加速康复外科临床路径应用于腹腔镜全子宫切除术患者的相关研究
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摘要
目的分析加速康复外科临床路径在腹腔镜全子宫切除术患者诊治中的应用效果,探讨其实践经验。方法选取青海交通医院妇产科2015年1月至2016年12月期间收治的子宫肌瘤、子宫腺肌症、宫颈病变以及子宫内膜病变患者,筛选出拟行腹腔镜全子宫切除术者108例,按随机数字表法分为两组,观察组采用加速康复外科临床路径诊治,对照组采用常规临床路径诊治;记录并比较两组病例一般资料和实施临床路径相关指标。结果观察组与对照组各纳入54例,两组年龄、BMI、腹部手术史以及疾病构成情况比较差异无统计学意义(P>0. 05);观察组术后排气时间[(19.5±5. 6)h vs (24. 2±7. 5)h]、下地活动时间[(17.2±7. 5)h vs (26. 4±5. 3)h]、留置尿管时间[(18.1±3.9)h vs (30.5±4.7)h]、住院时间[(5.2±1.1)d vs (6.3±1.7)d]和住院费用[(13 688.2±709.6)元vs (15 793. 4±1 021. 3)元]均少于对照组,差异有统计学意义(P <0. 05);两组手术时间[(66. 9±27. 3)min vs (72. 0±34. 4)min]、手术出血量[(88.4±39. 7)ml vs (101. 8±42. 2)ml]以及并发症发生率(13. 0%vs 9. 3%)比较差异无统计学意义(P>0. 05)。结论将加速康复外科临床路径引入至腹腔镜全子宫切除术患者围术期管理中,能够加快患者术后康复进程、减少住院时间和住院费用,具有重要意义。
Objective To investigate the effect of clinical pathway of enhanced recovery after surgery in patients undergoing laparoscopic hysterectomy. Methods All patients with uterine fibroids, uterine adenomyosis, cervical lesions and endometrial lesions were selected in Qinghai Provincial Traffic Hospital during the period of January 2015 to December 2016. Among them, 108 cases undergoing laparoscopic hysterectomy were analyzed and enrolled in the study. They were randomly divided into two groups. The observation group was treated with clinical pathway of enhanced recovery, while the control group received routine clinical pathway. The general situation, clinical pathway related indicators were recorded and compared between the two groups. Results The average age, BMI, abdominal surgery history and disease composition of the two groups were not statistically significant(P >0. 05). The exhaust time [(19. 5 ±5. 6)h vs(24. 2± 7. 5) h],activity time [(17. 2 ± 7. 5) h vs(26.4 ± 5. 3) h],indwelling catheter time [(18. 1 ± 3. 9) h vs(30. 5 ± 4. 7) h],average hospitalization days [(5.2±1. 1) days vs(6. 3 ± 1. 7) days ] and hospitalization expenses [(13 688. 2 ±709. 6)yuan vs(15 793, 4 ± 1 021. 3) yuan] of the observation group were less than those of the control group, with statistically significance difference(P < 0. 05). Conclusions Clinical pathway of enhanced recovery after surgery can speed up the rehabilitation of laparoscopic hysterectomy,improve the patient's medical experience and shorten the average length of stay.
Objective To investigate the effect of clinical pathway of enhanced recovery after surgery in patients undergoing laparoscopic hysterectomy. Methods All patients with uterine fibroids, uterine adenomyosis, cervical lesions and endometrial lesions were selected in Qinghai Provincial Traffic Hospital during the period of January 2015 to December 2016. Among them, 108 cases undergoing laparoscopic hysterectomy were analyzed and enrolled in the study. They were randomly divided into two groups. The observation group was treated with clinical pathway of enhanced recovery, while the control group received routine clinical pathway. The general situation, clinical pathway related indicators were recorded and compared between the two groups. Results The average age, BMI, abdominal surgery history and disease composition of the two groups were not statistically significant(P >0. 05). The exhaust time [(19. 5 ±5. 6)h vs(24. 2± 7. 5) h],activity time [(17. 2 ± 7. 5) h vs(26.4 ± 5. 3) h],indwelling catheter time [(18. 1 ± 3. 9) h vs(30. 5 ± 4. 7) h],average hospitalization days [(5.2±1. 1) days vs(6. 3 ± 1. 7) days ] and hospitalization expenses [(13 688. 2 ±709. 6)yuan vs(15 793, 4 ± 1 021. 3) yuan] of the observation group were less than those of the control group, with statistically significance difference(P < 0. 05). Conclusions Clinical pathway of enhanced recovery after surgery can speed up the rehabilitation of laparoscopic hysterectomy,improve the patient's medical experience and shorten the average length of stay.
