目的：对比分析加速康复外科（ERAS）理念下达芬奇机器人辅助胸腔镜手术（RATS）与单孔胸腔镜 手术（VATS）患者术后康复和疼痛情况。方法：回顾性分析 2021 年 9 月—2022 年 8 月在聊城市人民医院行 RATS 和单孔 VATS 的 68 例患者的临床资料，其中 RATS 组 33 例，单孔 VATS 组 35 例。两组患者均在 ERAS 理念下实施 多模式镇痛（MMA）管理方案，椎旁神经阻滞（PVB）联合静吸复合全麻，侧卧位下实施手术，术后急性疼痛服务 （APS）小组进行两次 / 天疼痛查房。比较两组患者的一般资料、手术时间、术中镇痛药物用量、术后入麻醉后恢 复室（PACU）、术后 24 h、48 h 和 72 h 患者的镇痛药物用量、恶心呕吐发生率、术后 24 h、48 h 和 72 h 的静息和 咳嗽疼痛评分，胸腔引流管的平均拔除时间、术后出院时间和首次下床活动时间。结果：两组患者均顺利完成手术， 无中转开胸。RATS 组手术时间和麻醉时间长于 VATS 组；两组患者术后 24 h 内的静息痛和咳嗽痛评分差异无统计 学意义（P>0.05），但 RATS 组患者术后 48 h 和 72 h 的静息痛和咳嗽痛评分低于单孔 VATS 组，且差异有统计学意 义（P<0.05）。RATS 组患者术后 48h、72h 阿片类药物用量低于单孔 VATS 组，差异有统计学意义（P<0.05）。两 组患者术后首次下床活动时间、胸腔引流管拔除时间、出院时间和术后麻醉并发症相比，差异无统计学意义（P>0.05）。 结论：基于 ERAS 理念实施 MMA，RATS 和单孔 VATS 有相似的围术期安全性和可靠性，但 RATS 手术时间、麻醉 时间长于单孔 VATS 组，RATS 术后 48 和 72 h 内静息、咳嗽疼痛评分和阿片药物用量低于单孔 VATS 组。

Objective: To compare the postoperative rehabilitation and pain of patients who underwent robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) based on the concept of enhanced recovery after surgery (ERAS). Methods: Clinical data of 68 patients who underwent RATS and single-port VATS in Liaocheng People’s Hospital from September 2021 to August 2022 were retrospectively analyzed. There were 33 cases in the RATS Group and 35 cases in single-port VATS Group. Patients in the two groups were both given multimodal analgesia (MMA) management program based on the concept of ERAS, paravertebral nerve block combined with intravenous inhalation and general anesthesia. Surgeries were performed in the lateral position. Patients were visited by Acute Pain Service (APS) twice a day after surgery for pain examination. The general data, operative time, intraoperative dosage of analgesics, postoperative dosage of analgesics in post anesthesia care unit (PACU), postoperative dosage of analgesics at 24 h, 48 h, 72 h after surgery, incidence of nausea and vomiting, resting and cough pain scores at 24 h, 48 h, 72 h after surgery, removal time of thoracic drainage, off-bed time, the length of hospital stay of patients in the two groups were compared. Results: All surgeries were successfully completed without conversion to thoracotomy. The operative time and anesthesia duration of patients in the RATS group were longer than those in the single-port VATS group. There was no significant difference in the pain scores at rest and cough within 24 h after surgery (P>0.05), but the pain scores at rest and cough in the RATS group were lower than those in the single-port VATS group at 48 h and 72 h after surgery (P<0.05). The dosage of opioids in the RATS group was lower than that in the single-port VATS group at 48 h and 72 h after surgery (P<0.05). There was no significant difference between the two groups in the time of getting out of bed, removal time of thoracic drainage, the length of hospital stay, the incidence of vomiting and adverse side effects of postoperative analgesia (P>0.05). Conclusion: Based on the concept of ERAS, the implementation of MMA management in RATS and singleport VATS have similar perioperative safety and reliability. However, the operative time and anesthesia duration in the RATS were longer than those in the single-port VATS. The resting and coughing pain scores at 48 h and 72 h after surgery and the opioid dosage at 48 h and 72 h after surgery were lower than those in the single-port VATS.

