加速康复外科在胆石症围手术期应用的前瞻性研究  

Clinical efficacy of enhanced recovery after surgery in patients with cholelithiasis: a prospective study

作　　者：伊鑫[1] 鲁志华[1] 邱博[1] 郑立杰[1] 张安红[1] 马杰[1] 姜远辉[1] 

机构地区：[1]山东大学齐鲁医院(青岛)普外科,山东青岛266000

出　　处：《中国现代普通外科进展》2016年第2期100-103,108,共5页Chinese Journal of Current Advances in General Surgery

基　　金：山东省医药卫生科技发展计划项目(2014WS0019)

摘　　要：目的：探讨加速康复外科（ERAS）在胆囊结石并胆总管结石患者行开腹胆囊切除并胆总管探查取石T管引流术中的临床应用价值。方法：选取2014年2月—2015年1月山东大学齐鲁医院（青岛）普外科因胆囊结石并胆总管结石行胆囊切除并胆总管切开探查取石T管引流术的患者94例,通过纳入、排除标准,将符合条件的患者随机分为ERAS组（围术期采用ERAS处理方案）和对照组（围术期采用传统处理方案）。观察患者围术期肝功能、应激状态等指标变化以及术后恢复情况。结果：符合研究条件并完成本项研究的患者共60例,ERAS组和对照组各30例。两组患者术前空腹血清总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）、血糖、C反应蛋白（CRP）、谷丙转氨酶（ALT）和直接胆红素（DBil）水平比较,差异均无统计学意义（P〉0.05）。ERAS组术后第5天的TP（t=3.125,P=0.002）、PA（t=3.574,P=0.001）水平均高于对照组,其术后第3天（t=-2.005,P=0.026）和第5天（t=-2.102,P=0.042）的CRP水平均低于对照组。ERAS组患者术后首次排气时间缩短（t=-7.635,P=0.000）,术后白蛋白用量减少（t=-2.036,P=0.047）,住院时间缩短（t=-3.952,P=0.000）,住院费用减少（t=-2.604,P=0.012）,术后镇痛效果好（t=-2.306,P=0.025）,术后随访期内并发症发生率减少（χ^2=5.079,P=0.024）。结论：ERAS应用于胆囊结石并胆总管结石患者的围手术期可以缩短排气时间,缩短住院时间并减少住院费用。同时ERAS可以优化患者术后营养状况,改善患者疼痛感受,Objective： To investigate the clinical efficacy of enhanced recovery after surgery（ERAS）in patients with cholelithiasis undergoing cholecystectomy and exploration of common bile duct and T tube drainage. Methods： The clinical data of 94 patients undergoing cholecystectomy and exploration of common bile duct and T tube drainage at department of general surgery in Qilu Hospital of Shandong University（QingDao）from Feb 2014 to Jan 2015 were prospectively analyzed.A randomized controlled study was performed in the 94 patients, these patients were divided into the ERAS group（patients undergoing perioperative management according to enhanced recovery rehabilitation program）and the control group（patients undergoing traditional perioperative management）based on a random number table. The liver function, stress state and postoperative recovery of patients were observed. The comparison between groups was evaluated with an independent sample t test. The count data were analyzed using the chi- square test. Results： 60 patients finally finished the study and were allocated into the ERAS group（30 patients）and the control group（30 patients）.The preoperative level of total protein in serum（TP）,albumin（ALB）,prealbumin（PA）,C reactive protein（CRP）, alanine transarninase（ALT）, direct bilirubin（DBil）respectively showing no significant difference between the two groups, P〉0.05. The TP（t=3.125, P =0.002）and PA（t=3.574,P =0.001） of ERAS patients at postoperative day 5 were higher than that in control group. While the CRP level at postoperative day 3（t=- 2.005, P =0.026） and 5（t=- 2.005, P =0.026） in ERAS group were significantly lower than that in control group. The first flatus time, ALB infusion, duration of hospital stay, total hospital expenses in ERAS group were significantly shortened compared with that in control group. And patients in ERAS group have better analgesia effect and fewer occurrences of complication. Conclusion： ERAS is safe and feasible for the

关 键 词：胆石症 加速康复外科 胆总管探查术 围手术期 

分 类 号：R657.42[医药卫生—外科学]