加速康复外科理念在肝癌切除围手术期的应用研究  

Application of enhanced recovery after surgery in the perioperative period of patients undergoing hepatectomy

作　　者：王远鹏[1] 刘会春[1] 黄伟[1] 潘科研 金浩[1] 周磊[1] 

机构地区：[1]蚌埠医学院第一附属医院肝胆外科,安徽省233004

出　　处：《中华普通外科杂志》2017年第3期243-246,共4页Chinese Journal of General Surgery

基　　金：蚌埠医学院科技发展基金资助项目（BYKF1404）

摘　　要：目的探讨加速康复外科理念在肝癌切除围手术期应用的安全性及有效性。方法将2014年12月至2016年5月收治经手术切除的原发性肝癌92例患者分成两组，其中加速康复组50例，接受加速康复外科（ERAS）指导的一系列干预措施，传统组42例，接受传统理念指导下的围手术期管理方法，比较两组术后恢复情况。结果ERAS组患者与传统组相比，住院费用明显减少[（40633．12±6336．46）元比（46139．23±9605．88）元，P〈0．05]，术后住院时间明显缩短[（10．24±1．67）d比（13．35±4．86）d，P〈0．05]，术后首次通气时间明显提前[（33．34±6．01）h比（50．31±3．53）h，P〈0．05]，患者围手术期疼痛控制满意度及舒适度显著提高[45／50（90％）比22／42（52．4％），P〈0．05]；而2组患者术后并发症的发生率和再人院率差异无统计学意义（P〉0．05）。结论ERAS可以减少患者的住院治疗费用，缩短术后住院时间，促进消化道功能恢复。Objective To observe the safety and clinical efficacy of enhanced recovery after surgery in the perioperation period of hepatectomy. Methods 92 patients with primary hepatic cancer who underwent surgical resection in our hospital from December 2014 to May 2016 were divided into two groups, 50 patients received well-organized and consecutive clinical interventions guided by ERAS. 42 patients underwent traditional perioperative management. Results Compared with traditional group, ERAS group had reduced hospital cost[ （40 633.12 ± 6 336.46）RMB vs. （46 139. 23 ± 9 605.88） RMB, P 〈 0. 05 ], shorter postoperative hospital stay[ （ 10. 24 ± 1.6 ） d vs. （ 13.35 ± 4. 86 ） d, P 〈 0. 05 ] , earlier flatus and defecation [ （33.34 ± 6. 01 ） h vs. （ 50. 31± 3.53 ） h, P 〈 0.05 ] , and improved satisfaction rate for pain management[ 45/50 （90%） vs. 22/42 （52. 4% ）, P 〈 0. 05 ] ; while the postoperative adverse events and complications of the two groups showed no difference （ P 〉 0. 05）. Conclusion The application of ERAS in the perioperation period of hepatectomy is safe and effective, reducing hospital cost, postoperative hospital stay, improving satisfaction rate to pain management, and facilitating recovery in hepatic surgery.

关 键 词：癌 肝细胞 肝切除术 医院 康复 疼痛管理 

分 类 号：R735.7[医药卫生—肿瘤]