| Objective To explore the practicability and effectiveness of perioperative management of lumbar degenerative diseases under the concept of enhanced recovery after surgery(ERS),and to provide theoretical and data support for the widespread use of the ERAS concept in clinical practice.Methods Sixty patients with lumbar degenerative diseases admitted to the spine surgery department of the Central Hospital of Shenyang Medical College from September2018 to December 2019 were selected according to the established inclusion and exclusion criteria.All patients were randomly divided into an experimental group and a control group using a random number table method,with 30 persons in each group.Patients in the experimental group were administered perioperatively with the ERAS concept,while patients in the control group were treated with traditional perioperative management.The pain VAS scores were given to patients in the two groups 3 days before admission,2 hours,6 hours,12 hours,24 hours,and 48 hours after surgery,and 30 minutes after functional exercise.Lumbar spine JOA scores were performed before and 1 week after surgery.Patient satisfaction was investigated using a self-made patient satisfaction score sheet before discharge.General data of patients before surgery(age,gender,BMI)and general information of patients during perioperative period(intraoperative blood loss,postoperative drainage,postoperative bedtime,hospitalization time,number of cases with SSI).For the above data,use Prism 8.0 software,t-test and x2 test to compare and analyze the data.P <0.05 indicates that the difference is statistically significant.Results The average age of the patients in the experimental group was 58.2 ± 2.9 years(48-74 years),and the average age of the patients in the control group was56.9 ± 3.7 years(49-71 years).There was no significant difference in age comparison between the two groups.(t = 1.515,P = 0.135> 0.05);there were 19 males and 11 females in the experimental group,21 males and 9 females in the control group,and there was no significant difference in the sex composition ratio between the two groups(x2 = 0.300,P = 0.584> 0.05);the average BMI of the experimental group was 25.4 ± 1.6,and the average of the BMI of the control group was 26.3 ± 2.4.There was no significant difference in the comparison of the BMI values between the two groups(t = 1.709,P = 0.093> 0.05);The intra-operative blood loss of the experimental group was 173.3 ± 34.54 ml,which was significantly lower than that of the control group's 269.27 ± 23.85ml(t = 12.52,P <0.0001 <0.05).The postoperative bed time and hospital stay in the experimental group were 2.15 ± 0.68 days,respectively.And 4.38 ± 1.26 days,respectively shorter than 5.84 ± 1.35 days and 8.63 ± 4.82 days in the control group(t = 13.37,4.672,P <0.0001 <0.05);the postoperative drainage of the two groups was compared,and the postoperative The drainage volume was 130.45 ± 34.74 ml,which was far lower than the control group's 248.5 ± 45.62ml(t = 11.27,P<0.0001).The comparison of VAS scores before surgery between the two groups of patients was 7.86 ± 1.26 in the experimental group and 7.79 ± in the control group.1.89,there was no significant difference between the two groups(P> 0.05).Through the pain management of the ERAS concept during the perioperative period,the VAS scores of the experimental group were lower than those of the control group at different time points within 24 hours(P <0.05),especially at 6hours after operation.The difference between the two groups was the largest.Comparison of VAS scores was performed again at 48 hours after operation,and no significant difference was found(P> 0.05).There was no significant difference in JOA scores of the lumbar spine between the two groups before surgery(JOA score in the experimental group: 17.35 ± 4.66,and JOA score in the control group:16.89.± 3.57,P = 0.6694> 0.05).After perioperative management through ERAS,the lumbar spine JOA score(25.31 ± 2.33)in the experimental group was significantly higher than that in the control group(20.47 ± 2.31)(P <0.0001).In addition,when comparing within the group,we can see that,whether in the experimental group or the control group,the JOA score of the lumbar spine after surgery is significantly higher than that before the operation(comparison before and after operation in the experimental group t = 8.368,P <0.0001;control group surgery Before and after comparison t = 4.611 P <0.0001);in the patient satisfaction assessment survey before discharge,we found that in the experimental group,3 people scored 65-84,and the remaining 27 people scored 85-100 The average score is 92.3 ± 3.6.In the control group,2 people scored less than 65,9people scored 65-84,and the remaining 19 people scored between 85-100,with an average score of 87.4 ± 2.1.Comparing the satisfaction of the two groups of patients,it can be seen that the satisfaction of the patients in the experimental group is significantly higher than that in the control group(P <0.0001)Conclusion Perioperative management under the ERAS concept for surgical patients with lumbar degenerative diseases can reduce the postoperative pain of patients to a certain extent,shorten the bedtime and hospital stay after surgery,and improve patient satisfaction.Reducing the psychological and physical burden of patients,the economic burden of families and society,improving the utilization of medical resources,and improving the relationship between doctors and patients should be reasonably promoted and applied in clinical work. |
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