基于加速康复外科的全程营养管理模式在胰十二指肠切除术患者中的应用  

Application of ERAS-based whole nutrition management mode in patients with pancreaticoduodenectomy

作　　者：董芳芳[1] 赵书敏[1] 鲁华鹏 冯爱芳[1] 耿智敏[1] DONG Fangfang;ZHAO Shumin;LU Huapeng;FENG Aifang;GENG Zhimin(Department of Hepatobiliary Surgery,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科

出　　处：《西部医学》2019年第12期1952-1956,共5页Medical Journal of West China

基　　金：陕西省重点研发项目(2017SF-237);西安交通大学第一附属医院院基金(2016HL-21)

摘　　要：目的探讨基于加速康复外科(ERAS)的全程营养管理模式在胰十二指肠切除术(PD)患者中的应用效果。方法选择我院2016年1月~12月行PD的108例患者作为对照组,予以传统营养支持;2017年1月~2018年6月行PD的144例患者作为观察组,予以基于ERAS的全程营养管理模式。比较两组快速康复指标及检验指标、项目实施前后医护人员营养知识水平。结果观察组首次肠内营养(EN)开始平均时间、肠鸣音恢复时间、肛门排气时间、住院时间均较对照组缩短,住院费用较对照组减少(P<0.05);术后10d血清白蛋白值较对照组提高(P<0.05);术前1d血清白蛋白值、术后并发症发生情况两组比较,差异无统计学意义(P>0.05);项目实施后医护人员营养知识水平高于实施前(P<0.05)。结论基于ERAS的全程营养管理模式,可有效促进PD患者快速康复,提高医护人员营养知识水平,对规范围手术期患者的营养管理具有推动作用。Objective To investigate the effect of Whole-course nutrition management model based on ERAS concept on patients with pancreaticoduodenectomy.Methods 108 patients underwent PD in January-December 2016 were used as a control group for traditional nutritional support.144 patients underwent PD from January to February 20,2017 were used as observation groups to provide full nutrition.The management model included setting up a full-scale nutrition management team,establishing a full-scale nutrition management process,and formulating detailed pre-and post-nutrition nutrition support programs according to the nutrition screening-nutrition assessment-nutrition intervention principle,and making a medical history acquisition board.The postoperative rapid recovery index and albumin level were compared between the two groups.Results The mean time to start EN,recovery time of bowel sounds,time of anal exhaust,length of hospitalization day,and hospitalization cost of the observation group were shorter than those of the control group(P<0.05).The albumin value was higher than that of the control group on the 10 th day after surgery(P<0.05).There was no significant difference in postoperative complications between the two groups at the time of admission and 1 day before surgery(P>0.05).Conclusion The whole process of nutrition management based on ERAS can effectively promote the recovery of intestinal function after PD,shorten the hospitalization day,reduce the hospitalization cost,and improve the postoperative albumin level.

关 键 词：加速康复 营养管理 肠内营养 肠外营养 胰十二指肠切除术 

分 类 号：R459.3[医药卫生—治疗学] R473.6[医药卫生—临床医学]