快速康复外科在急诊上消化道穿孔修补术中的应用  

Application of fast track-surgery in the neoplasty for emergency upper gastrointestinal perforation

作　　者：谢正勇[1] 程黎阳[1] 张玉新[1] 赵为国[1] 柯永莉[1] 

机构地区：[1]广州军区广州总医院普通外科,510010

出　　处：《实用医学杂志》2012年第1期21-24,共4页The Journal of Practical Medicine

基　　金：广东省自然科学基金资助项目(编号:8151001002000010);全军医学科研"十二五"面上课题(编号:CWS11J270)

摘　　要：目的:探讨在急诊上消化道穿孔修补术中应用快速康复外科(FTS)的安全性、可行性及有效性。方法:回顾性分析2008年1月至2011年5月间广州军区广州总医院普外科收治的62例行上消化道穿孔修补术患者的临床资料,其中32例为FTS组,30例为传统组,两组行非随机对照研究。比较两组术后首次排气、排便时间、住院时间、住院费用和C-反应蛋白(CRP)、白细胞介素-6(IL-6)、皮质醇等应激反应指标及术后并发症。结果:FTS组同传统组相比,术后首次排气时间(2.5dvs4.7d)、排便时间(3.2dvs5.1d)提前,住院时间(4.5dvs7.8d)缩短,住院费用降低(6.5千元vs9.3千元),差异均具有显著性(P<0.05);FTS组术后第1、3天CRP、IL-6、皮质醇等应激反应指标均明显低于传统组(P<0.05)。FTS组肺部并发症(1/32,3.1%)显著低于传统组(5/30,16.7%,P<0.01),其余单个并发症及总体并发症FTS组略低于传统组,但差异无统计学意义(P>0.05)。结论:FTS应用于急诊上消化道穿孔修补术安全有效,可促进术后胃肠功能恢复,缩短住院时间,降低住院费用,并不增加术后并发症。Objective To investigate the safety,feasibility,and efficacy of fast track-surgery in the neoplasty for emergency upper gastrointestinal perforation. Methods Data of 62 patients with upper gastrointestinal perforation receiving neoplasty from Jan 2008 to May 2011 were retrospectively analyzed, among whom 32 patients received fast-track surgery （FTS group） and 30 patients received conventional perioperative care （conventional group）. The first time of flatus and defecation, the length of hospital stay, medical cost, stress index including CRP, IL-6, and cortisol, and postoperative complications were assessed after surgery. Results The first time of flatus （2.5 d vs 4.7 d） and defecation （3.2 d vs 5.1 d）, the length of hospital stay （4.5 d vs 7.8 d） in FTS group were significantly shorter, and the medical cost [ （6.5 vs 9.3） thousand yuan] were less than those in conventional group （P 〈 0.05）. Serum levels of CRP, IL-6, and cortisol at day 1 and 3 after surgery in FTS group were lower than those in conventional group （P 〈 0.05）. Pulmonary complications in FTS group （1/32,3.1%） was lower than that in conventional group （5/30, 16.7% ,P 〈 0.01 ）, and other complication or total complications in FTS group were not significantly lower than those in conventional group （P 〉 0.05）. Conclusion Fast-track surgery is safe, feasible, and effective in the neoplasty for emergency upper gastrointestinal perforation, and may contribute to the recovery of gut function, the reduction of hospital stay time and medical cost, and do not increase postoperative complications.

关 键 词：消化性溃疡穿孔 快速康复外科 上消化道穿孔 急诊手术 

分 类 号：R656.62[医药卫生—外科学]