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Open Access Article

Journal of Modern Nursing Medicine. 2025; 4: (1) ; 172-177 ; DOI: 10.12208/j.jmnm.20250056.

Research progress on influencing factors of rapid recovery after thoracic surgery
胸外科患者术后快速康复影响因素的研究进展

作者: 文华艳, 陈敏 *, 杨东

贵黔国际总医院胸心外科 贵州贵阳

*通讯作者: 陈敏,单位:贵黔国际总医院胸心外科 贵州贵阳;

发布时间: 2025-01-21 总浏览量: 59

摘要

胸外科患者术后常面临着肺部并发症、疼痛、PONV及心律失常等不利影响因素的威胁,严重影响患者术后快速康复,增加患者医疗负担。如何有效预防及治疗术后各种并发症,是保证医疗安全、加速胸外科患者术后快速康复的重要保障。本研究将胸外科患者术后康复的不利影响因素进行总结,旨在为胸外科手术患者的管理、加速患者术后康复提供参考。

关键词: 胸外科手术;快速康复;肺部并发症;疼痛;PONV;心率失常

Abstract

Thoracic surgery patients often face the threat of adverse factors such as pulmonary complications, pain, PONV and arrhythmia after surgery, which seriously affect the rapid recovery of patients after surgery and increase the medical burden of patients. How to effectively prevent and treat various postoperative complications is an important guarantee to ensure medical safety and accelerate the rapid recovery of thoracic surgery patients. This study summarized the adverse factors affecting the postoperative rehabilitation of thoracic surgery patients, the aim is to provide reference for the management of thoracic surgery patients and to accelerate the postoperative rehabilitation of patients.

Key words: Thoracic surgery; Rapid recovery; Pulmonary complications; Pain; PONV; Arrhythmia

参考文献 References

[1] ZHAO Y, ZHENG R, XIANG W, et al. Systematic review and meta-analysis on perioperative intervention to prevent postoperative atelectasis complications after thoracic surgery [J]. Annals of Palliative Medicine, 2021, 10(10): 10726-34.

[2] 陶为杰, 石小举, 孙晓东, et al. 快速康复外科理念在肝移植围手术期应用的研究进展 [J]. 中华肝胆外科杂志, 2017, (01): 60-3.

[3] DING Q, ZHANG W, WEI L, et al. Application of rapid rehabilitation surgical concept in perioperative nursing of patients undergoing single-port thoracoscopic lobectomy [J]. Minerva Medica, 2023, 113(6).

[4] BOGANI G, SARPIETRO G, FERRANDINA G, et al. Enhanced recovery after surgery (ERAS) in gynecology oncology [J]. European Journal of Surgical Oncology, 2021, 47(5): 952-9.

[5] NOBA L, RODGERS S, CHANDLER C, et al. Enhanced Recovery After Surgery (ERAS) Reduces Hospital Costs and Improve Clinical Outcomes in Liver Surgery: a Systematic Review and Meta-Analysis [J]. Journal of Gastrointestinal Surgery, 2020, 24(4): 918-32.

[6] DEBONO B, WAINWRIGHT T W, WANG M Y, et al. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations [J]. The Spine Journal, 2021, 21(5): 729-52.

[7] FERNANDEZ-BUSTAMANTE A, FRENDL G, SPRUNG J, et al. Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery [J]. JAMA Surgery, 2017, 152(2).

[8] LUGG S T, AGOSTINI P J, TIKKA T, et al. Long-term impact of developing a postoperative pulmonary complication after lung surgery [J]. Thorax, 2016, 71(2): 171-6.

[9] GRANELL-GIL M, MURCIA-ANAYA M, SEVILLA S, et al. Clinical guide to perioperative management for videothoracoscopy lung resection (Section of Cardiac, Vascular and Thoracic Anesthesia, SEDAR; Spanish Society of Thoracic Surgery, SECT; Spanish Society of Physiotherapy) [J]. Revista Española de Anestesiología y Reanimación (English Edition), 2022, 69(5): 266-301.

