加速康复外科在肝切除术治疗肝胆管结石病中的应用  

Clinical application of enhanced recovery after surgery （ERAS） program in hepatectomy for hepatolithiasis

作　　者：蒋遗云 邬林泉[1] 李恩亮[1] 邓泽福 冯潜[1] 雷钧[1] 袁荣发[1] 朱恒清 Jiang Yiyun Wu Linquan Li Enliang Deng Zefu Feng Qian Lei Jun Yuan Rongfa Zhu hengqing.(Department of Hepatobiliary Surgery, Second Affiliated Hospital of Nanchang University, Nanchang 33006, Chin)

机构地区：[1]南昌大学第二附属医院肝胆外科,南昌330006

出　　处：《中华肝胆外科杂志》2016年第12期814-818,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金（81560396）;江西省自然科学基金（20142BAB215037）

摘　　要：目的探讨加速康复外科（ERAS）在肝切除术治疗肝胆管结石患者围手术期的临床应用价值。方法回顾性分析2014年12月至2016年5月南昌大学第二附属医院肝胆外科收治的81例肝胆管结石行肝部分切除术患者的临床资料。将围手术期严格按照ERAS理念管理的36例患者作为ERAS组，将按照传统模式管理的45例患者作为对照组，比较两组患者术后疼痛评分、围手术期炎性介质变化、术后临床指标以及并发症发生等情况。结果ERAS组患者术后疼痛评分明显低于对照组（P〈0．05），ERAS组患者于术后1、4、7天降钙素原（PCT）水平分别为（2．6±0．5）μg／L、（2．1±1．2）μg／L和（1．0±0．6）μg／L，对照组分别为（3．8±0．8）μg／L、（3．0±1．7）μg／L和（2．1±0．8）μg／L，两组差异有统计学意义（P〈0．05）。ERAS组患者术后1、4、7天白介素-6（IL-5）分别是（128．5±15．2）ng／L、（87．9±10．3）ng／L和（33．8±7．5）ng／L，对照组分别为（264．8±18．3）ng／L、（195．3±12．7）ng／L、（95．4±10．9）ng／L，两组差异有统计学意义（P〈0．05）。ERAS组患者术后1、4、7天C反应蛋白（CRP）分别是（40．4±9．8）mg／L、（67．2±6．4）mg／L和（32．2±5．4）mg／L，对照组分别为（58．4±13．2）mg／L、（100．5±10．8）mg／L和（50．6±8．7）mg／L，两组差异有统计学意义（P〈0．05）。ERAS组患者术后肛门排气时间明显缩短[（34．4±8．7）h比（57．7±11．8）h，P〈0．05]；术后住院时间明显缩短[（8．4±2．5）d比（11．6±3．3）d，P〈0．05]，而切口感染、胆漏、膈下脓肿、腹胀等术后常见并发症发生率差异无统计学意义（均P〉0．05）。结论ERAS理念应用于肝切除术治疗肝胆管结石病患者的围手术期管理，可减轻患者术后疼痛、降低围手术期应激反应、缩短术后肛门排气时间、住院时�Objective J To investigate the＇clinical value of enhanced recovery after surgery （ERAS） program in the perioperative period of hepatectomy for bepatolithiasis. Methods From December 2014 to May 2016, 81 hepatolithiasis patients who underwent hepatectomy at the Second Affiliated Hospital Of Nan- chang University were retrospectively reviewed. Patients in the ERAS group （ n = 36 ） received ERAS man- agement and the control group （ n = 45 ） received conventional management. The pain score, changes in in- flammatory mediators during the perioperative period, postoperative clinical index and postoperative compli- cations were compared between the two groups. Results The postoperative pain score was significantly low- er in the ERAS group when compared with the control group （P 〈 0.05）. The levels of PCT on postoperative day 1,4 and 7 were （ 2.6±0.5 ）μg/L, （ 2.1 ± 1.2） μg/L and （ 1.0 ± 0.6） μg/L in the ERAS group and （3.8 ±0.8） μg/L, （3.0 ±1.7） μg/L and （2.1±0.8） μg/L in the control group. There were significant differences between the 2 groups （ P 〈 0. 05 ）. The IL-6 levels on postoperative day 1, 4 and 7 were （ 128.5 ±15.2） ng/L, （87.9 ± 10.3） ng/L and （33.8 ± 7.5 ） ng/L in the ERAS group, and （264.8± 18.3 ） ng/L, （ 195.3 ± 12.7 ） ng/L and （95.4 ± 10.9 ） ng/L in the control group. There were significant differences between the 2 groups （ P 〈 0.05 ）. The CRP levels on postoperative day 1, 4 and 7 were （40.4± 9.8 ） mg/L, （67.2 ± 6.4） mg/L and （ 32.2 ±5.4） mg/L in the ERAS group and （58.4 ± 13.2 ）mg/L, （100.5 ± 10.8） mg/L and （50.6 ± 8.7） mg/L in the control group. There were significant differ- ences between the 2 groups （ P 〈 0.05）. The time to first pass flatus was significantly shorter in the ERAS group [ （34.4 ± 8.7） h vs. （57.7 ± 11.8 ） h, P 〈 0.05 ], and the postoperative hospital stay was signifi- cantly shorter in the ERAS group [ （8.4 ± 2.5） d vs. （ 11.6 ± 3.

关 键 词：肝胆管结石 加速康复外科 应激反应 肝切除术 

分 类 号：R657.3[医药卫生—外科学]