加速康复外科在腹腔镜胆囊切除术中的应用
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摘要
目的探讨加速康复外科(enhanced recovery after surgery,ERAS)在腹腔镜胆囊切除术中的应用。方法选取2017年1～8月在邛崃市医疗中心接受腹腔镜胆囊切除术治疗的148例患者,采用随机数字表法分为处理组和对照组各74例。处理组采用ERAS流程,对照组采用常规流程。采用视觉模拟量表行术前1 h、术后6 h的饥饿评分与术后6、24 h的疼痛评分;评价两组患者术后6、24 h恶心呕吐(post-operative nausea and vomiting,PONV)程度,术后12、24 h腹胀程度;观察并记录术后48 h日常生活能力(activies of daily living,ADL)评分,疼痛、恶心呕吐、腹胀满意度及总体满意度等。结果处理组饥饿评分、术后疼痛评分、术后恶心呕吐评分与术后腹胀评分均明显低于对照组(P <0. 05);处理组ADL评分明显高于对照组,住院天数和总费用明显少于对照组(P <0. 05),处理组疼痛、恶心呕吐及腹胀控制满意度及总体满意度评分均明显高于对照组(P <0. 05)。结论应用ERAS流程可有效减轻腹腔镜胆囊切除术围手术期患者的腹胀、恶心呕吐等临床症状,减轻患者的疼痛,促进患者生活能力的恢复,促进患者的病情恢复,减轻患者经济负担,有实际推广意义。
Objective To investigate the application of enhanced recovery after surgery( ERAS) during the perioperative period of laparoscopic cholecystectomy.Methods We selected 148 patients with laparoscopic cholecystectomy in our hospital from January2017 to August 2017 as research subjects.The patients were randomly divided into experimental or control groups,74 in each group.The experimental group was given the procedure of ERAS while the control group was treated with routine procedure.VAS was used to assess the hunger score at one hour before operation and six hours after operation and the pain score at 6 and 24 hours after operation.The postoperative nausea and vomiting( PONV) at 6 and 24 hours after operation and activities of daily living( ADL) after 48 hours of operation as well as pain,nausea and vomiting,and abdominal distension satisfaction and overall satisfaction score were recorded and compared.Results The hunger score,postoperative pain score,postoperative nausea and vomiting score and postoperative bloating score were significantly lower in the treatment group than those in the control group( P < 0. 05).The ADL score of the treatment group was significantly higher than that of the control group,and the hospitalization days and total cost were significantly less than the control group( P < 0. 05).The pain,nausea and vomiting,bloating control satisfaction and overall satisfaction scores of the treatment group were significantly higher than those of the control group.Conclusion ERAS during the perioperative period of laparoscopic cholecystectomy can effectively reduce the abdominal distension,nausea and vomiting and other symptoms,reduce the pain of patients,promote the recover ability of patients,promote the recovery of patients and reduce the economic burden of patients.It has practical significance.
Objective To investigate the application of enhanced recovery after surgery( ERAS) during the perioperative period of laparoscopic cholecystectomy.Methods We selected 148 patients with laparoscopic cholecystectomy in our hospital from January2017 to August 2017 as research subjects.The patients were randomly divided into experimental or control groups,74 in each group.The experimental group was given the procedure of ERAS while the control group was treated with routine procedure.VAS was used to assess the hunger score at one hour before operation and six hours after operation and the pain score at 6 and 24 hours after operation.The postoperative nausea and vomiting( PONV) at 6 and 24 hours after operation and activities of daily living( ADL) after 48 hours of operation as well as pain,nausea and vomiting,and abdominal distension satisfaction and overall satisfaction score were recorded and compared.Results The hunger score,postoperative pain score,postoperative nausea and vomiting score and postoperative bloating score were significantly lower in the treatment group than those in the control group( P < 0. 05).The ADL score of the treatment group was significantly higher than that of the control group,and the hospitalization days and total cost were significantly less than the control group( P < 0. 05).The pain,nausea and vomiting,bloating control satisfaction and overall satisfaction scores of the treatment group were significantly higher than those of the control group.Conclusion ERAS during the perioperative period of laparoscopic cholecystectomy can effectively reduce the abdominal distension,nausea and vomiting and other symptoms,reduce the pain of patients,promote the recover ability of patients,promote the recovery of patients and reduce the economic burden of patients.It has practical significance.
