Kết quả bước đầu áp dụng chương trình hồi phục sớm cho phẫu thuật tim hở tại bệnh viện Trung ương Huế
Authors: Đặng Uyên 
Published: May 2023

Đặt vấn đề: Enhanced Recovery After Surgery (ERAS) là một chiến lược tiếp cận toàn diện kết hợp đa phương thức, đa mô thức, dựa trên bằng chứng để điều trị, chăm sóc bệnh nhân phẫu thuật nhằm mục đích tối ưu hóa kết quả và quản lý chu phẫu. Nhiều quan điểm và thói quen theo lối chăm sóc cũ trước đây đã thay đổi, càng tập hợp được nhiều yếu tố trong chiến lược chăm sóc toàn diện càng thúc đẩy khả năng hồi phục sớm cho người bệnh, góp phần nâng cao chất lượng điều trị, giảm các biến chứng, thời gian nằm viện và chi phí điều trị cho người bệnh. Phẫu thuật tim là một phẫu thuật đặc biệt, trên những bệnh nhân có bệnh lý nền tim mạch, thời gian phẫu thuật dài, có nhiều nguy cơ biến chứng sau phẫu thuật, do đó đòi hỏi sự chuẩn bị bệnh nhân chu đáo trước phẫu thuật, chăm sóc bệnh nhân trong và sau phẫu thuật với sự tham gia của nhiều chuyên khoa. Do vậy, nghiên cứu này nhằm mục đích đánh giá hiệu quả bước đầu áp dụng chương trình hồi phục sớm cho phẫu thuật tim hở tại bệnh viện Trung Ương Huế.

Đối tượng, phương pháp: Nghiên cứu mô tả cắt ngang có so sánh trên những bệnh nhân được phẫu thuật tim hở tại Khoa GMHSTM - Trung tâm Tim mạch - Bệnh viện Trung Ương Huế từ tháng 05/2021 đến tháng 08/2022. Số liệu được xử lý bằng phần mềm R4.2.2.

Kết quả: Nghiên cứu trên 2 nhóm bệnh nhân phẫu thuật tim hở. Nhóm 1: 60 bệnh nhân được thực hiện đầy đủ theo chương trình ERAS cho phẫu thuật tim, nhóm 2: 60 bệnh nhân được chuẩn bị, điều trị và chăm sóc thường quy. Kết quả cho thấy trên 120 bệnh nhân phẫu thuật tim hở: độ tuổi trung bình là 64,75 ± 8,95 tuổi, tỷ lệ nam/nữ là 75/45, 2 bệnh lý kèm thường gặp là tăng huyết áp (85 bệnh nhân) và đái tháo đường (35 bệnh nhân), 58,33% bệnh nhân có phân độ NYHA I, II trước phẫu thuật, 23,33% bệnh nhân có EF ≤ 40%, 58,33% bệnh nhân có EF > 50%. Nghiên cứu kết quả sau phẫu thuật giữa 2 nhóm cho thấy nhóm 1 có thời gian thở máy, thời gian nằm hồi sức, thời gian nằm viện ngắn hơn nhóm 2. Cụ thể, thời gian thở máy nhóm 1: 8,12 ± 2,07 giờ; nhóm 2: 8,88 ± 1,73 giờ, thời gian nằm hồi sức nhóm 1: 4,19 ± 1,04 ngày; nhóm 2:5,00 ± 0,85 ngày, thời gian nằm viện nhóm 1: 15,00 ± 3,01 ngày; nhóm 2: 18,90 ± 3,09 ngày. Nghiên cứu cũng cho thấy lượng Opioid cần sử dụng trên nhóm 1: 8,15 ± 8,03 mg, thấp hơn nhóm 2 12,3 ± 8,42mg. Các biến chứng sau phẫu thuật như chảy máu phải phẫu thuật lại, tổn thương thận cấp, tràn máu màng phổi phải dẫn lưu, viêm phổi, suy tim nặng cần hỗ trợ IABP, nhiễm trùng vết mổ, viêm xương ức, tổn thương thần kinh trung ương, tử vong trên nhóm 1 thấp hơn ở nhóm 2 tuy nhiên tỷ lệ biến chứng thấp nên chưa có ý nghĩa thống kê.

Kết luận: ERAS là một chiến lược điều trị, chăm sóc bệnh nhân phẫu thuật toàn diện. Việc áp dụng ERAS trong phẫu thuật tim hở giúp giảm đáng kể thời gian thở máy, thời gian nằm hồi sức, thời gian nằm viện.

ABSTRACT THE EARLY RESULT OF USING ERAS FOR OPEN-HEART SURGERY AT HUE CENTRAL HOSPITAL

Background: Enhanced Recovery After Surgery (ERAS) is a comprehensive, multimodal, evidence-based approach to the treatment and care of surgical patients for the ultimate outcome optimization and perioperative management. Many views and habits of the old way of care have changed, the more elements are gathered in the comprehensive care strategy, the better the possibility of early recovery for patients, contributing to improving the quality of treatment, reducing complications, length of hospital stay and treatment costs for patients. Cardiac surgery is a special surgery, these patients had cardiovascular disease, long operative time, high risk of postoperative complications, thus requiring careful preoperative patient preparation, care for patients during and after surgery with the participation of many specialties. Therefore, this study aims to evaluate the initial effectiveness of applying ERAS for open-heart surgery at Hue Central Hospital.

Methods: A comparative cross-sectional descriptive study on patients undergoing open-heart surgery at the Cardiovascular Anesthesiology Department - Cardiovascular Center - Hue Central Hospital May 2021 to August 2022. The data were processed by software R4.2.2.

Results: A Study on 2 groups of open-heart surgery patients. Group 1: 60 patients were fully implemented under the ERAS program for cardiac surgery, group 2: 60 patients received routine preparation, treatment and care. The results showed that on 120 open-heart surgery patients: the average age of 64.75 ± 8.95 years old, male/female ratio í 75/45, 2 common comorbidities were hypertension (85 patients) and diabetes (35 patients), 58.33% of patients had NYHA class I, II before surgery, 23.33% of patients had EF ≤ 40%, 58.33% of patients had EF > 50%. The study on postoperative results between the 2 groups showed that group 1 had a shorter extubation time, ICU stay, and hospital stay than group 2. Specifically, the mechanical ventilation time group 1: 8.12 ± 2.07 hours; group 2: 8.88 ± 1.73 hours, The average length of stay in the ICU in group 1: 4.19 ± 1.04 days; group 2:5,00 ± 0.85 days, the days of hospitalization in group 1: 15.00 ± 3.01 days; group 2: 18.90 ± 3.09 days. The study also showed that the dose of Opioid needed to be used in group 1: 8.15 ± 8.03 mg, lower than group 2: 12.3 ± 8.42mg. Post - operative complications such as bleeding requiring reoperation, acute kidney injury, hemothorax requiring drainage, pneumonia, severe heart failure requiring IABP support, surgical infection, sternal inflammation, central nervous system, mortality in group 1 was lower than in group 2, but the complication rate was low, so it was not statistically significant.

Conclusion: ERAS is a comprehensive surgical patient care and treatment strategy. The application of ERAS in open - heart surgery significantly reduces the time of mechanical ventilation, the length of stay in the ICU, and the days of hospitalization.