Accelerated Recovery Surgery In The Application Of Thyroid Surgery

enhanced recovery after surgery(ERAS)was first proposed by Kehlet,a scholar at University of Copenhagen in Denmark,and was first applied to colorectal surgery.The core of ERAS is to take a series of effective treatment measures which have been proved by evidence-based medicine during perioperative period,could significantly relieve postoperative stress,reduce the morbidity associated with complications,shorten hospitalization time,reduce the risk of readmission and death,lower the medical cost and accelerated recovery.So far ERAS has been successfully applied to many fields,such as general,orthopeic,urological,gynecological,cardiovascular and thoracic surgery,and has been widely concerned and highly valued by the academic circles.Professor Li Jieshou first introduced the concept of ERAS to china.In recent years,the concept and method of ERAS began to be applied in our country,and achieved good effects,however,there are few reports on the application of thyroid surgery.In this study,ERAS was applied to the field of thyroid surgery,and we through the contrastive study,objective analysis and overall merit to analyze its application value.Objective: We apply the ERAS concept to the field of thyroid surgery,and through the contrastive study,objective analysis and overall merit to analyze its application value,promote the application and development of ERAS in the field of thyroid surgery.Methods: 90 patients with thyroid disease were admitted to our hospital from January 2015 to January 2017,and were randomly divided into test and control group.In the experimental group,48 patients were treated with the concept and method of enhanced recovery after surgery,while the control group(n=42)were treated with conventional surgical methods.The two groups of treatment were completed by the same operation,anesthesia and nursing team.The C-reactive protein(CRP)and the chin-neck space were detected at 1day before surgery and 1,3 and 5 days after surgery in the two groups;Pain scores and Chin-collar pitch shortens the distance were recorded at first,third,and fifth days after surgery;the following clinical parameters were recorded: amount of post-operation drainage,drainage tube exelcymosis time,hospitalization days,anesthesia time,operation time,intraoperative blood loss and postoperative complications.SPSS 21.0 was used for the analysis.Consistent with the measurement data normal distribution using t-test,not in line with normal measurement data using the wilcoxon rank sum test;Count data using chi-square test,repeated measurement data using repeated measurement ANOVA.Difference was statistically significant(P<0.05).Results:1 The amount of CRP in the experimental group at 1day before surgery and 1,3 and 5 days after surgery is 1.81±0.97mg/L,18.61±0.48 mg/L,16.56± 0.52 mg/L,8.54±0.43mg/L;The amount of CRP in the control group at 1day before surgery and 1,3 and 5 days after surgery is 1.64±0.66mg/L,22.28±0.63 mg/L,20.09±0.72 mg/L,14.23±0.61 mg/L.There was no significant difference in CRP of preoperative(P>0.05);The CRP in the experimental group was lower than that in the control group at 1,3 and 5 days after surgery,and the difference was significant(P<0.05).2 Pain score of the experimental group at 1,3 and 5 days after surgery is 4.06±0.14,3.06±0.11,2.02±0.11;Pain score of the control group at 1,3 and 5 days after surgery is 7.02±0.22,6.04±0.12,4.09±0.12.The pain score of the experimental group was significantly lower than that of the control group at 1,3 and5 days after operation,and the difference was significant(P<0.05).3 The chin-neck space of the experimental group at 1,3 and 5 days after surgery is 4.12±0.10 cm,2.76±0.13 cm,1.53±0.10cm;the chin-neck space of the control group at 1,3 and 5 days after surgery is 6.04±0.13 cm,5.71± 0.18 cm,5.22±0.10 cm.There was significant difference between the two groups(P<0.05).4 The amount of post-operation drainage in the experimental group is 35.02±1.05 ml,and the drainage tube exelcymosis time in the experimental group is 3.02±0.11days;The amount of post-operation drainage in the control group is 40.04±1.15 ml,and the drainage tube exelcymosis time in the control group is 5.00±0.12 days.There was no significant difference in the amount of post-operation drainage between the experimental group and the control group(P>0.05),the extubation time of the experimental group was earlier than that of the control group,and there was significant difference between the two groups(P<0.05).5 Hospitalization days of the experimental group and the control group were 5.00±0.17 days and 8.04±0.15 days,respectively.There was significant difference between the two groups(P<0.05).6 Anesthesia time,operation time and intraoperative blood loss of the experimental group was 150.00±2.45 minutes,120.62±2.27 minutes,30.20± 1.18 ml,respectively;Anesthesia time,operation time and intraoperative blood loss of the control group was 150.47±2.06 minutes,120.83±1.82 minutes,35.11±1.43 ml,there was no significant difference between the two groups(P>0.05).7 The same as the control group,there were 2 cases of postoperative complications(hoarseness,low voice,supervened dysdipsia,numbness in the hands and feet)in the experimental group,there was no significant difference between the two groups(P>0.05).Conclusions:1 The application of ERAS concept and method in thyroid surgery can significantly reduce the post-operative stress response,reduce the pain score,increase the neck activity and comfort,shorten the extubation time and hospital stay time and accelerate rehabilitation.2 The application of ERAS concept and method in thyroid surgery did not increase the anesthesia time,operation time,intraoperative blood loss,amount of post-operation drainage and postoperative complications.