快速康复外科理念在腹腔镜解剖性肝切除治疗肝包虫病中的应用效果
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摘要
目的探讨快速康复外科(ERAS)理念在腹腔镜解剖性肝切除治疗肝包虫病中的应用效果。方法选取2015年9月至2017年12月行腹腔镜解剖性肝切除治疗肝包虫病的患者62例,按照是否将ERAS理念运用于围手术期处理过程中,将患者分成ERAS组(n=30)和对照组(n=32)。ERAS组采用ERAS理念指导下的围手术期处理措施,对照组采用传统围手术期处理措施,观察并比较两组患者一般资料、手术时间、术中出血量,手术前后疼痛视觉模拟评分(VAS),术后下床活动时间、进食时间、肛门排气时间、住院时间、并发症发生情况。结果两组患者术前一般资料、手术时间、术中出血量、新入院时疼痛视觉模拟评分(VAS)比较差异无统计学意义(P> 0. 05); ERAS组手术前一天及术后各阶段VAS评分低于对照组(P <0. 01),术后下床活动时间、进食时间、肛门排气时间早于对照组(P <0. 01),住院时间、并发症发生情况少于对照组(P <0. 01)。结论 ERAS理念应用于腹腔镜解剖性肝切除治疗肝包虫病患者,可有效减轻围手术期疼痛,减少术后并发症发生,促进术后早期康复,缩短住院时间,具有临床推广使用价值。
Objective To investigate the application of enhanced recovery after surgery( ERAS) in laparoscopic anatomical hepatectomy for hepatic hydatid disease.Methods Sixty-two patients with hepatic hydatidosis who underwent laparoscopic hepatectomy from September 2015 to December 2017 were randomly divided into ERAS group( n = 30) and control group( n = 32).The ERAS group received perioperative management guided by ERAS concept,while the control group received traditional perioperative management.The general data,operation time,intraoperative bleeding volume,visual analogue score( VAS) of pain before and after operation,time of ambulation,dinning time,anal exhaust time,hospitalization time and complications were observed and compared between the two groups.Results There was no significant difference in preoperative general data,operative time,intraoperative bleeding volume and new admission VAS between the two groups( P > 0. 05).The VAS scores of the ERAS group were lower than those of the control group on one day before operation and at all stages after operation( P < 0. 01).The postoperative ambulation time,dinning time and anal exhaust time in the ERAS group were earlier than those in the control group( P < 0. 01),hospitalization time and complications in the ERAS were less than those in the control group( P < 0. 01).Conclusion The application of ERAS concept in laparoscopic anatomical hepatectomy for hepatic hydatid disease can effectively relieve the perioperative pain,reduce the postoperative complications,promote the early postoperative rehabilitation and shorten the hospital stay.It is of clinical value.
Objective To investigate the application of enhanced recovery after surgery( ERAS) in laparoscopic anatomical hepatectomy for hepatic hydatid disease.Methods Sixty-two patients with hepatic hydatidosis who underwent laparoscopic hepatectomy from September 2015 to December 2017 were randomly divided into ERAS group( n = 30) and control group( n = 32).The ERAS group received perioperative management guided by ERAS concept,while the control group received traditional perioperative management.The general data,operation time,intraoperative bleeding volume,visual analogue score( VAS) of pain before and after operation,time of ambulation,dinning time,anal exhaust time,hospitalization time and complications were observed and compared between the two groups.Results There was no significant difference in preoperative general data,operative time,intraoperative bleeding volume and new admission VAS between the two groups( P > 0. 05).The VAS scores of the ERAS group were lower than those of the control group on one day before operation and at all stages after operation( P < 0. 01).The postoperative ambulation time,dinning time and anal exhaust time in the ERAS group were earlier than those in the control group( P < 0. 01),hospitalization time and complications in the ERAS were less than those in the control group( P < 0. 01).Conclusion The application of ERAS concept in laparoscopic anatomical hepatectomy for hepatic hydatid disease can effectively relieve the perioperative pain,reduce the postoperative complications,promote the early postoperative rehabilitation and shorten the hospital stay.It is of clinical value.
引文
[1] KehletH. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth,1997,78(5):606-617.
