ERAS对胆囊结石合并胆总管结石患者术后康复及应激因子的影响  

Effect of ERAS on postoperative rehabilitation and stress factors in patients with cholecystolithiasis and choledocholithiasis

作　　者：张娟[1] 张艳芳[4] 马静[1] 杨雷[1] 吴华彰[2] 李灵艳 叶枫林[3] Zhang Juan;Zhang Yanfang;Ma Jing;Yang Lei;Wu Huazhang;Li Lingyan;Ye Fenglin(Department of General Surgery,First People's Hospital of Bengbu City,233000;College of Life Sciences,Bengbu Medical College,233030;Department of Surgery of the First Affiliated Hospital of Bengbu Medical College,233004;Department of Hepatobiliary Surgery of the First Affiliated Hospital of Bengbu Medical College,233004)

机构地区：[1]蚌埠市第一人民医院普外科,233000 [2]蚌埠医学院生命科学院,233030 [3]蚌埠医学院第一附属医院外科,233004 [4]蚌埠医学院第一附属医院肝胆外科,233004

出　　处：《中华普外科手术学杂志（电子版）》2021年第4期444-446,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：2019年度安徽省自然科学基金项目(1908085MH257)。

摘　　要：目的探究加速康复外科(ERAS)对胆囊结石合并胆总管结石患者术后康复及应激因子的影响。方法选取71例胆囊结石合并胆总管结石患者,分别纳入ERAS组(n=35)、常规组(n=36),常规组接受围术期常规康复干预,ERAS组接受ERAS理念的围术期干预,两组患者均接受腹腔镜胆囊切除+胆总管切开+胆道镜探查取石+胆总管Ⅰ期缝合或T管引流治疗,手术均由同组医师完成。使用SPSS 22.0软件分析数据,围术期各项指标、肝功能和炎症因子指标以(x±s)表示,独立t检验;并发症发生率采用χ^(2)检验,P<0.05差异有统计学意义。结果ERAS组术后排气时间、术后排便时间、术后补液总量、术后住院时间、住院费用和术后并发症发生率均低于常规组(P<0.05)。两组患者术后3 d谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)均较术前下降,ERAS组下降更为明显;两组患者术后3 d白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、肾素(PRA)、血管紧张素-2(Ang-2)、醛固酮(ALD)均较术前上升,IL-10均较术前下降,常规组变化更为明显(P<0.05)。结论基于ERAS理念开展围术期管理,能促进胆囊结石合并胆总管结石患者腹腔镜术后早期康复,减轻炎症反应与应激反应,并提高手术安全性。Objective To analyze the effect of enhanced recovery after surgery(ERAS)on postoperative rehabilitation and stress factors of patients with cholecystolithiasis complicated with choledocholithiasis.Methods Seventy-one patients with cholecystolithiasis complicated with choledocholithiasis were divided into ERAS group(n=35)and routine group(n=36).The routine group received routine perioperative rehabilitation intervention,while ERAS group received perioperative intervention based on ERAS concept.Both groups received laparoscopic cholecystectomy+choledocholithotomy+choledochoscope exploration+primary suture of common bile duct or T\tube drainage,and all the operations were performed by doctors in the same group.SPSS 22.0 software was used to analyze the data.The indexes of intraoperative and postoperative liver function and inflammatory factors were expressed as (x±s),and independent t test was performed.The incidence of complications was tested byχ^(2) tests.The difference was statistically significant(P<0.05).Results The postoperative exhaust time,postoperative defecation time,postoperative rehydration amount,postoperative hospitalization time,hospitalization expenses and postoperative complication rate in ERAS group were lower than those in routine group(P<0.05).AST,ALT and TBIL decreased 3 days after operation,On the 3rd day after operation,IL-6 and TNF-αincreased and IL-10 decreased in both groups,especially in the routine group(P<0.05).The PRA,Ang-2,ALD in the two groups increased 3 days after operation,especially in the routine group(P<0.05).ConclusionPerioperative management based on ERAS concept can promote early rehabilitation of patients with cholecystolithiasis complicated with choledocholithiasis after laparoscopic surgery,reduce inflammatory reaction and stress reaction,and improve surgical safety.

关 键 词：胆囊结石病 胆总管结石 加速康复外科 应激因子 手术后并发症 

分 类 号：R657.42[医药卫生—外科学]