[10] BRUNELLI A, REFAI M, SALATI M, et al. Predicted Versus Observed FEV1 and Dlco After Major Lung Resection: A Prospective Evaluation at Different Postoperative Periods [J]. The Annals of Thoracic Surgery, 2007, 83(3): 1134-9.

[11] 姜格宁, 张雷, 朱余明, et al. 肺切除手术患者术前肺功能评估肺科共识 [J]. 临床医学研究与实践, 2020, 5(01): 201.

[12] 刘朝, 肖丹. 吸烟与呼吸系统疾病的关系及科学戒烟治疗方法 [J]. 国际呼吸杂志, 2024, (03): 272-8.

[13] LUGG S T, TIKKA T, AGOSTINI P J, et al. Smoking and timing of cessation on postoperative pulmonary complications after curative-intent lung cancer surgery [J]. Journal of Cardiothoracic Surgery, 2017, 12(1).

[14] GALLART L, CANET J. Post-operative pulmonary complications: Understanding definitions and risk assessment [J]. Best Practice & Research Clinical Anaesthesiology, 2015, 29(3): 315-30.

[15] VOGELMEIER C F, CRINER G J, MARTíNEZ F J, et al. Informe 2017 de la Iniciativa Global para el Diagnóstico, Tratamiento y Prevención de la Enfermedad Pulmonar Obstructiva Crónica: Resumen Ejecutivo de GOLD [J]. Archivos de Bronconeumología, 2017, 53(3): 128-49.

[16] SANCHEZ LEON R M, RAJARAMAN A, KUBWIMANA M N. Optimizing Nutritional Status of Patients Prior to Major Surgical Intervention [J]. Methodist DeBakey Cardiovascular Journal, 2023, 19(4): 85-96.

[17] MARTíNEZ-ORTEGA A J, PIñAR-GUTIéRREZ A, SERRANO-AGUAYO P, et al. Perioperative Nutritional Support: A Review of Current Literature [J]. Nutrients, 2022, 14(8).

[18] WU L, YANG L, YANG Y, et al. Ultrasound-guided versus conventional lung recruitment manoeuvres in thoracic surgery: a randomised controlled study [J]. Journal of Clinical Monitoring and Computing, 2024, 38(3): 731-9.

[19] 刘金阳, 尚自强, 郝磊磊, et al. 电视胸腔镜手术和传统开胸手术治疗胸腺瘤患者的临床效果 [J]. 深圳中西医结合杂志, 2023, 33(8): 76-8.

[20] BATTAGLINI D, BALL L, WITTENSTEIN J, et al. PEEP in thoracic anesthesia: pros and cons [J]. Minerva Anestesiologica, 2021, 87(2).

[21] 中华医学会麻醉学分会"围术期肺保护性通气策略临床应用专家共识"工作小组. 围术期肺保护性通气策略临床应用专家共识[J]. 中华麻醉学杂志, 2020, (05): 513-9.

[22] 吴觉伦, 申乐. 肥胖患者围术期肺保护性通气策略的研究进展 [J]. 中华麻醉学杂志, 2023, (02): 244-8.

[23] STENBERG E, DOS REIS FALCãO L F, O'KANE M, et al. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update [J]. World Journal of Surgery, 2022, 46(4): 729-51.

[24] 中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021)(一) [J]. 中华麻醉学杂志, 2021, (09): 1028-34.

[25] SINGER M, YOUNG P J, LAFFEY J G, et al. Dangers of hyperoxia [J]. Critical Care, 2021, 25(1).

[26] 陈雪姿, 王彬. 单肺通气肺萎陷及肺复张的方法及进展 [J]. 河北医科大学学报, 2023, 44(09): 1108-13.

[27] TAKENAKA S, SAEKI A, SUKENAGA N, et al. Acute and chronic neuropathic pain profiles after video-assisted thoracic surgery [J]. Medicine, 2020, 99(13).

[28] WEI S, ZHANG G, MA J, et al. Randomized controlled trial of an alternative drainage strategy vs routine chest tube insertion for postoperative pain after thoracoscopic wedge resection [J]. BMC Anesthesiology, 2022, 22(1).

[29] MARSHALL K, MCLAUGHLIN K. Pain Management in Thoracic Surgery [J]. Thoracic Surgery Clinics, 2020, 30(3): 339-46.