[2]刘永强,奥妮,赵海平,等.不同手术方式治疗肝包虫病89例临床疗效及体会[J].临床实验医学杂志,2015,14(4):288-291.
[3]母齐鸣,贺伟,侯桂敏,等.腹腔镜解剖性肝切除与常规开腹肝切除术治疗肝包虫病的疗效分析[J].实用医院临床杂志,2018,15(2):131-134.
[4]黄海,张洪昌,莫世发,等.快速康复外科在腹腔镜下精准肝切除患者中的应用[J].中国内镜杂志,2013,19(6):603-606.
[5]吴在德,吴肇汉.外科学[M].第7版.北京:人民卫生出版社,2008:516-518.
[6]田宏伟,苏河,马云涛.腹腔镜手术治疗肝包虫病的体会[J].腹腔镜外科杂志,2014,19(4):290-292.
[7]张万广,陈孝平.腹腔镜肝切除从技术到理念的改变[J].腹腔镜外科杂志,2017,22(5):321-324.
[8]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-416.
[9]中国研究型医院学会肝胆胰外科专业委员会.肝胆胰外科术后加速康复专家共识(2015版)[J].中华消化外科杂志,2016,15(1):1-6.
[10]方贵蓉;王效惠;杨娟.优质护理在5920例腹腔镜胆囊切除术患者中的应用效果研究[J].四川医学,2014,35(11):1501-1504
[11]Bilku DK,Dennison AR,Hall TC,et al.Role of preoperative carbohydrate loading a systematic review[J]. Ann R Coll Sung Engl,2014,96(1):15-22.
[12]Smith I,Kranke P,Murat I,et al.Perioperative fasting in adults and children:guidelines from the European Society of Anaesthesiology[J].Eur J Anaesthesiol,2011,28(8):556-569.
[13]Brower RG.Consequences of bed rest[J].Crir Care Med,2009,37(supp110):422-428.
[14]杨帆.《抗菌药临床应用指导原则(2015年版)》解读[J].中华临床感染病杂志,2016,9(5):390-393.
[2]刘永强,奥妮,赵海平,等.不同手术方式治疗肝包虫病89例临床疗效及体会[J].临床实验医学杂志,2015,14(4):288-291.
[3]母齐鸣,贺伟,侯桂敏,等.腹腔镜解剖性肝切除与常规开腹肝切除术治疗肝包虫病的疗效分析[J].实用医院临床杂志,2018,15(2):131-134.
[4]黄海,张洪昌,莫世发,等.快速康复外科在腹腔镜下精准肝切除患者中的应用[J].中国内镜杂志,2013,19(6):603-606.
[5]吴在德,吴肇汉.外科学[M].第7版.北京:人民卫生出版社,2008:516-518.
[6]田宏伟,苏河,马云涛.腹腔镜手术治疗肝包虫病的体会[J].腹腔镜外科杂志,2014,19(4):290-292.
[7]张万广,陈孝平.腹腔镜肝切除从技术到理念的改变[J].腹腔镜外科杂志,2017,22(5):321-324.
[8]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016)[J].中华外科杂志,2016,54(6):413-416.
[9]中国研究型医院学会肝胆胰外科专业委员会.肝胆胰外科术后加速康复专家共识(2015版)[J].中华消化外科杂志,2016,15(1):1-6.
[10]方贵蓉;王效惠;杨娟.优质护理在5920例腹腔镜胆囊切除术患者中的应用效果研究[J].四川医学,2014,35(11):1501-1504
[11]Bilku DK,Dennison AR,Hall TC,et al.Role of preoperative carbohydrate loading a systematic review[J]. Ann R Coll Sung Engl,2014,96(1):15-22.
[12]Smith I,Kranke P,Murat I,et al.Perioperative fasting in adults and children:guidelines from the European Society of Anaesthesiology[J].Eur J Anaesthesiol,2011,28(8):556-569.
[13]Brower RG.Consequences of bed rest[J].Crir Care Med,2009,37(supp110):422-428.
[14]杨帆.《抗菌药临床应用指导原则(2015年版)》解读[J].中华临床感染病杂志,2016,9(5):390-393.