收稿日期：2023-09-21  录用日期：2024-05-16 

Received Date: 2023-09-21  Accepted Date: 2024-05-16 

基金项目：中华医学会杂志社 2021~2022 年护理学科研究发展课题（CMAPH-NRD2021057） 

Foundation Item: Nursing Research and Development Project of Chinese Medical Association Publishing House in 2021-2022 (CMAPH-NRD2021057) 

通讯作者：张英慧，Email：13346258672@163.com；刘冬华，Email：lyliudonghua@126.com 

Corresponding Author: ZHANG Yinghui, Email: 13346258672@163.com; LIU Donghua, Email: lyliudonghua@126.com 

引用格式：刘冬华，林艳荣，张英慧，等 . ERAS 理念下达芬奇机器人与单孔胸腔镜肺叶切除术患者术后康复和疼痛的对比研究 [J]. 机器人外科学杂志（中英文），2024，5（5）：926-931. 

Citation: LIU D H, LIN Y R, ZHANG Y H, et al. Comparative study of postoperative rehabilitation and pain in patients undergoing Da Vinci robot-assisted thoracoscopic surgery and single-port video-assisted thoracoscopic surgery based on the concept of ERAS [J]. Chinese Journal of Robotic Surgery, 2024, 5(5): 926-931.

[1] Baig M Z, Razi S S, Agyabeng-Dadzie K, et al. Robotic-assisted thoracoscopic surgery demonstrates a lower rate of conversion to thoracotomy than video-assisted thoracoscopic surgery for complex lobectomies[J]. Eur J Cardiothorac Surg, 2022, 62(3): 1-7. 

[2] Hofmann H S. Robotic-assisted thoracic surgery: currently available standard systems and future developments[J]. Zentralbl Chir, 2023, 148(1): 11-16. 

[3] 黄佳 , 田禹 , 陆佩吉 , 等 . 国产图迈 ® 微创腔镜手术机器人辅 助右肺上叶切除两例 [J]. 中国胸心血管外科临床杂志 , 2022, 29(4): 519-523. 

[4] Patel Y S, Hanna W C, Fahim C, et al. RAVAL trial: Protocol of an international, multi-centered, blinded, randomized controlled trial comparing robotic-assisted versus video-assisted lobectomy for earlystage lung cancer[J]. PLoS One, 2022, 17(2): e0261767. 

[5] Williams A M, Zhao L, Grenda T R, et al. Higher long-term quality of life metrics after video-assisted thoracoscopic surgery lobectomy compared with robotic-assisted lobectomy[J]. Ann Thorac Surg, 2022, 113(5): 1591-1597. 

[6] 李冰 , 刘瑶 , 康慷 , 等 . 胸科手术患者 PACU 中重度疼痛的危险 因素 [J]. 中华麻醉学杂志 , 2021, 41(1): 34-38. 

[7] 刘冬华 , 杨庆菊 , 王泽中 , 等 . 基于国际“PAIN OUT”调查 工具 PDCA 改进术后患者镇痛管理质量 [J]. 麻醉安全与质控 , 2021, 5(6): 403-408. 

[8] WANG H , LI S Q, LIANG N X, et al. Postoperative pain experiences in Chinese adult patients after thoracotomy and video-assisted thoracic surgery[J]. J Clin Nurs, 2017, 26(17): 2744-2754. 

[9] 魏华 , 甘祥芝 , 王德林 , 等 . 加速康复外科理念在机器人辅助腹 腔镜下前列腺癌根治术中的应用及效果观察 [J]. 机器人外科学 杂志 ( 中英文 ), 2023, 4(6): 549-555. 