[30] JOSHI G P, OGUNNAIKE B O. Consequences of Inadequate Postoperative Pain Relief and Chronic Persistent Postoperative Pain [J]. Anesthesiology Clinics of North America, 2005, 23(1): 21-36.

[31] LEANDRO J D, RODRIGUES O R, SLAETS A F F, et al. Comparison between two thoracotomy closure techniques: postoperative pain and pulmonary function [J]. Jornal Brasileiro de Pneumologia, 2014, 40(4): 389-96.

[32] FERAY S, LUBACH J, JOSHI G P, et al. PROSPECT guidelines for video‐assisted thoracoscopic surgery: a systematic review and procedure‐specific postoperative pain management recommendations [J]. Anaesthesia, 2021, 77(3): 311-25.

[33] ODERDA G M, SENAGORE A J, MORLAND K, et al. Opioid-related respiratory and gastrointestinal adverse events in patients with acute postoperative pain: prevalence, predictors, and burden [J]. J Pain Palliat Care Pharmacother, 2019, 33(3-4): 82-97.

[34] 段函宇, 刘子嘉, 许广艳, et al. 胸腔镜肺叶切除术的快速康复外科多模式镇痛管理 [J]. 中国医学科学院学报, 2021, 43(1): 136-43.

[35] YAN X, LIANG C, JIANG J, et al. Effects of opioid-free anaesthesia on postoperative nausea and vomiting in patients undergoing video-assisted thoracoscopic surgery (OFA-PONV trial): study protocol for a randomised controlled trial [J]. Trials, 2023, 24(1).

[36] WU S, GAN C, HUANG X, et al. Incidence and risk factors of postoperative nausea and vomiting in lung cancer patients following lobectomy and application of analgesic pumps [J]. Journal of International Medical Research, 2022, 50(6).

[37] NAKAI A, NAKADA T, OKAMOTO S, et al. Risk factors for postoperative nausea and vomiting after thoracoscopic pulmonary wedge resection: pitfalls of an increased fentanyl dose [J]. Journal of Thoracic Disease, 2021, 13(6): 3489-96.

[38] GAN T J, DIEMUNSCH P, HABIB A S, et al. Consensus Guidelines for the Management of Postoperative Nausea and Vomiting [J]. Anesthesia & Analgesia, 2014, 118(1): 85-113.

[39] 张美怡, 宋吉贵, 周凯, et al. 成人术后恶心呕吐评估和预防指南的系统评价 [J]. 中华现代护理杂志, 2023, (17): 2274-81.

[40] HOOPER V D. SAMBA Consensus Guidelines for the Management of Postoperative Nausea and Vomiting: An Executive Summary for Perianesthesia Nurses [J]. Journal of PeriAnesthesia Nursing, 2015, 30(5): 377-82.

[41] DOBREV D, AGUILAR M, HEIJMAN J, et al. Postoperative atrial fibrillation: mechanisms, manifestations and management[J]. Nature Reviews Cardiology, 2019, 16(7): 417-36.

[42] DIALLO E H, BROUILLARD P, RAYMOND J M, et al. Predictors and impact of postoperative atrial fibrillation following thoracic surgery: a state‐of‐the‐art review [J]. Anaesthesia, 2023, 78(4): 491-500.

[43] LIU J, HUANG Y, MA W, et al. Prediction, prevention and management of new onset perioperative atrial fibrillation and flutter in patients undergoing non-cardiac thoracic surgery [J]. Minerva Anestesiologica, 2022, 88(6).

[44] JANUARY C T, WANN L S, CALKINS H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons [J]. Circulation, 2019, 140(2).

[45] JANUARY C T, WANN L S, ALPERT J S, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary [J]. Circulation, 2014, 130(23): 2071-104.

[46] 聂晶, 田轶魁, 杨清. 开胸外科手术后心房颤动的处理策略进展 [J]. 中国动脉硬化杂志, 2020, 28(7): 634-8.

引用本文

文华艳, 陈敏, 杨东, 胸外科患者术后快速康复影响因素的研究进展[J]. 现代护理医学杂志, 2025; 4: (1) : 172-177.