加速康复外科策略在胰腺外科围手术期的应用
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吴绍峰, Email: wushaofengxm@163.com

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福建省厦门市医疗卫生重点基金资助项目(3502Z20191106)。


Efficacy of application of enhanced recovery after surgery in pancreatic surgery
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    摘要:

    目的:探讨加速康复外科(ERAS)策略在胰腺外科围手术期应用的安全性及有效性。
    方法:选取200例拟行胰腺手术患者,按照手术时间顺序依次入选ERAS组或对照组,ERAS组患者在围手术期采取ERAS策略进行干预,对照组患者采用常规胰腺手术围手术期处理流程。最终纳入ERAS组
    97例,对照组90例,对两组患者的相关临床指标进行比较分析。
    结果:两组患者的性别、年龄、手术类型及术式均无统计学差异(均P>0.05)。与对照组比较,ERAS组术后VAS评分明显降低、首次肛门排气时间明显缩短、术后肺部感染发生率明显降低、术后住院时间明显缩短(均P<0.05)。两组在麻醉清醒时间、术后恶心呕吐发生率、术后重新留置导尿管、其他手术并发症发生率以及非计划重返手术、非计划重返住院方面差异性均无统计学意义(均P>0.05)。
    结论:ERAS策略可安全应用于胰腺手术,促进术后机体功能恢复、缩短住院时间、改善患者治疗体验。

    Abstract:

    Objective: To evaluate the safety and effectiveness of using enhanced recovery after surgery (ERAS) programs in pancreatic surgery.
    Methods: Two-hundred patients scheduled to undergo pancreatic surgery were enrolled and assigned to ERAS group or control group according to the order of operation time. Patients in ERAS group received perioperative care with the ERAS protocol, and those in control group underwent the conventional protocol for pancreatic surgery. Ninety-seven patients in ERAS group and 90 patients in control group were finally selected, and the relevant clinical variables between the two groups of patients were compared and analyzed.
    Results: There were no significant differences in sex, age, surgery type and surgical procedure between the two groups of patients (all P>0.05). In ERAS group, the postoperative VAS score was significantly reduced, the time to first anal gas passage was significantly shortened, the incidence of pulmonary infection was significantly decreased, and the length of postoperative hospital stay was significantly reduced compared with control group (all P<0.05). There were no significant differences in terms of the time of anesthesia awareness, incidence rates of postoperative nausea/vomiting, and re-insertion of the urethral catheter, and incidence rates of other surgical complications as well as the rates of unplanned return to the operating room and unplanned return to hospital after discharge (all P>0.05).
    Conclusion: ERAS pathway can be safely applied to pancreatic surgery, and it can promote the recovery of body function, shorten the length of hospital stay and improve the patient’s healthcare experience.

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李湧, 吴绍峰, 王付强, 刘平果.加速康复外科策略在胰腺外科围手术期的应用[J].中国普通外科杂志,2019,28(12):1513-1518.
DOI:10.7659/j. issn.1005-6947.2019.12.011

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  • 收稿日期:2019-04-16
  • 最后修改日期:2019-11-08
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  • 在线发布日期: 2019-12-25