快速康复外科理念在后腹腔镜根治性肾切除术患者围手术期中的应用  

Application of enhanced recovery after surgery during perioperative period of retroperitoneal laparoscopic radical nephrectomy

作　　者：吉正国[1] 周海波[2] 许永德 杨培谦[1] Ji Zhengguo;Zhou Haibo;Xu Yongde;Yang Peiqian(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Urology,the Second Hospital of Beijing,Beijing 100031,China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,100050 [2]北京市第二医院泌尿外科,100031

出　　处：《国际外科学杂志》2021年第12期814-818,共5页International Journal of Surgery

基　　金：首都卫生发展科研专项(首发2020-2-1111)。

摘　　要：目的探讨快速康复外科(ERAS)理念在后腹腔镜根治性肾切除术患者围手术期中的应用效果。方法回顾性分析2015年10月—2021年7月首都医科大学附属北京友谊医院收治的189例后腹腔镜根治性肾切除术患者,根据围手术期管理方法不同将其分为两组:ERAS组(n=97)和传统组(n=92)。ERAS组患者围手术期采用ERAS理念管理,传统组患者围手术期采用传统方法管理。记录并比较两组患者术后首次饮水时间、术后首次排气时间、术后24 h疼痛评分、术后首次下床时间、术后导尿管留置时间、术后引流管留置时间、术后住院时间、手术切口长度以及术后肺炎、静脉血栓并发症情况。计量资料以均数±标准差(Mean±SD)表示,组间比较采用独立样本t检验;计数资料组间比较采用χ^(2)检验。结果两组患者的性别、年龄、体重指数、肿瘤侧别、肿瘤直径、肾脏标本最大横径、肿瘤T分期以及并发糖尿病、高血压方面比较,差异均无统计学意义(P>0.05)。ERAS组患者术后首次饮水时间为(3.8±1.4)h,术后首次排气时间为(10.2±2.5)h,术后24 h疼痛评分为(2.4±1.0)分,术后首次下床时间为(18.8±3.6)h,术后导尿管留置时间为(19.8±3.7)h,术后引流管留置时间为(3.4±0.5)d,手术切口长度为(7.2±0.9)cm,术后住院时间为(5.5±0.6)d。传统组患者术后首次饮水时间为(21.2±4.2)h,术后首次排气时间为(20.1±4.3)h,术后24 h疼痛评分为(5.4±1.0)分,术后首次下床时间为(32.8±7.8)h,术后导尿管留置时间为(55.7±8.0)h,术后引流管留置时间为(4.2±0.5)d,手术切口长度为(13.6±1.5)cm,术后住院时间为(7.2±1.3)d。两组比较,这些指标差异均具有统计学意义(P<0.05)。结论围手术期ERAS理念的临床应用能够促进后腹腔镜根治性肾切除术患者的术后快速康复,能够切实体现后腹腔镜技术的微创优势。Objective To investigate the effectiveness of enhanced recovery after surgery(ERAS)concept in perioperative period of retroperitoneal laparoscopic radical nephrectomy.Methods The clinical data of 189 patients who underwent retroperitoneal laparoscopic radical nephrectomy from October 2015 to July 2021 were retrospectively analyzed.According to different perioperative management methods,they were divided into two groups:ERAS group(n=97)and traditional group(n=92).Patients of ERAS group were managed by the ERAS concept during the perioperative period,patients of traditional group were managed by the traditional method during the perioperative period.First drinking time after surgery,first exhaust time,24 h postoperative pain score,first activity time out of bed,indwelling time of urinary catheter,indwelling time of drainage tube,postoperative hospital stay,incision length and complications of pneumonia and venous thrombosis were recorded and compared between the two groups.Measurement data were expressed as mean±standard deviation(Mean±SD),and independent sample t-test was used for comparison between groups;count data comparison between groups was by Chi-square test or Fisher exact probability method.Results There were no significant differences in age,gender,body mass index,tumor side,tumor diameter,maximum diameter of samples,T stage,diabetes and hypertension from between two groups(P>0.05).In ERAS group,the time of first drinking water after surgery was(3.8±1.4)h,the time of first anal exhaust was(10.2±2.5)h,the 24 h pain score was(2.4±1.0),the time of first activity out of bed after surgery was(18.8±3.6)h,the indwelling time of urinary catheter was(19.8±3.7)h,the indwelling time of drainage tube was(3.4±0.5)d,the surgical incision length was(7.2±0.9)cm,and the postoperative hospital stay was(5.5±0.6)d.In the traditional group,the time of first drinking water after surgery was(21.2±4.2)h,the time of first anal exhaust was(20.1±4.3)h,the 24 h pain score was(5.4±1.0),the time of first activity out of

关 键 词：加速康复外科 后腹腔镜 根治性肾切除术 肾肿瘤 围手术期医护 

分 类 号：R737.11[医药卫生—肿瘤]