we selected152patients who took in the caesarean birth in Nanjing Jingling Hospital from November1,2012to January1,2013and stochastic divided into the group of FTS (group A,89cases) and the group of control (group B,63cases). The average ages of group A and B were29.08±3.39years and27.86±1.97years respectively. Length of postoperative hospital stay, uterine involution, postpartum hemorrhage amount, lactation, the first time of flatus, bladder function and postoperative complication were compared between the two groups. All analyses were performed by using SPSS version18.0(SPSS, Chicago, IL, USA). Differences between different groups were assessed by using Chi-squared tests. P<0.05was considered significant for all tests.Results1. Uterine involution:The average heights of fundus of uterus at postoperative72h were16.81±0.64cm and17.12±0.80cm in group A and B, respectively. As compared with those in group B, the uterine involution was significantly better in group A (P=0.009>0.05).2. Postpartum hemorrhage:The average postpartum hemorrhage amounts24h after operations were284.04±100.94ml in group A and327.14±93.14ml in group B. It was significantly lower than group B(P=0.008<0.05).3. Lactation:The percentages of successfully lactation within24h were97.75%(87/89) and68.25%(43/63) in group A and group B respectively. What’s more,96.63%(86/89) of patients were sufficiently lactation within72h in group A, while that of group B was80.95%(51/63). The time of lactation in group A was much more earlier (X2=23.603, P=0.000<0.05),and significantly more patients in group A could secrete sufficient lactation(X2=8.506, P=0.004<0.05).4. Recovery of gastrointestinal functions:The first time of flatus (30.98±10.46h vs.35.59±9.7h) in group A were significantly shorter (P=0.007<0.05). Furthermore, the proportion of constipation (8.99%vs.22.22%) in group A was much lower(X2=5.219, P=0.022<0.05). More rapid intestinal recovery than group B could be observed.5. Recovery of bladder functions:There was no significant difference in the incidence of urinary retention (4.49%vs.4.76%) between the two groups (P=1.000>0.05). The process of FTS did not improve the incidence of urinary retention after removal of catheter24h postoperatively.6. Puerperal morbidity:No significantly differences of puerperal morbidity were observed between the two groups (X2=0.734, P=0.204>005). The procedure of FTS did not increase the risk of puerperal morbidity.7. Postoperative hospital stay:The length of postoperative hospital stay (4.12±0.96d vs.4.48±0.93d) in group A were significantly shorter (P<0.05)ConclusionThe application of FTS for caesarean section can improve the postoperative rehabilitation process, including an early recovery of uterine, gastrointestinal and bladder functions and a decrease in the postpartum hemorrhagent amount and the time of lactation. Meanwhile, the procedure of FTS did not increase the risk of urinary retention and puerperal morbidity. FTS is worthy of further studies in obstetrics.