加速康复外科优化肺移植患者术后重症监护管理的经验  

Experience of ERAS in optimizing intensive care management after lung transplantation

作　　者：伍威[1] 邹捍东[1] 谢文杰[1] 王璐[1] 夏文芳[1] 周青山[1] 詹丽英[1] WU Wei;ZOU Handong;XIE Wenjie;WANG Lu;XIA Wenfang;ZHOU Qingshan;ZHAN Liying(Dept,of Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院重症医学科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2021年第4期542-545,共4页Medical Journal of Wuhan University

基　　金：中央高校基本科研业务费专项资金资助项目(编号:2042020kf0057)。

摘　　要：目的:探讨加速康复外科(ERAS)理念在肺移植患者术后重症监护管理中的应用。方法:回顾性收集武汉大学人民医院2016年12月—2020年12月术后重症监护期实施ERAS方案的14例肺移植患者的资料,统计患者的一般资料、ERAS具体实施情况、围术期(<30 d)并发症的发生率及生存率、术后早期恢复情况(术后气管插管留置时间/胃管留置时间/尿管留置时间/首次下床活动时间)、术后住院时间(术后住ICU的时间/术后住院时间/出院后30 d再入院率)等指标,并进行分析。结果:患者围术期(术后<30 d)并发症的发生率为21.4%(3/14),双肺移植围术期(<30 d)生存率为90%(9/10),单肺移植围术期(<30 d)无死亡病例。患者术后气管插管留置时间为6 h~21 d(中位时间1.5 d),术后胃管留置时间为12 h~7 d(中位时间1.8 d),尿管留置时间为1~7 d(中位时间4 d),术后首次下床活动时间为2~20 d(中位时间7 d)。术后住ICU的时间为1~8 d(中位时间4 d),术后住院平均时间为3~92 d(中位时间19d),出院后30 d再入院率为0。结论:在肺移植患者术后重症监护期实施ERAS方案安全可行,值得临床应用推广。Objective:To explore the application of enhanced recovery after surgery(ERAS) in the intensive care management of patients after lung transplantation.Methods:The clinical data of 14 lung transplant patients who underwent the ERAS during postoperative intensive care period from December2016 to December 2020 in Renmin Hospital of Wuhan University were collected retrospectively.The general information were collected, including specific implementation plan of ERAS, the incidence and survival rate of complications during the perioperative period(<30 d), recovery indexes in the early postoperative period(duration of tracheal intubation/nasogastric tube/urinary catheter/the time for the first ambulation), and postoperative length of stay(median time in ICU/median time of stay/re-admission rate within 30 days after discharge).Results:The incidence of complications in the perioperative period(postoperative <30 d) was 21.4%(3/14).The perioperative(<30 d) survival rate of double lung transplantation was 90%(9/10), and no death was occurred during the perioperative period of single lung transplantation(<30 d).The median time of tracheal intubation was 1.5 d(6 h-21 d), average duration of nasogastric tube was 1.8 d(12 h-7 d), and median time of urinary catheter was 4.0 d(1-7 d), and median time for the first ambulation was 7 d(2-20 d).The median time of postoperative ICU stay was 4 d(1-8 d), and median time of postoperative hospital stay was 19 d(3-92 d).The rate of re-admission within 30 days after discharge was zero.Conclusion:It is safe and feasible to implement ERAS in ICU after lung transplantation.

关 键 词：加速康复外科 肺移植 术后 重症监护 

分 类 号：R655.3[医药卫生—外科学]