引文
[1]边立华,王楠,范文生,等.腹腔镜全子宫切除术中结扎束血管闭合系统的应用研究[J/CD].中华腔镜外科杂志:电子版,2016,9(6):358-361. DOI:10. 3877/cma. j. issn. 1674-6899.2016.06.011.
[2]谢彩霞,李爱明,范淑静,等.腹腔镜全子宫切除术与开腹手术在大子宫良性病变治疗的回顾性队列研究[J].中国医师杂志,2017, 19(2):296-298. DOI:10. 3760/cma. j. issn. 1008-1372.2017.02.037.
[3]Wodlin NB,Nilsson L. The development of fast-track principles in gynecological surgery. Acta Obstet Gynecol Scand[J]. 2012, 92(1):17-27. DOI:10.1111/j. 1600-0412.2012.01525. x.
[4]郭筱萍,杨丽霞,刘波,等.妇科单病种实施临床路径的应用效果[J].医学信息,2015,28(z3):82-83. DOI:10. 3969/j. issn.1006-1959.2015.z3.113.
[5]李明子.临床路径的基本概念及其应用[J].中华护理杂志,2010,45(1):59-61. DOI:10. 3761/j. issn. 0254-1769.2010.01.023.
[6]郑飞,于慧敏,高丽.肠外营养在妇科恶性肿瘤患者围术期的应用[J].现代实用医学,2016,28(7):917-918. DOI:10. 3969/j. issn. 1671-0800.2016.07.039.
[7]杜盟盟,刘红,王蓉蓉,等.子宫切除手术方式新进展[J].中国医师杂志,2016,18(1):157-160. DOI:10. 3760/cma.j.issn.1008-1372.2016.01.052.
[8] Lawal AK, Rotter T, Kinsman L, et al. What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review[J]. BMC Med,2016,14:35. DOI:10.1186/s12916-016-0580-z.
[9] Wilmore DW, Kehlet H. Management of patients in fast track surgery[J]. BMJ, 2001,322(7284):473 476. DOI:10.1136/bmj. 322.7284.473.
[10] Moller C, Kehlet H, Friland SG, et al. Fast track hysterectomy[J]. Eur J Obstet Gynecol Reprod Biol, 2001,98(1):18-22.DOI:https://doi. org/10. 1016/S0301-2115(01)00342-6.
[11] Nelson G, Kalogera E, Dowdy SC. Enhanced recovery pathways in gynecologic oncology[J]. Gynecol Oncol, 2014,135(3):586-594. DOI:10.1016/j.ygyno.2014.10.006.
[12] Nelson G, Altman AD, Nick A, et al. Guidelines for pre-and intra-operative care in gynecologic/oncology surgery:Enhanced Recovery After Surgery(ERAS?)Society recommendations--Part I[J]. Gynecol Oncol, 2016,140(2):313-322. DOI:10. 1016/j.ygyno. 2015.11.015.
[13]贺红英,李力,陈江鸿,等.腹腔镜子宫切除术治疗妇科良性疾病疗效的系统评价[J].中国循证医学杂志,2013,13(1):62-69. DOI:10.7507/1672-2531.20130013.
[14] Nelson G, Altman AD, Nick A, et al. Guidelines for postoperative care in gynecologic/oncology surgery:Enhanced Recovery After Surgery(ERAS?)Society recommendations--Part II[J]. Gynecol Oncol, 2016,140(2):323-332. DOI:10. 1016/j. ygyno.2015.12.019.
[15] Steinberg AC, Schimpf MO, White AB, et al. Preemptive analgesia for postoperative hysterectomy pain control:systematic review and clinical practice guidelines[J]. Am J Obstet Gynecol, 2017,217(3):303-313.e6. DOI:10.1016/j. ajog.2017.03.013.
[16]郭顺萍,刘豫瑞,蒋文欣,等.临床路径变异控制的思考[J].中国病案,2016,17(1):18-21,36.
[17] Miller S, Abalos E, Chamillard M, et al. Beyond too little, too late and too much, too soon:a pathway towards evidence-based,respectful maternity care worldwide[J]. Lancet, 2016, 388(10056):2176-2192. DOI:10.1016/S0140-6736(16)31472-6.
