生殖医学杂志

目的 评价加速康复外科(ERAS)干预对剖宫产术后功能恢复的影响。方法 收集2021年9月1日至2022年9月1日在深圳市龙岗区妇幼保健院产科行剖宫产分娩的194例产妇为研究对象，采用前瞻性、随机单盲的研究方法，使用随机数表法将产妇随机分为快速康复组(ERAS组，96例)和常规组(98例)。ERAS组给予跨越术前、术中和术后的综合干预措施；常规组给予常规围手术期干预措施。观察剖宫产围手术期的ERAS措施对产妇疼痛视觉模拟评分(VAS)、术后阿片类药物使用情况、胃肠道恢复情况、膀胱功能、首次下床活动时间、24 h阴道出血量等的影响。结果 ERAS组和常规组基线资料比较均无显著性差异(P>0.05)。ERAS组产妇剖宫产术后回病房0 h的VAS与常规组无显著性差异(P=0.546),但术后回病房4 h、12 h、16 h和24 h的VAS显著低于常规组(P均<0.05)。ERAS组术后需要联合使用舒芬太尼和地佐辛的比率显著低于常规组(29.2%vs. 46.9%,P<0.05)。ERAS组术后首次进食流质时间[(2.6±1.1)h vs.(4.3±2.3)h]、进食半流质时间[(7.5±6.8)h vs.(20.5±15.0)h]、进食普食时间[(35.1±15.7)h vs.(41.4±13.2)h]、拔尿管时间[(9.8±5.1)h vs.(23.5±4.5)h]、拔尿管后首次排尿时间[(12.9±5.4)h vs.(25.9±4.3)h]及首次下床时间[(13.8±6.0)h vs.(26.8±6.7)h]均显著短于常规组(P<0.01)。两组的首次肛门排气时间及产后24 h出血量均无显著性差异(P>0.05)。结论 ERAS干预应用于剖宫产孕妇围手术期，能够减轻产妇疼痛，具有阿片节省效应，还能有效缩短孕产妇空腹时间，促进膀胱功能恢复和产后尽早活动。

Objective:To evaluate the impact of enhanced recovery after surgery(ERAS) intervention on functional recovery after caesarean section.Methods:A total of 194 pregnant women who were delivered by caesarean section in Longgang District Maternal & Child Healthcare Hospital from September 1,2021 to September 1,2022 were collected as the research objects. Using a prospective, randomized, single blind research method, the patients were randomly divided into the enhanced recovery group(ERAS group, n=96) and the conventional group(n=98) by using a random number table. The patients in ERAS group were received comprehensive intervention regimen spanning preoperative, intraoperative, and postoperative stages, while the patients in control group were performed routine perioperative measures. The effect of ERAS measures during the perioperative period of caesarean section on the visual analogue score(VAS) of maternal pain, postoperative use of opioids, gastrointestinal recovery, bladder function, the time of first ambulation, and the amount of vaginal bleeding in 24 hours were observed.Results:There was no significant difference in baseline data between the ERAS group and the conventional group(P>0.05). There was no significant difference in VAS at 0 hour after caesarean section between ERAS group and the conventional group(P=0.546),but VAS at 4,12,16 and 24 hours after cesarean section was significantly lower than those in the conventional group(P<0.05). The proportion of the patients requiring combined use of sufentanil and dezocine after surgery in ERAS group was significantly lower than that in conventional group(29.2% vs. 46.9%,P<0.05). The first fluid intake time [(2.6±1.1) h vs.(4.3±2.3) h],half fluid intake time [(7.5±6.8) h vs.(20.5±15.0) h],general food intake time [(35.1±15.7) h vs.(41.4±13.2) h],urinary catheter removal time [(9.8±5.1) h vs.(23.5±4.5) h],the first urination time after catheter removal [(12.9±5.4) h vs.(25.9±4.3) h] and the first off bed time [(13.8±6.0) h vs.(26.8±6.7) h] in ERAS group were significantly shorter than those in conventional group(P<0.01). There was no significant difference in the first anal exsufflation time and bleeding volume of postpartum 24-hour between the two groups(P>0.05).Conclusions:ERAS intervention applied in the perioperative period of caesarean section of pregnant women can reduce maternal pain, have opioid saving effect, effectively shorten the fasting time of pregnant women, promote the recovery of bladder function and early postpartum activities.