微创经皮肾镜碎石取石术中快速康复外科理念的应用  

Efficacy of enhanced recovery after surgery in minimally invasive percutaneous nephrolithotomy

作　　者：罗慧[1] 陈雪莲[2] 李文标[2] 杨飞[2] 李腾成[2] 蔡佳荣[2] 毛云华[2] 周祥福[2] 湛海伦[2] Luo Hui;Chen Xuelian;Li Wenbiao;Yang Fei;Li Tengcheng;Cai Jiarong;Mao Yunhua;Zhou Xiangfu;Zhan Hailun(Department of Operating Room;Department of Urology,the Third Affliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院麻醉手术中心,广州510630 [2]中山大学附属第三医院岭南医院泌尿外科,广州510530

出　　处：《中华腔镜泌尿外科杂志（电子版）》2018年第4期240-243,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：广东省自然科学基金项目(S2013040014333)

摘　　要：目的探讨快速康复外科理念(ERAS)在微创经皮肾镜碎石取石术中(MPCNL)的应用价值。方法回顾性分析我院2016年6月1日至2017年11月30日收治的243例肾及输尿管上段结石患者,根据处理措施不同分为快速康复外科组(ERAS组,n=116)和传统组(n=127),比较两组术后气管导管拔管时间、首次肛门排气时间、首次进食时间、拔除肾造瘘管及尿管时间、发生低体温及术后发热情况、术后住院时间等临床指标。结果两组患者年龄、性别、结石大小和位置、术前泌尿系统感染情况及手术时间的差异无统计学意义。所有患者均成功完成MPCNL。与传统组相比,ERAS组气管导管拔管时间[(10.6±5.2)min vs(28.4±9.5)min,P<0.01]、术后拔除肾造瘘管时间[(4.7±1.5)d vs(7.8±1.2)d,P<0.01]、拔除尿管时间[(5.1±1.2)d vs(8.3±1.4)d,P<0.01]、术后住院时间[(5.2±0.6)d vs(7.3±0.8)d,P<0.01]均缩短,两组差异比较均有统计学意义。ERAS组术后首次肛门排气时间、进食时间明显提前。ERAS组术中发生低体温和术后发热的患者明显减少。结论在MPCNL围手术期应用快速康复外科理念进行指导,可明显加速术后康复,改善患者预后,值得推广应用。Objective To study the value of enhanced recovery after surgery in minimally invasive percutaneous nephrolithotomy（MPCNL）. Methods Between June 2016 and November 2017, 243 patients with renal calculi or upper ureter calculi in our hospital were retrospectively analyzed. They were assigned to ERAS group（n=116） and control group（n=127） and accepted different treatment in perioperative period. The time of extraction of tracheal intubation, anal exhaust, first feeding, remove of drainage tube and urinary catheter, and postoperative hospitalization were compared between then two groups. The incidence of fever and hypothermia were also compared. Results There was no significant difference in age, sex, stone size and location, preoperative urinary tract infection and operative time between the two groups. All patients had undergone MPCNL successfully. Compared with the control group, the time of extraction of tracheal intubation [（10.6±5.2） min vs（28.4±9.5） min, P〈0.01], drainage tube[（4.7±1.5） d vs（7.8±1.2） d, P〈0.01], urinary catheter [（5.1±1.2） d vs（8.3±1.4） d, P〈0.01], and the time of postoperative hospitalization [（5.2±0.6） d vs（7.3±0.8） d, P〈0.01] were shorter in the ERAS group. The first anal exhaust time and thefirst feeding time of ERAS group were significantly earlier than that of control group. The incidence of hypothermia and postoperative fever were significantly reduced in ERAS group. Conclusions Application of ERAS in minimally invasive percutaneous nephrolithotomy can enhance the recovery and improve the prognosis. It is worth to be applied.

关 键 词：经皮肾镜 快速康复 外科 

分 类 号：R473.6[医药卫生—护理学]