Enhanced Recovery After Surgery Program Uesed In Gynecologic Laparoscopic Surgery

Objective:To evaluate the safety and effectiveness of Enhanced Recovery After Surgery program uesed in gynecological laparoscopic surgery.Methods: 200 gynecological patients undergoing laparoscopic surgery are randomly divided into ERAS group and control group,the ERAS group treated with ERAS measures,while the control group adopted the traditional treatment.Two groups of patients share the common discharge standards----compare and analysis the thirst and hunger before suegery,the time of achieving discharge standard,postoperative recovery of gastrointestinal function,the total cost,postoperative complications such as pain?nausea and vomiting.The treatment of ERAS group :Preoperative education to patients;preoperative fasting 6 hours and 2 hours water deprivation,orally taking 350 ml 5% glucose 2 hour before surgery;giving 1mg/kg flurbiprofen and 10 mg dexamethasone by intravenous drip 15 minutes before the operation;preemptive local anesthetics in the trocar areas with 0.5% ropivacaine after anesthesia induction;adopt lung protective ventilation strategy with small tidal volume and positive end-expiratory pressure during the operation;heating the infusion and washing liquid,added sterile clothes to maintains the normal temperature;placing the pelvic drainage according to the surgical conditions;drinking clear liquid is allowed 4 hours after operation,and the patients was permitted gradually transferred to the liquid diet to normal diet according to the patient's tolerance;on-bad movement was allowed 6 hours after operation,and gradually transferred to off-bed according to the patient's tolerance;removing the catheter after the patients off-bed moving,and removing the pelvic drainage tube as soon as possible within 48 h.The treatment of control group :Preoperative routine visit patients;avoid fasting from midnight;adopt volume control or pressure control to ventilation;placing the pelvic drainage according to the surgical conditions;no fasting before anal vent,and gradually transferred to normal diet according to the patient's tolerance;off-bad movement was performed according to the patient's intention;removing the catheter after the patients off-bed moving;removing the pelvic drainage tube after 48 hours,when the drainage solution was clear and less than 100 ml.Results: 172 patients completed the experiment,86 in the ERAS group and 86 in the control group.The differences in age,BMI,ASA classification,operation time,anesthesia time and surgical method had not statistical statistically between the two groups.Compared with control group,the rates of thirst and hungry and nausea and vomiting were obviously lower,the visual analogue score within 24 hours was less,the exhaust time and length of hospital stay were significantly shorten,and the hospitalization costs was significantly lower in ERAS group(P < 0.05).ERAS group had a lower rat of complications,higher rat of discharge within three days and lower ECOG score on the third day after surgery compared with control group.Conclusion: ERAS strategy can be used for gynecological laparoscopic surgery safely.It can promote postoperative recovery of patients effectively,shorten length of stay and reduce medical costs.