加速康复外科在老年腹腔镜右半结肠切除术患者围手术期的应用  

Application of enhanced recovery after surgery in laparoscopic right hemicolectomy for elderly patients

作　　者：周雪玲[1] 蔡蕾[1] 粟静[1] 刘健培[1] 

机构地区：[1]中山大学附属第三医院胃肠外科,广州510630

出　　处：《中华普通外科学文献（电子版）》2017年第5期310-313,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：教育部博士点基金(新教师类)资助项目(20130171120101)

摘　　要：目的研究加速康复外科(ERAS)在老年患者行腹腔镜下右半结肠切除术围手术期中的应用效果,为临床实践提供依据。方法回顾性分析2014年12月到2016年12月中山大学附属第三医院胃肠外科行腹腔镜下右半结肠切除术的77例老年升结肠癌患者资料,根据治疗措施不同分为ERAS组(39例,采用加速康复外科措施)和对照组(38例,应用传统围手术期方案),对比两组患者的术后恢复情况、患者出院满意度以及围手术期血清白蛋白和前白蛋白水平。结果 ERAS组在肛门排气时间、首次下床活动时间、排便时间和术后住院时间方面较对照组均有不同程度的缩短(t=5.848、10.758、13.859、5.803,均P<0.01);术后恶心、呕吐反应发生率较对照组减少(12.8%vs57.9%,χ~2=17.174,P<0.01),差异具有统计学意义。ERAS组术后3、5 d的血清白蛋白和前白蛋白质量浓度均较对照组高(P<0.01),患者出院满意度高于对照组,差异具有统计学意义(χ~2=6.829,P=0.033)。结论 ERAS在老年患者行腹腔镜右半结肠切除术围手术期的应用安全有效,值得在临床实践中推广应用。Objective：To evaluate the effect of enhanced recovery after surgery （ERAS） on elderly patients undergoing laparoscopic right hemicolectomy. Methods：The data of seventy-seven elderly patients who received laparoscopic right hemicolectomy from December 2014 to December 2016 in the Third Affiliated Hospital of Sun Yat-sen University were collected and analyzed, among whom 39 patients received perioperative treatment according to ERAS guideline （ERAS group）, and 38 patients received traditional perioperative treatment （control group）. Results：Flatus time, first ambulation time, defecation time and length of hospital stay in ERAS group were significantly shorter than control group （t=5.848, 10.758, 13.859, 5.803, all P〈0.01）. Compared with those in the control group, patients in ERAS group had a higher level of serum albumin after surgery, but a lower rate of postoperative nausea and vomiting （12.8% vs 57.9%, χ2=17.174, P〈0.01）. Moreover, patients in ERAS group reported a higher rate of inpatient satisfaction （χ2=6.829, P=0.033）. Conclusion：ERAS is safe and effective in elderly patients undergoing laparoscopic right hemicolectomy, which can improve postoperative recovery and inpatient satisfaction.

关 键 词：结肠切除术 腹腔镜检查 老年人 加速康复外科 

分 类 号：R735.34[医药卫生—肿瘤]