加速康复外科在Ⅱ型巴德-吉亚利综合征腔房转流术中的临床应用  

Clinical efficacy of enhanced recovery after surgery in atrial caval shunting for type II Budd-Chiari syndrome

作　　者：田广金[1] 李德宇[1] 余海波[1] 董亚东[1] 彭亚南 刘鹏[1] 魏艳奎 薛焕洲[1] 

机构地区：[1]河南省人民医院肝胆外科,郑州450003

出　　处：《中华外科杂志》2017年第9期671-677,共7页Chinese Journal of Surgery

基　　金：河南省科技厅科技攻关项目（162102310021）

摘　　要：目的 探讨加速康复外科（ERAS）在Ⅱ型巴德-吉亚利综合征（BCS）腔房转流术中的应用价值.方法 选取2014年1月至2016年6月河南省人民医院肝胆外科收治的Ⅱ型BCS患者进行前瞻性研究.采用随机、单盲、对照方法,通过随机数字表法将符合纳入和排除标准的患者分为对照组和ERAS组.两组均行腔房转流术.对照组患者围手术期采用传统处理方案,ERAS组患者围手术期采用ERAS处理方案.观察两组患者的手术情况、术后情况、炎症指标、应激状态指标和术后并发症情况.采用电话和门诊复诊相结合的方式进行随访,随访截至2016年8月.组间数据的比较采用独立样本t检验;各指标趋势比较采用重复测量方差分析;计数资料比较采用x2检验或Fisher确切概率法.结果 共有82例患者符合纳入和排除标准,其中对照组40例,ERAS组42例.两组患者均顺利完成手术,无死亡病例.对照组和ERAS组的手术时间、术中出血量分别为（211.0±12.9）min和（207.7±10.7）min、（167.5±28.3）ml和（165.0±28.4） ml,分别有3例和1例患者输血,差异均无统计学意义（t=0.90、0.29,x2=0.32,P值均＞0.05）.对照组和ERAS组术后胃管拔除时间、尿管拔除时间、胸管拔除时间、肛门排气时间、开始进食时间、术后输液时间、术后住院时间、疼痛评分分别为（3.7±0.5）d和（0.0±0.0）d、（2.3±0.7）d和（1.4±0.5）d、（3.7±0.7）d和（2.3±0.5）d、（75.2±3.8）h和（46.6±4.2）h、（75.7±4.7）h和（21.4±2.1）h、（10.0±1.0）d和（5.8±0.9）d、（11.4±1.0）d和（7.8±0.6）d、（2.9±0.4）分和（1.9±0.6）分,差异均有统计学意义（t=35.03、4.36、8.10、22.89、47.78、14.75、14.22、6.13,P值均＜0.05）.对照组和ERAS组患者术前、术后1、3、5d胰岛素抵抗指数分别为2.7±0.1和2.7±0.1、8.8±0.7和5.2±0.3、11.0±0.5和7.3±0.5、4.9±0.2和3.9±0.1;血清C反应蛋白分别为（14.6±1.3） mg/L和（14.6Objective To investigate the clinical efficacy of enhanced recovery after surgery （ERAS） in atrial caval shunting （ACS） for type Ⅱ Budd-Chiari syndrome（BCS）.Methods The clinical data of patients underwent ACS for type Ⅱ BCS in the Henan Province People＇s Hospital from January 2014 to June 2016 were prospectively analyzed.Randomized and single-blind,controlled study was performed among the patients,and all of them underwent ACS and were divided into control group （patients underwent traditional perioperative management） and ERAS group （patients underwent ERAS perioperative management） based on a random number table.Operational and postoperative data,levels of inflammatory cytokines,stress state evaluation and postoperative complications were observed.The comparison between the two groups was evaluated with an independent sample t test.The trend analyses for variables were done using repeated measures ANOVA.The count data were analyzed using the chi-square test or Fisher exact.Results Eighty-two patients were screened for eligibility,and allocated into the control group （40 patients） and the ERAS group （42 patients）.All patients underwent ACS successfully with no death.Comparison of intraoperative status：operation time,volume of intraoperative blood and number of patients receiving blood transfusion were （211.0± 12.9） minutes vs.（207.7± 10.7） minutes,（167.5± 28.3） ml vs.（165.0 ± 28.4） ml and 3 cases vs.1 case between the control group and the ERAS group,respectively,showing no difference between the two groups （t =0.90,0.29,x2 =0.32,all P 〉 0.05）.Comparison of postoperative status：time of gastric tube removal,time of catheter removal,time of chest tube,time to flatus,time of food intake,duration of postoperative infusion,duration of postoperative hospital stay and numeric rating scale were （3.7±0.5）daysvs.（0.0±0.0）days,（2.3±0.7）daysvs.（1.4±0.5）days,（3.7±0.7）daysvs.（2.3± 0.5） days,（75.2± 3.8） hours vs.（46.6 ± 4.2）

关 键 词：巴德-吉亚利综合征 腔房转流术 加速康复外科 

分 类 号：R657.3[医药卫生—外科学]