[10] Merritt R E, D’Souza D M, Abdel-Rasoul M, et al. Analysis of outcomes for robotic-assisted lobectomy with an enhanced recovery after surgery protocol[J]. Ann Thorac Surg, 2023, 115(6): 1353-1359. 

[11] 邢晓羽 . 围手术期快速康复外科护理模式在达芬奇机器人肺 癌切除术患者中的应用 [J]. 当代护士 ( 上旬刊 ), 2022, 29(16): 67-70. 

[12] 赵磊 , 罗玉红 , 尹新玮 , 等 . 快速康复外科理念在机器人辅助前 列腺癌根治术中应用的 Meta 分析 [J]. 机器人外科学杂志 ( 中英 文 ), 2022, 3(3): 171-181. 

[13] 王刚 , 叶永强 , 谢宝龙 , 等 . 单孔胸腔镜肺癌根治术的临床应用 体会 [J]. 现代肿瘤医学 , 2019, 27(6): 988-990. 

[14] 张靖 , 路璐 , 王晓楠 , 等 . 达芬奇机器人与单孔、三孔胸腔镜 肺癌根治术的临床疗效比较 [J]. 现代肿瘤医学 , 2020, 28(12): 2046-2049. 

[15] 叶贯超 , 刘亚飞 , 张春敭 , 等 . 达芬奇机器人与胸腔镜肺段切除 术治疗早期非小细胞肺癌的有效性对比 [J]. 机器人外科学杂志 ( 中英文 ), 2021, 2(1): 1-9. 

[16] 李帅 , 曹国庆 , 许培培 , 等 . 机器人辅助胸腔镜与传统胸腔镜膈 肌折叠术治疗膈膨升的比较研究 [J]. 机器人外科学杂志 ( 中英 文 ), 2023, 4(2): 121-125. 

[17] 谭征 , 俞建根 , 梁靓 . 达芬奇机器人辅助腔镜技术在小儿胸科 手术中的应用 [J]. 中华小儿外科杂志 , 43(3): 206-209. 

[18] Mattioni G, Palleschi A, Mendogni P, et al. Approaches and outcomes of robotic-assisted thoracic surgery (RATS) for lung cancer: a narrative review[J]. J Robot Surg, 2021, 17(3): 797-809. 

[19] 李冰 , 刘瑶 , 康慷 , 等 . 胸科手术患者 PACU 中重度疼痛的危险 因素 [J]. 中华麻醉学杂志 , 2021, 41(1): 34-38. 

[20] 张冉 , 霍飞 , 田龙 , 等 . 超声引导下椎旁神经阻滞与肋间神经阻 滞用于胸腔镜肺部术后镇痛效果的比较 [J]. 临床麻醉学杂志 , 2022, 36(9): 886-889. 

[21] 秦雯 , 朱琴 . 80 例单辅助孔达芬奇机器人肝切除手术的护理配 合 [J].2023, 21(9): 1212-1215. 

[22] Darr C, Cheufou D, Weinreich G, et al. Robotic thoracic surgery results in shorter hospital stay and lower postoperative pain compared to open thoracotomy: a matched pairs analysis[J]. Surg Endosc, 2017, 31(10): 4126-4130. 

[23] 侯越 , 丁瑞芳 , 姜春平 , 等 . 达芬奇机器人手术护理团队的构建 与管理策略 [J]. 当代护士 , 2021, 28(36) ( 下旬刊 ): 181-183. 

[24] Palleschi A, Mattioni G, Mendogni P, et al. A real-world experience of transition to robotic-assisted thoracic surgery (RATS) for lung resections[J]. Front Surg, 2023, 1(10): 1-7. 

[25] 汤联 . 达芬奇机器人腹腔镜下前列腺癌根治术患者的围手术期 整体护理 [J]. 当代护士 ( 上旬刊 ), 2019, 26( 12) : 114-115. 

[26] Cohen T N, Anger J T, Shamash K, et al. Discovering the barriers to efficient robotic operating room turnover time: perceptions vs. reality[J]. Robot Surg, 2020, 14(5): 717-724.