摘要目的 探讨加速康复外科(ERAS)理念在胸腰椎骨折伴神经损伤患者护理中的应用效果.方法 采用回顾性病例对照研究分析2013年11月一2017年11月重庆市人民医院收治的64例双节段胸腰椎骨折伴神经损伤患者的临床资料,其中男52例,女12例;年龄26 ～ 62岁,平均43岁.损伤节段:T.～T12 28例,T12～L115例,L1～L210例,L2～ L311例.神经功能Frankel分级:A级14例,B级18例,C级24例,D级8例.患者均采用小切口直视置入普通椎弓根螺钉联合穹隆状椎管减压治疗.32例采用ERAS康复护理(ERAS护理组),32例采用常规康复护理(常规护理组).比较两组并发症发生率、住院时间、住院费用、患者满意度、术后3个月视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及神经功能Frankel分级.结果 患者均获随访8～ 12个月[(10.2±1.3)个月].ERAS护理组发生肺部感染1例;常规护理组发生伤口感染1例,褥疮1例,下肢静脉血栓1例(P＜0.01).ERAS护理组住院时间较常规护理组显著缩短[(9.3±1.2)d∶(15.6±1.8)d](P＜0.01).ERAS护理组住院费用较常规护理组显著减少[(5.2±1.3)万元∶(6.3±1.7)万元](P＜0.05).ERAS护理组和常规护理组的患者满意度分别为84％(27/32)和56％ (18/32) (P＜ 0.05).术后3个月,ERAS护理组VAS[(2.6±1.2)分∶(3.8±1.5)分]和ODI(11.4 ±2.1∶15.8±2.5)均较常规护理组显著降低(P＜0.05或0.01).术后3个月,ERAS护理组神经功能Frankel分级A级1例,B级5例,C级9例,D级5例,E级12例;常规护理组分别为A级3例,B级7例,C级7例,D级9例,E级6例.ERAS护理组神经功能Frankel分级1级及以上恢复率较常规护理组显著提高[97％ (31/32)∶91％ (29/32)] (P ＜0.05).结论 与常规护理比较,ERAS康复护理有利于减少胸腰椎骨折伴神经损伤患者围术期并发症、缩短住院时间、减少住院费用、减少疼痛、促进功能恢复并提高神经功能恢复率,同时也可获得更高的患者满意度.

abstractsObjective To investigate the application of enhanced recovery after surgery (ERAS)in the nursing of thoracolumbar fracture with nerve injury.Methods A retrospective case-control study was conducted to analyze the clinical data of 64 patients with bilateral thoracolumbar fractures with nerve injury admitted to the Chongqing General Hospital from November 2013 to November 2017.There were 52 males and 12 females,aged 26-62 years,with an average age of 43 years.The injured segments were located at T11-T12in 28 patients,T12-L1 in 15 patients,L1-L2 in 10 patients,and L2-L3 in 11 patients.According to the Frankel classification of neurological function,there were 14 patients at grade A,18 at grade B,24 at grade C and eight at grade D.All patients were treated with common pedicle screw placement under direct vision combined with dome shaped decompression through small incision.Among the patients,32 received ERAS rehabilitation nursing (ERAS group) and 32 received routine rehabilitation nursing (routine group).The incidence of complications,hospitalization time,hospitalization expense,patients' satisfaction with nursing work,visual analogue scale (VAS),Oswestry dysfunction index (ODI) and Frankel classification of neurological function at 3 months after operation were compared between the two groups.Results The patients were followed up for 8-12 months [(10.2 ±1.3) months].In the ERAS group,one patient had pulmonary infection;in the routine group one patient had wound infection,one had bedsore,and one had venous thrombosis in lower limb (P ＜ 0.01).The hospitalization time of ERAS group was significantly shorter than that of routine group [(9.3 ± 1.2)days:(15.6 ± 1.8) days] (P ＜ O.01).The hospitalization expense of ERAS group was significantly lower than that of routine group [(52 ± 13)thousand yuan (RMB) vs.(63 ± 17) thousand yuan (RMB)](P ＜ 0.05).The satisfaction rates of ERAS group and routine group were 84％ (27/32) and 56％ (18/ 32),respectively (P ＜ 0.05).At 3 months after operation,the ERAS group had significantly lower VAS [(2.6±1.2)pointsvs.(3.8±1.5)points] and ODI (11.4±2.1)pointsvs.(15.8±2.5)points]than the routine group (P ＜ 0.05 or 0.01).At 3 months after operation,according to the Frankel grading,there was one patient at grade A,five at grade B,nine at grade C,five at grade D,and 12 at grade E in the ERAS group;while there were three patients at grade A,seven at grade B,seven at grade C,nine at grade D,and six at grade E.The recovery rate of Frankel grade 1 and/or above in ERAS group was significantly higher than that in routine group [97％ (31/32) vs.91％ (29/32),P ＜0.05].Conclusion Rehabilitation nursing measures of ERAS can help reduce perioperative complications,hospitalization time and hospitalization expenses,relieve pain,promote functional recovery,and gain satisfactory feedbacks from the patients.