集束化干预理念在食管癌吻合口瘘治疗中的应用  

Application of bundles of intervention in the treatment of esophageal carcinoma anastomotic leak

作　　者：田文泽[1] 胡忠吾[1] 嵇建[1] 徐达夫[1] 尤振兵[1] 郭伟[1] 徐克平[1] 

机构地区：[1]南京医科大学附属淮安第一医院胸外科,江苏淮安223300

出　　处：《中华胃肠外科杂志》2016年第9期1009-1013,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的：探讨集束化干预理念在食管癌术后吻合口瘘治疗中的应用。方法自2014年1月至2015年5月，南京医科大学附属淮安第一医院胸外科应用集束化干预理念（即通过集合一系列有循证基础的治疗及护理措施治疗疾病）治疗44例食管癌术后吻合口瘘患者（集束化治疗组），并以2012年1月至2013年12月间常规保守治疗的68例食管癌术后吻合口瘘患者为对照（常规治疗组），比较两组临床指标和营养指标。结果两组一般资料的比较及吻合口瘘分级比例的比较，差异无统计学意义（均P＞0.05），具有可比性。住院期间，全组共11例患者死亡，其中集束化治疗组和常规治疗组病死率分别为6．8％（3／44）和11．8％（8／68），差异无统计学意义（χ2＝0．738， P＝0．390）。41例集束化治疗组患者与60例常规治疗组比较，中度以上发热持续时间[（4．1±2．4） d比（8．3±4．4） d，t＝6．171，P＝0．001]、抗生素使用时间[（8．2±3．8） d比（12．8±5．2） d，t＝5．134， P＝0．001]、瘘口愈合时间[（21．5±12．7） d比（32．2±15．8） d， t＝3．610，P＝0．001]均明显缩短，住院总费用亦明显减少[（6．3±1．2）万元比（7．4±1．9）万元，t＝3．564，P＝0．001]。在出现吻合口瘘时，两组患者的血红蛋白、血清白蛋白和前白蛋白水平差异无统计学意义（均P ＞0．05），而在瘘口愈合时，集束化治疗组与常规治疗组比较，患者的血红蛋白[（110．6±10．5） g／L 比（103．8±11．1） g／L，t＝3．090，P＝0．002]、血清白蛋白[（39．2±5．2） g／L比（36．3±5．9） g／L，t＝2．543，P＝0．013]和前白蛋白水平[（129．3±61．9） g／L比（94．1±66．4） g／L，t＝2．688，P＝0．008]均明显升高。结论在食管癌术后吻合口瘘的治疗中，应用集束化干预理念可以明显改善患者临床结局和营养状况。Objective To investigate the application of bundles of intervention in the treatment of esophageal carcinoma anastomotic leak. Methods From January 2014 to May 2015, 44 cases of esophageal carcinoma anastomotic fistula were treated by bundles of intervention （through the collection of a series of evidence-based treatment and care measures for the treatment of diseases ） in Department of Thoracic Surgery, Huai′an First Hospital, Nanjing Medical University （bundles of intervention group）, and 68 patients with esophageal carcinoma postoperative anastomotic leak from December 2013 to January 2012 receiving traditional therapy were selected as the control group. The clinical and nutritional indexes of both groups were compared. Results There were no significant differences in general data and proportion of anastomotic leak between the two groups. Eleven patients died during hospital stay, including 3 cases in bundles of intervention group （6.8%） and 8 cases in control group （11.8%） without significant difference （P=0.390）. In bundles of intervention group, 1 case died of type Ⅲ intrathoracic anastomotic leak, 2 died of type Ⅳ intrathoracic anastomotic leak. In control group, 2 cases died of type Ⅲ cervical anastomotic leak, 2 died of type Ⅲ intrathoracic anastomotic leak and 4 of type Ⅳ intrathoracic anastomotic leak. The mortality of bundles of intervention group was lower than that of control group. The duration of moderate fever [（4.1 ± 2.4） days vs. （8.3 ± 4.4） days, t=6.171, P=0.001], the time of antibiotic use [（8.2 ± 3.8） days vs.（12.8 ± 5.2） days, t=5.134, P = 0.001], the healing time [（21.5 ± 12.7） days vs.（32.2 ± 15.8） days, t=3.610, P=0.001] were shorter, and the average hospitalization expenses [（63 ± 12） thousand yuan vs. （74 ± 19） thansand yuan, t=3.564, P=0.001] was lower in bundles of intervention group than those in control group. Forty-eight hours after occurrence of anastomotic leak, the levels of hemoglobin, albumin and prealbu

关 键 词：食管肿瘤 吻合口瘘 集束化干预 

分 类 号：R473.73[医药卫生—护理学]