引文
[1]戴蒙,刘艳梅,刘波,等.快速康复外科护理联合中医护理技术在腹腔镜胆囊切除术围手术期的应用研究进展[J].山西医药杂志,2017,46(15):1827-1829.
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[6] Yang M,Su W,Deng X,et al. Enhanced recovery after surgery program in patients from Tibet Plateau undergoing surgeries for hepatic alveolar echinococcosis[J]. Journal of Surgical Research,2017,219:188-193.
[7]靳红绪,黄立宁,王忠义,等.加速康复外科策略对腹腔镜结直肠癌手术患者术后恢复的影响[J].临床麻醉学杂志,2016,32(12):1149-1153.
[8]杨孟昌,苏文杰,邓佳,等.碳水化合物饮料对腹腔镜胆囊切除术患者术后恶心呕吐的影响[J].实用医院临床杂志,2017,14(5):223-225.
[9]Prevot F,Fuks D,Cosse C,et al.The Value of Abdominal Drainage After Laparoscopic Cholecystectomy for Mild or Moderate Acute Calculous Cholecystitis:A Post Hoc Analysis of a Randomized Clinical Trial[J].World Journal of Surgery,2016,40(11):2726-2734.
[10]郎海丽,蔡俊赢,周志东,等.术后加速康复对腹腔镜肝部分切除术患者免疫功能的影响[J].临床麻醉学杂志,2016,32(6):525-529.
[11]郭文娟,丁丽,周承刚,等.快速康复干预腹腔镜胆囊切除术围手术期抗菌药物的合理应用[J].医药导报,2017,36(9):1051-1053.
[2]Fry DE,Pine M,Nedza SM,et al.Comparison of Risk-Adjusted Outcomes in Medicare Open versus Laparoscopic Cholecystectomy.[J].American Surgeon,2018,84(1):12.
[3]Lindberg MF,Miaskowski C,Rustoen T,et al. The Impact of Demographic,Clinical,Symptom and Psychological Characteristics on the Trajectories of Acute Postoperative Pain After Total Knee Arthroplasty[J].Pain Medicine,2017,18(1):124-139.
[4]李英妮.个性化护理对肝胆术后恶心呕吐的缓解效果分析[J].临床医学研究与实践,2016,1(22):158-159.
[5]Sattari H,Haghbin MA,Etminan M,et al.Survey of the Effect of Intraoperative Intravenous Lidocaine Infusion on Postoperative Pain in Laparoscopic Cholecystectomy Surgery[J].Pediatric Research,2015,15(4):719-719.
[6] Yang M,Su W,Deng X,et al. Enhanced recovery after surgery program in patients from Tibet Plateau undergoing surgeries for hepatic alveolar echinococcosis[J]. Journal of Surgical Research,2017,219:188-193.
[7]靳红绪,黄立宁,王忠义,等.加速康复外科策略对腹腔镜结直肠癌手术患者术后恢复的影响[J].临床麻醉学杂志,2016,32(12):1149-1153.
[8]杨孟昌,苏文杰,邓佳,等.碳水化合物饮料对腹腔镜胆囊切除术患者术后恶心呕吐的影响[J].实用医院临床杂志,2017,14(5):223-225.
[9]Prevot F,Fuks D,Cosse C,et al.The Value of Abdominal Drainage After Laparoscopic Cholecystectomy for Mild or Moderate Acute Calculous Cholecystitis:A Post Hoc Analysis of a Randomized Clinical Trial[J].World Journal of Surgery,2016,40(11):2726-2734.
[10]郎海丽,蔡俊赢,周志东,等.术后加速康复对腹腔镜肝部分切除术患者免疫功能的影响[J].临床麻醉学杂志,2016,32(6):525-529.
[11]郭文娟,丁丽,周承刚,等.快速康复干预腹腔镜胆囊切除术围手术期抗菌药物的合理应用[J].医药导报,2017,36(9):1051-1053.