加速康复外科在肝胆胰外科手术中的应用效果分析  

Accelerated rehabilitation surgery in major surgery for hepatobiliary and pancreatic surgery

作　　者：杨育新[1] 谢楠[2] 孟怀聪 许彦丽 Yang Yuxin;Xie Nan;Meng Huaicong;Xu Yanli(Department of General Surgery,Shizong County People's Hospital,Qujing,Yunnan 655000,China;Department of Hepatobiliary and Pancreatic Surgery,No2.Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650101,China)

机构地区：[1]师宗县人民医院普外科,云南曲靖655000 [2]昆明医科大学第二附属医院肝胆胰外科,云南昆明650101

出　　处：《医药前沿》2020年第27期29-31,共3页Journal of Frontiers of Medicine

摘　　要：目的:探讨加速康复外科(ERAS)在肝胆胰围手术期的临床应用价值。方法:分析我院2010年1月-2018年1月普外科及肝胆科所收治的112例行肝胆胰外科手术患者。将所有患者按治疗方式的不同分为ERAS组52例和传统治疗模式的对照组60例。比较两组患者术后疼痛、手术前后的炎性介质PCT、IL-6、CRP、生化指标、术后患者各对应的临床指标及术后并发症(出血、发热、切口感染等的情况),并分析两组的差异。结果:ERAS组患者术后疼痛评分第1天(4.1±0.8)分、第2天(3.6±1.1)分、第3天(2.8±0.7)分、第4天(1.9±0.5)分,PCT、IL-6及CRP的分泌程度按照手术后第1~6天的结果显著低于对照组(P<0.05);ERAS组白蛋白、WBC及ALT结果显著优于对照组(P<0.05);ERAS组术后并发症的发生率(30.7%)及住院时间(7.7±2.8)d显著少于对照组(P<0.05)。结论:ERAS理念的应用可使肝胆胰外科手术患者获益,该理念可以用于肝胆胰外科的各项大手术中。该方法可减轻患者手术后的疼痛、减轻患者围手术期的应激及降低炎性介质的释放,减轻炎症反应、改善患者术后多种临床指标,提高患者术后生活质量,减少住院时间,进而最大程度加速患者康复。Objective To investigate the clinical application value and efficacy of ERAS in perioperative period of hepatobiliary and pancreatic cancer.Methods The clinical data of 112 patients admitted to the department of general surgery and Hepatobiliary department from January 2010 to January 2018 who underwent major hepatobiliary and pancreatic surgery in our hospital were retrospectively analyzed.According to the different treatment modes,all patients were successively divided into 52 cases in ERAS group of accelerated rehabilitation surgery and 60 cases in control group of traditional treatment mode.Postoperative pain,inflammatory mediators PCT,IL-6,CRP,biochemical indexes,clinical indexes of postoperative patients and postoperative complications(bleeding,fever,incision infection,etc.)were compared between the two groups,and the differences between the two groups were summarized and analyzed.Results The postoperative pain scores of ERAS group were(4.1±0.8),(3.6±1.1),(2.8±0.7)and(1.9±0.5)on the 1st day,the levels of PCT,IL-6 and CRP were significantly lower than those of the control group(P<0.05)on the 1st to 6th day after surgery.The Results of albumin,WBC and ALT in ERAS group were significantly better than those in control group(P<0.05).The incidence of postoperative complications(30.7%)and length of hospital stay(7.7±2.8)in ERAS group were significantly lower than those in the control group(P<0.05).Conclusion The application and promotion of ERAS concept can benefit patients with major hepatobiliary and pancreatic surgery,and the concept can be applied to all major operations of hepatobiliary and pancreatic surgery.This method can alleviate postoperative pain,reduce perioperative stress,reduce the release of inflammatory mediators,reduce inflammatory response,improve postoperative clinical indicators,improve postoperative quality of life,reduce hospital stay,and thus accelerate the recovery of patients to the greatest extent.

关 键 词：加速康复外科 肝胆胰外科 应激 手术治疗 

分 类 号：R61[医药卫生—外科学]