精细化策略结合ERAS理念对膀胱癌围手术期手术质量、疼痛、应激及预后的影响

目的:探讨精细化策略结合ERAS理念对膀胱癌围手术期手术质量、疼痛、应激及预后的影响。方法:选取2019年01月-2020年06月于我院行腹腔镜下膀胱癌根治术的膀胱癌患者76例，按照随机数字法分为观察组和对照组，每组各38例。对照组患者给予常规围手术期处置，观察组患者给予在精细化策略结合ERAS理念指导下的围手术期处置。比较两组患者的围手术期手术质量指标、术后视觉模拟评分法（VAS）评分、术后焦虑和抑郁情况、术后并发症以及术后30 d内再入院发生情况。结果:观察组患者术后首次下床时间、术后首次排气时间、术后首次排便时间、术后住院时间较对照组均显著缩短，住院费用较对照组显著降低，差异均具有统计学意义（P＜0.05）。观察组患者术后6 h、12 h、24 h、48 h的VAS疼痛评分显著低于对照组，术后SAS、SDS评分均显著低于对照组，术后并发症发生率、30 d内再入院发生率均显著低于对照组，差异均具有统计学意义（P＜0.05）。结论:在精细化策略结合ERAS理念指导下的膀胱癌围手术期处置能够有效提高手术质量，减轻疼痛程度，改善负面情绪，减少术后并发症，促进术后康复。

Effect of refined strategy combined with ERAS concept on perioperative quality,pain degree,stress and prognosis in perioperative management for patients with bladder cancer

Objective:To explore the effect of refined strategy combined with ERAS concept on perioperative quality,pain degree,stress and prognosis in perioperative management for patients with bladder cancer.Methods:76 patients with bladder cancer who underwent laparoscopic radical resection of bladder cancer in our hospital from January 2019 to June 2020 were selected and randomly divided into the observation group and control group,with 38 cases in each group.Patients in the control group were given conventional perioperative management,while patients in the observation group were given perioperative management under the guidance of refined management combined with ERAS concept.The perioperative quality index,postoperative visual analogue scale (VAS) score,postoperative anxiety and depression,postoperative complications and readmission within 30 days were compared between the two groups.Results:The first time of getting out of bed,the first time of exhaust,the first time of defecation and the length of hospitalization in the observation group were significantly shorter than those in the control group,and the hospitalization expenses was significantly lower than that in the control group,all above had statistical difference (P＜0.05).VAS scores at 6 h,12 h,24 h,and 48 h after surgery in the observation group were significantly lower than those in the control group,SAS and SDS scores after surgery in the observation group were significantly lower than those in the control group,and the incidence of postoperative complications and readmission within 30 days were significantly lower than those in the control group,all above had statistical difference (P＜0.05).Conclusion:Perioperative management of bladder cancer under the guidance of refined management combined with ERAS concept could effectively improve the quality of surgery,relieve pain,improve negative emotions,reduce postoperative complications and promote postoperative recovery.