加速康复外科理念在老年患者腹腔镜辅助胃癌根治术中的应用  

Application of enhanced recovery after surgery in laparoscopic-assisted radical gastrectomy for elderly patients

作　　者：程康文 王贵和[1] 唐爱平[2] 刘红霞 束宽山[1] 郑明[1] 左伯海[1] 王振兴 马冬花 胡文君 CHENG Kang-Wen;WANG Gui-He;TANG Ai-Ping;LIU Hong-Xia;SHU Kuan-Shan;ZHENG Ming;ZUO Bo-Hai;WANG Zhen-Xing;MA Dong-Hua;HU Wen-Jun(Gastrointestinal Surgery,Tongling People′s Hospital of Anhui Province,Tongling 244000,China;Department of Anesthesiology,Tongling People′s Hospital of Anhui Province,Tongling 244000,China;Operating Room,Tongling People′s Hospital of Anhui Province,Tongling 244000,China;Nursing Department,Tongling People′s Hospital of Anhui Province,Tongling 244000,China)

机构地区：[1]安徽省铜陵市人民医院胃肠外科,铜陵244000 [2]安徽省铜陵市人民医院麻醉科,铜陵244000 [3]安徽省铜陵市人民医院手术室,铜陵244000 [4]安徽省铜陵市人民医院护理部,铜陵244000

出　　处：《中华老年多器官疾病杂志》2020年第2期109-114,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：安徽省铜陵市卫生科研项目[卫科研(2015)12号;卫科研(2016)3号;卫科研(2016)11号]~~

摘　　要：目的探讨实施腹腔镜辅助胃癌根治术老年患者应用加速康复外科理念(ERAS)的效果及安全性。方法入选铜陵市人民医院胃肠外科2015年12月至2018年12月拟行腹腔镜辅助胃癌根治术患者80例,随机数表法分为ERAS组和常规组,每组40例,比较2组患者术后相关指标和并发症。应用SPSS 22.0统计软件对数据进行分析。依据数据类型,采用t检验或χ2检验进行组间比较。结果相比常规组,ERAS组术后首次通气时间[(53.77±23.53)和(64.24±22.44)h]、首次排便时间[(60.92±22.15)和(75.10±22.25)h]、首次下床活动时间[(18.77±3.27)和(26.67±4.29)h]、首次经口流质饮食时间[(22.26±9.64)和(89.47±13.39)h]、肠外营养时间[(5.43±1.57)和(7.46±1.45)d]、腹腔引流管拔除时间[(4.90±1.24)和(6.60±1.04)d]和住院时间[(8.73±1.80)和(10.83±2.07)d]短,术后住院费用[(5.35±0.58)万元和(6.06±0.65)万元]低,差异均有统计学意义(P<0.05)。ERAS组相比常规组咽喉疼痛[7.5%(3/40)和27.5%(11/40)]、切口疼痛>Ⅱ级[5.0%(2/40)和20.0%(8/40)]、术后并发症Clavien-DindoⅠ级[17.5%(7/40)和37.5%(15/40)]发生率低,差异均具有统计学意义(P<0.05)。结论ERAS在老年患者腹腔镜胃癌根治术中应用安全有效,可降低术后并发症Clavien-DindoⅠ级发生率。Objective To investigate the effect and safety of enhanced recovery after surgery(ERAS)in the elderly patients undergoing laparoscopic-assisted radical gastrectomy.Methods From December 2015 to December 2018,80 patients undergoing laparoscopic-assisted radical gastrectomy were randomly divided into ERAS group and routine group(n=40 in each).The two groups were compared in postoperative indicators and complications.SPSS statistics 22.0 was used to analyze the data,and depending on data type,t test orχ2 test was used for comparison between the two groups.Results Compared with the routine group,the ERAS group had shorter time before the first exhaust[(53.77±23.53)vs(64.24±22.44)h]and the first defecation[(60.92±22.15)vs(75.10±22.25)h];earlier ambulation[(18.77±3.27)vs(26.67±4.29)h],oral feeding for liquids[(22.26±9.64)vs(89.47±13.39)h],postoperative parenteral nutrition[(5.43±1.57)vs(7.46±1.45)d]and removal of peritoneal drainage[(4.90±1.24)vs(6.60±1.04)d];shorter postoperative hospital stay[(8.73±1.80)vs(10.83±2.07)d];and lower postoperative hospitalization expenses[(5.35±0.58)×104 vs(6.06±0.65)×104 yuan],all differences being statistically significant(P<0.05).ERAS group had significantly lower incidences than the routine group of sore throat[7.5%(3/40)vs 27.5%(11/40)],incision pain above gradeⅡ[5.0%(2/40)vs 20.0%(8/40)],and postoperative complications of Clavien-Dindo gradeⅠ[17.5%(7/40)vs 37.5%(15/40)],all differences being statistically significant(P<0.05).Conclusion ERAS is safe and effective in the elderly patients undergoing laparoscopic-gastric radical gastrectomy and can reduce postoperative Clavien-Dindo gradeⅠcomplications.

关 键 词：腹腔镜检查 胃切除术 胃肿瘤 康复 

分 类 号：R656[医药卫生—外科学] R592[医药卫生—临床医学]