[18] Lassen PD, Moeller-Larsen H, DE NP. Same-day discharge after laparoscopic hysterectomy[J]. Acta Obstet Gynecol Scand, 2012,91(11):1339-1341. DOI:10.1111/j. 1600-0412. 2012. 01535.x.
[2]谢彩霞,李爱明,范淑静,等.腹腔镜全子宫切除术与开腹手术在大子宫良性病变治疗的回顾性队列研究[J].中国医师杂志,2017, 19(2):296-298. DOI:10. 3760/cma. j. issn. 1008-1372.2017.02.037.
[3]Wodlin NB,Nilsson L. The development of fast-track principles in gynecological surgery. Acta Obstet Gynecol Scand[J]. 2012, 92(1):17-27. DOI:10.1111/j. 1600-0412.2012.01525. x.
[4]郭筱萍,杨丽霞,刘波,等.妇科单病种实施临床路径的应用效果[J].医学信息,2015,28(z3):82-83. DOI:10. 3969/j. issn.1006-1959.2015.z3.113.
[5]李明子.临床路径的基本概念及其应用[J].中华护理杂志,2010,45(1):59-61. DOI:10. 3761/j. issn. 0254-1769.2010.01.023.
[6]郑飞,于慧敏,高丽.肠外营养在妇科恶性肿瘤患者围术期的应用[J].现代实用医学,2016,28(7):917-918. DOI:10. 3969/j. issn. 1671-0800.2016.07.039.
[7]杜盟盟,刘红,王蓉蓉,等.子宫切除手术方式新进展[J].中国医师杂志,2016,18(1):157-160. DOI:10. 3760/cma.j.issn.1008-1372.2016.01.052.
[8] Lawal AK, Rotter T, Kinsman L, et al. What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review[J]. BMC Med,2016,14:35. DOI:10.1186/s12916-016-0580-z.
[9] Wilmore DW, Kehlet H. Management of patients in fast track surgery[J]. BMJ, 2001,322(7284):473 476. DOI:10.1136/bmj. 322.7284.473.
[10] Moller C, Kehlet H, Friland SG, et al. Fast track hysterectomy[J]. Eur J Obstet Gynecol Reprod Biol, 2001,98(1):18-22.DOI:https://doi. org/10. 1016/S0301-2115(01)00342-6.
[11] Nelson G, Kalogera E, Dowdy SC. Enhanced recovery pathways in gynecologic oncology[J]. Gynecol Oncol, 2014,135(3):586-594. DOI:10.1016/j.ygyno.2014.10.006.
[12] Nelson G, Altman AD, Nick A, et al. Guidelines for pre-and intra-operative care in gynecologic/oncology surgery:Enhanced Recovery After Surgery(ERAS?)Society recommendations--Part I[J]. Gynecol Oncol, 2016,140(2):313-322. DOI:10. 1016/j.ygyno. 2015.11.015.
[13]贺红英,李力,陈江鸿,等.腹腔镜子宫切除术治疗妇科良性疾病疗效的系统评价[J].中国循证医学杂志,2013,13(1):62-69. DOI:10.7507/1672-2531.20130013.
[14] Nelson G, Altman AD, Nick A, et al. Guidelines for postoperative care in gynecologic/oncology surgery:Enhanced Recovery After Surgery(ERAS?)Society recommendations--Part II[J]. Gynecol Oncol, 2016,140(2):323-332. DOI:10. 1016/j. ygyno.2015.12.019.
[15] Steinberg AC, Schimpf MO, White AB, et al. Preemptive analgesia for postoperative hysterectomy pain control:systematic review and clinical practice guidelines[J]. Am J Obstet Gynecol, 2017,217(3):303-313.e6. DOI:10.1016/j. ajog.2017.03.013.
[16]郭顺萍,刘豫瑞,蒋文欣,等.临床路径变异控制的思考[J].中国病案,2016,17(1):18-21,36.
[17] Miller S, Abalos E, Chamillard M, et al. Beyond too little, too late and too much, too soon:a pathway towards evidence-based,respectful maternity care worldwide[J]. Lancet, 2016, 388(10056):2176-2192. DOI:10.1016/S0140-6736(16)31472-6.
[18] Lassen PD, Moeller-Larsen H, DE NP. Same-day discharge after laparoscopic hysterectomy[J]. Acta Obstet Gynecol Scand, 2012,91(11):1339-1341. DOI:10.1111/j. 1600-0412. 2012. 01535.x.