快速康复外科在创伤性肝脾破裂并失血性休克围术期中的应用  

Application of Fast Track Surgery in Hepatic and Splenic Injury Combined with hemorrhagic shock by trauma during Perioperative Period

作　　者：樊献军[1] 谭黄业[1] 张立峰[1] 肖咏梅[1] 赛沙金[1] 吴久坤[1] 杨泽波[1] 

机构地区：[1]解放军59医院成都军区腹部外科中心,云南开远661699

出　　处：《解放军医药杂志》2013年第9期55-59,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：成都军区医学科学技术研究"十二五"课题计划项目(C12013)

摘　　要：目的探讨快速康复外科理念指导下的围术期处理措施在创伤性肝脾破裂并失血性休克中应用的安全性及有效性。方法将我院腹部外科中心2012年1月—2012年12月收治23例创伤性肝脾破裂并失血性休克患者,随机分为快速康复外科组(FTS组)和对照组,FTS组(n=16)采用快速康复外科理念指导下的围术期处理方法,对照组(n=7)采用传统的围术期处理方法,比较两组术前、术后第1天及第5天C反应蛋白(CRP)水平,术后乳酸清除时间、排气排便时间、住院天数及住院费用、不良反应及并发症发生情况。结果 23例均治愈,与对照组相比,FTS组术后第1 d及第5 d CRP水平减低,术后乳酸清除时间、排便排气时间、住院天数明显缩短、住院费用明显减少(P<0.05,P<0.01),不良反应及并发症发生率无显著差异(P>0.05)。结论快速康复外科理念在创伤性肝脾破裂并失血性休克围术期处理中的应用安全、有效,可加速康复进程。Objective To explore the safety and effectiveness of fast track surgery （FTS） in hepatic and splenic injury combined with hemorrhagic shock by trauma during perioperative period. Methods A total of 23 patients with hepatic and splenic injury combined with hemorrhagic shock by trauma from January to December 2012 were randomly divided into FTS group （n = 16） and control group （n = 7）. FI＇S group received FTS treatment during perioperative period, while control group accepted routine treatment. C-reactive protein （CRP） levels before operation and at 1th and 5th d after operation, postoperative clearance time of lactic acid, postoperative venting and defaecation time, hospital day, cost of hospitalization, adverse reactions and complications in the two groups were compared. Results The 23 patients were cured. In FTS group, CRP levels at lth and 5th d after operation were lower; postoperative clearance time of lactic acid, postoperative venting and defaeeation time,and hospital day were significantly shortened; cost of hospitalization was less compared with those in control group（P 〈0. 05, P 〈 0. 01 ）. The differences of adverse reactions and complications in the two groups showed no statistical significance （ P 〉 0. 05）. Conclusion Fast track surgery in application for hepatic and splenic injury combined with hemorrhagic shock by trau- ma during perioperative period is safe and efficient, which could accelerate the recovery.

关 键 词：脾破裂 休克 出血性 快速康复外科 手术期间 

分 类 号：R641[医药卫生—外科学]