加速康复外科理念在外伤性肝破裂围手术期管理中的应用  

Application of enhanced recovery after surgery concept in perioperative management of traumatic hepatic rupture

作　　者：王理[1] 黄威[1] 李俐 罗灿军[1] 方凌云[1] 金河[1] 王梦炎[1] Wang Li;Huang Wei;Li Li;Luo Canjun;Fang Lingyun;Jin He;Wang Mengyan(Department of General Surgery, the 113rd Hospital of People's Liberation Army, Anhui Medical University, Ningbo 315040,China)

机构地区：[1]安徽医科大学解放军113临床学院解放军第113医院普通外科,浙江省宁波市315040

出　　处：《中华肝脏外科手术学电子杂志》2017年第6期459-463,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨加速康复外科(ERAS)在外伤性肝破裂围手术期的应用价值。方法回顾性分析2008年8月至2016年12月安徽医科大学解放军113临床学院解放军第113医院收治的41例外伤性肝破裂患者临床资料。患者均签署知情同意书,符合医学伦理学规定。根据治疗方式不同将患者分为ERAS组和对照组。ERAS组22例,男15例,女7例;平均年龄(43±16)岁。对照组19例,男14例,女5例;年龄(45±17)岁。两组患者术后胃肠功能恢复时间、住院时间、住院费用、术后C-反应蛋白(CRP)水平比较采用t检验。结果 ERAS组术后胃肠功能恢复时间、住院时间、住院费用分别为(2.8±0.7)d、(6.5±1.5)d、(3.7±1.3)万元,明显低于对照组的(3.3±0.5)d、(8.5±1.5)d、(5.8±1.1)万元(t=-2.507,-3.935,-5.806;P<0.05)。ERAS组术后1、3 d的CRP水平分别为(81±16)、(25±10)mg/L,明显低于对照组的(93±19)、(36±8)mg/L(t=-2.123,-4.151;P<0.05)。结论 ERAS措施的应用可有效控制机体炎症反应,缩短胃肠功能恢复时间和住院时间,降低住院费用,促进患者快速康复。Objective To investigate the application value of enhanced recovery after surgery(ERAS)concept in perioperative period of traumatic hepatic rupture.Methods Clinical data of41patients with traumatic hepatic rupture who were admitted to the113rd Hospital of People's LiberationArmy of Anhui Medical University between August2008and December2016were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.According to the treatment methods,the patients were divided into the ERAS group(n=22)and controlgroup(n=19).In the ERAS group,15cases were male and7were female,aged(43±16)years old onaverage.In the control group,14cases were male and5were female,aged(45±17)years old on average.The postoperative recovery time of gastrointestinal function,hospital stay,hospitalization expenses andpostoperative C-reactive protein(CRP)level between both groups were compared by t test.Results Thepostoperative recovery time of gastrointestinal function,hospital stay and hospitalization expenses wasrespectively(2.8±0.7)d,(6.5±1.5)d and(3.7±1.3)×104yuan in the ERAS group,significantly less than(3.3±0.5)d,(8.5±1.5)d and(5.8±1.1)×104yuan in the control group(t=-2.507,-3.935,-5.806;P<0.05).The postoperative1,3d CRP level was respectively(81±16)and(25±10)mg/L in the ERAS group,significantly lower than(93±19)and(36±8)mg/L in the control group(t=-2.123,-4.151;P<0.05).Conclusions Application of ERAS measures can effectively control the inflammatory reaction,shorten the recovery time of gastrointestinal function and hospital stay,reduce hospitalization expensesand promote rapid rehabilitation of patients.

关 键 词：加速康复外科 创伤和损伤 肝 围手术期医护 

分 类 号：R657.3[医药卫生—外科学]