王丽 黄晓虹 谢清

[摘要] 目的 探討加速康复外科理念（ERAS）在瘢痕子宫再次剖宫产中的应用效果。 方法 将本院于2018年6月至2020年2月间收治的瘢痕子宫再次妊娠行择期剖宫产产妇90例，随机分成对照组和研究组各45例，对照组采取传统剖宫产手术方式，研究组采取加速康复外科理念模式，比较两组产妇首次进食（半流）时间、首次自主排尿时间、术后首次下床时间、住院时间、住院费用和术后并发症发生率。 结果 与对照组比较，研究组产妇的首次进食（半流）时间（5.84±0.65）h、首次自主排尿时间（21.13±7.50）h、首次下床时间（1.23±0.49）d、住院时间（3.49±1.23）d和住院费用（5.20±1.15）千元、术后并发症（4.4%），均明显优于对照组，两组比较差异均有统计学意义（P<0.05）。 结论 在瘢痕子宫再次妊娠剖宫产产妇中实施ARS，能有效促进产妇术后康复，降低手术并发症发生率，降低住院费用，值得在临床中推广。

[关键词] 加速康复外科理念; 瘢痕子宫;再次妊娠;剖宫产

[中图分类号] R473.71          [文献标识码] B          [文章编号] 1673-9701（2021）07-0081-03

Application value of accelerated rehabilitation surgery concept in patients with scarred uterus undergoing cesarean section again

WANG Li   HUANG Xiaohong   XIE Qing

The Second People′s Hospital of Beihai in Guangxi Zhuang Autonomous Region， Beihai   536000， China

[Abstract] Objective To explore the application effect of accelerated rehabilitation surgery in the re-cesarean section in the scarred uterus. Methods Ninety scarred uterus women with repeated pregnancy who had undergone elective cesarean section in our hospital from June 2018 to February 2020 were randomly divided into the control group and the study group， with 45 cases in each group. The control group received traditional cesarean section. The study group adopted the accelerated rehabilitation surgery concept mode. The first eating time（half-flow）， the time to first voluntary urination， the time of getting out of bed， the hospitalization time， the hospitalization cost and the incidence of complications after the operation between the two groups were compared. Results The first eating time（half-flow） of the puerpera in the study group（5.84±0.65）h， the time to first voluntary urination（21.13±7.50）h， the time to get out of bed for the first time （1.23±0.49）d， the hospitalization time （3.49±1.23）d， the hospitalization cost（5.20±1.15） thousand yuan， and the postoperative complications（4.4%） were significantly better than those of the control group. The difference between the two groups was significant（P<0.05）. Conclusion The implementation of ARS in re-cesarean women with the scarred uterus can effectively promote the postoperative rehabilitation of the women， reduce the incidence of surgical complications， and reduce the cost of hospitalization. It is worthy of clinical promotion.

[Key words] Accelerated rehabilitation surgery concept; Scarred uterus; Repeated pregnancy; Cesarean section

剖宫产不仅可以减轻产妇阵痛的痛苦，并且是临床上解决难产及高危妊娠的重要手段，可有效降低各种不良因素对母婴的影响[1]。近年来，随着国家实施二孩生育政策之后，瘢痕子宫再次妊娠孕妇日益增多，致使行再次剖宫产手术率不断上升。临床认为[2]围术期患者管理及并发症的处理是决定手术患者预后的要素之一，由于有过剖宫产手术史，其围术期的难度有所加大。因此对于瘢痕子宫再次剖宫产产妇而言，手术安全性及不良妊娠结局尤其需要高度关注[3]。有研究证实，加速康复外科（Enhanced rehabilitation after surgery，ERAS）理念集合多学科技术于一体[4]，该理念与传统围术期护理相比，可有效降低患者的创伤应激反应，减少产妇的机能损伤和促进其机能恢复，从而达到快速康复目的。……