運用術後加速康復療程行腰椎融合手術術後照護之成效

The effectiveness of post-operative care after lumbar fusion surgery using accelerated postoperative rehabilitation therapy

本研究旨在探討加速康復療程(ERAS)照護模式在65歲以上腰椎融合手術患者中的應用效果。採用回溯性研究法，分析2023年某區域教學醫院65歲以上住院患者的手術全期護理紀錄，共收案110位患者，其中67位接受傳統術式，43位接受ERAS照護模式。研究結果顯示，噁心嘔吐發生率、管路留置率、術後下床時間、術後疼痛指數、住院天數等均達顯著(p<.05)。雖然麻醉甦醒時間、噁心嘔吐的發生率在統計上未達顯著性，但ERAS組的噁心嘔吐發生率為9.3%，顯著低於傳統組的22.4%。麻醉甦醒時間ERAS組平均為7.79小時，相較於傳統組的13.50小時縮短42.3%。此外，ERAS組的導尿管使用率僅為9.3%，完全不需要使用引流管；另外術後下床活動時間ERAS組平均0.23天，遠低於傳統組2.94天。最終，平均住院天數ERAS組為1.98天，低於傳統組的5.45天。總結來說，ERAS組的病人在手術後醒來時能很快回應醫生的問題，甚至還可以下床走動。這說明ERAS照護模式在腰椎融合手術中展現出顯著的臨床優勢。不僅讓病人更滿意，還縮短了住院時間，節省了醫療資源。建議未來研究可擴大隨機對照試驗，以及進行長期預後評估和成本效益分析，以嘉惠腰椎融合手術的標準照護模式，增進患者手術安全及術後護理。

This study aims to investigate the effectiveness of Enhanced Recovery After Surgery (ERAS) care protocol in patients aged 65 and above undergoing lumbar fusion surgery. Using a retrospective research method, perioperative nursing records of hospitalized patients aged 65 and above from a regional teaching hospital in 2023 were analyzed, including 110 patients, of whom 67 received traditional surgery and 43 received ERAS care protocol. Research results showed significant differences (p<.05) in rates of nausea and vomiting, tube retention, time to post-operative ambulation, post-operative pain index, and length of hospital stay. Although the time to anesthesia recovery and incidence of nausea and vomiting did not reach statistical significance, the ERAS group showed a nausea and vomiting rate of 9.3%, significantly lower than the traditional group's 22.4%. The average anesthesia recovery time in the ERAS group was 7.79 hours, 42.3% shorter than the traditional group's 13.50 hours. Furthermore, the catheter usage rate in the ERAS group was only 9.3%, with no need for drainage tubes; the average time to post-operative ambulation was 0.23 days, much lower than the traditional group's 2.94 days. Finally, the average length of hospital stay for the ERAS group was 1.98 days, lower than the traditional group's 5.45 days. In conclusion, patients in the ERAS group could quickly respond to doctors' questions after surgery and even walk. This demonstrates that the ERAS care protocol shows significant clinical advantages in lumbar fusion surgery. It not only increases patient satisfaction but also reduces hospital stay and conserves medical resources. Future research suggestions include expanding randomized controlled trials, conducting long-term prognosis evaluations, and cost-effectiveness analyses to benefit the standard care protocol for lumbar fusion surgery and enhance patient surgical safety and post-operative care.