加速康复外科理念联合清醒麻醉对脑胶质瘤预后的影响

Effect of the concept of enhanced recovery after surgery combined with awake anesthesia on the prognosis of glioma

摘要:

目的 探讨加速康复外科（ERAS）理念联合清醒麻醉下开颅对脑功能区胶质瘤患者预后的影响。方法 分析2019年9月—2020年9月西京医院神经外科收治的脑功能区胶质瘤患者90例，根据不同麻醉及处理方式分为全身麻醉（GA）组、清醒麻醉（AA）组和清醒麻醉联合加速康复外科理念（AA+ERAS）组各30例，收集并比较3组患者的性别、年龄、术前症状、肿瘤位置、侧别、病理级别、失血量、手术时间、切除程度、术后恶心呕吐、住院时间、术后癫痫、术后1周功能改善、术后2个月卡诺夫斯凯计分（KPS）等资料。所有病例都有2年随访资料，根据随访对死亡情况绘制生存曲线。结果 3组患者的预后指标中，AA+ERAS组的肿瘤全切程度高、术后恶心呕吐发生率低、住院时间短、术后2个月KPS高，结果均优于GA组和AA组，差异具有统计学意义（P<0.05），其余指标差异无统计学意义（P>0.05）。生存曲线结果显示术后2年的无进展生存率、总存活率均高于GA组和AA组，差异具有统计学意义（P<0.05）。结论 ERAS理念联合清醒麻醉可明显改善脑胶质瘤患者的预后，术后近期可减少患者术后应激反应和并发症，术后远期可延长患者生存率、提高患者生活质量，为临床治疗提供有力的理论依据和指导意义。国际神经病学神经外科学杂志, 2023, 50(2): 34-39]

Abstract:

Objective To investigate the effect of the enhanced recovery after surgery （ERAS） concept combined with craniotomy under awake anesthesia on the prognosis of patients with glioma in brain functional areas.Methods A retrospective analysis was performed for the clinical data of 90 patients with glioma in brain functional areas who were admitted to Department of Neurosurgery， Xijing Hospital， from September 2019 to September 2020， and according to different anesthesia and treatment methods， they were divided into general anesthesia （GA） group， awake anesthesia （AA） group， and ERAS+AA group， with 30 patients in each group. Related clinical data were compared between the three groups， including sex， age， preoperative symptoms， tumor location， side， pathological grade， blood loss， time of operation， extent of resection， postoperative nausea and vomiting， length of hospital stay， postoperative seizures， functional improvement at 1 week after surgery， and Karnofsky Performance Scale （KPS） score at 2 months after surgery. All patients were followed up for 2 years to plot survival curves based on mortality.Results As for the prognostic indicators， compared with the GA group and the AA group， the AA+ERAS group had a significantly higher degree of complete tumor resection， a significantly lower incidence rate of postoperative nausea and vomiting， a significantly shorter length of hospital stay， and a significantly higher KPS score at 2 months after surgery （P <0.05）， and there were no significant differences in the other indicators （P >0.05）. The survival curve analysis showed that the AA+ERAS group had significantly higher progression-free survival rate and overall survival rate than the GA group and the AA group at 2 years after surgery （P <0.05）.Conclusions The ERAS concept combined with awake anesthesia can significantly improve the prognosis of patients with glioma， reduce postoperative stress response and complications within a short term after surgery， and prolong survival time and improve quality of life in the long term after surgery， which provides a powerful theoretical basis and guiding significance for clinical treatment. ［Journal of International Neurology and Neurosurgery, 2023, 50(2): 34-39］