加速康复外科技术在腹腔镜胆囊切除术患者中的应用价值研究  

Study on the Value of Enhanced Recovery after Surgery in Patients with Laparoscopic Cholecystectomy

作　　者：芦霞[1] 贾海明[2] 米泰宇[2] 张文权[2] 谢峰[1] 高鹏[3] 

机构地区：[1]甘肃省兰州市第二人民医院功能科,730046 [2]甘肃省兰州市第二人民医院普外科,730046 [3]甘肃省人民医院普外科,甘肃省兰州市730046

出　　处：《中国全科医学》2017年第24期2998-3003,共6页Chinese General Practice

基　　金：甘肃省自然科学基金资助项目(145RJZA057);兰州市人才创新创业项目(2015-RC-17)

摘　　要：目的观察加速康复外科(ERAS)技术对腹腔镜胆囊切除术患者负性情绪、营养指标及预后的影响,以期为ERAS技术在腹腔镜胆囊切除术患者中的应用提供理论依据。方法选取2014年5月—2016年5月在兰州市第二人民医院普外科住院行腹腔镜胆囊切除术的患者500例为研究对象。按照围术期诊治措施的不同,将患者分为ERAS组(250例,采用ERAS技术)和对照组(250例,采用传统方法)。记录两组患者入院时、术前1 h、术后24 h及术后48 h负性情绪得分、营养指标[前清蛋白(PA)、清蛋白(ALB)、尿素氮(BUN)、血浆游离氨基酸(PFAA)水平],预后指标[术后恢复情况(肠鸣音恢复时间、排气时间、排便时间)、并发症(胆囊窝积液、胆漏、术后出血、腹腔感染)发生情况、住院时间及住院费用]。结果治疗方法与时间在负性情绪得分上存在交互作用(P<0.05);治疗方法、时间在负性情绪得分上主效应显著(P<0.05);ERAS组术前1 h、术后24 h、术后48 h负性情绪得分低于对照组(P<0.05)。治疗方法与时间在PA、ALB、BUN、PFAA水平上存在交互作用(P<0.05);治疗方法、时间在PA、ALB、BUN、PFAA水平上主效应显著(P<0.05);ERAS组术后24 h、术后48 h PA、ALB、BUN、PFAA水平高于对照组(P<0.05)。ERAS组患者肠鸣音恢复时间、排气时间、排便时间均短于对照组(P<0.05)。ERAS组住院时间短于对照组,住院费用低于对照组(P<0.05)。结论 ERAS技术有助于缓解患者的负性情绪,改善营养状态,加快患者康复,进而缩短住院时间,减少医疗费用。Objective To observe the effect of enhanced recovery after surgery（ ERAS） on negative emotion,nutritional indicators and prognosis of patients with laparoscopic cholecystectomy,in order to provide the theoretical basis for the application of ERAS in patients with laparoscopic cholecystectomy. Methods From May 2014 to May 2016,500 patients accepted laparoscopic cholecystectomy in Department of General Surgery of the Second People＇s Hospital of Lanzhou were selected as the study subjects. They were divided into the ERAS group（ n = 250, using ERAS technique） and the control group（ n= 250,using conventional method） according to the different measures of perioperative treatment. The negative emotion scores and the nutritional indexes [prealbumin（ PA）,albumin（ ALB）,urea nitrogen（ BUN）,plasma free amino acid（ PFAA） ]at the time of admission,1 h before operation,24 h after operation and 48 h after operation, and the prognosis indexes[postoperative recovery（ the recovery time of bowel sounds,exhaust time,defecation time）,the incidence of postoperative complications（ gallbladder fossa fluid,bile leakage,postoperative bleeding,abdominal infection）,hospitalization duration and hospital costs]of the two groups were recorded. Results There was interaction in negative emotion scores between treatment method and duration（ P〈0. 05）. The main effect of treatment method and duration on negative emotion scores was significant（ P〈0. 05）. The negative emotion scores at 1 h before operation,24 h and 48 h after operation in the ERAS group were lower than those in the control group（ P〈0. 05）. There was interaction in PA,ALB,BUN and PFAA levels between the treatment method and duration（ P〈0. 05）. The main effects of treatment method and duration on PA,ALB,BUN and PFAA levels were significant（ P〈0. 05）. The levels of PA,ALB,BUN and PFAA at 24 h and 48 h after operation in the ERAS group were higher than those in the control group（ P〈0. 05）. The recovery time of bowel

关 键 词：胆囊切除术 腹腔镜 情绪 营养状况 预后 加速康复外科 

分 类 号：R657.4[医药卫生—外科学]