加速康复外科理念在老年患者行脾切除联合贲门周围血管离断术中的应用  

Enhanced recovery after surgery in elderly patients receivedsplenectomy combined with pericardial devascularization

作　　者：王丹丹 张建淮[1] 宋研[1] 禹亚彬[1] 徐建波[1] 祁付珍[1] WANG Dan-dan;ZHANG Jian-huai;SONG Yan;YU Ya-bin;XU Jian-bo;QI Fu-zhen(Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University,Huai'an,Jiangsu 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院肝胆外科,江苏淮安223300

出　　处：《中国临床研究》2022年第2期198-201,共4页Chinese Journal of Clinical Research

基　　金：淮安市自然科学项目(HAB202016);南京医科大学附属淮安第一医院高层次人才科研项目(YGRX201902)。

摘　　要：目的探讨加速康复外科(ERAS)在老年门静脉高压患者行脾切除联合贲门周围血管离断术围手术期应用的效果和意义。方法回顾性分析2015年8月至2019年8月在南京医科大学附属淮安第一医院因肝硬化门静脉高压行脾切除联合贲门周围血管离断术患者的临床资料,挑选出年龄>65岁的老年患者共62例。其中有32例患者采用加速康复理念进行围手术期相关处理,作为加速康复组;另30例患者采用传统围手术期处理,作为传统组。比较两组患者术中情况、术后并发症发生率、住院时间、住院费用等指标。结果加速康复组与传统组相比,术中出血量、手术时间、心血管事件、感染、出血、肝功能不全、门静脉血栓的发生率、术后死亡率及30 d再入院率比较差异无统计学意义(P>0.05)。ERAS组患者电解质紊乱发生率、住院费用、术后住院时间以及术后疼痛评分优于传统组,差异有统计学意义(P<0.05,P<0.01)。结论加速康复理念应用于脾切除联合贲门周围血管离断的老年门静脉高压患者的围手术期能够降低手术风险,缩短住院时间,减少住院费用。Objective To explore the effect of enhanced recovery after surgery(ERAS)in the perioperative period of splenectomy combined with pericardial devascularization in elderly patients with portal hypertension.Methods A retrospective analysis was performed on the clinical data of 62 elderly patients over 65 years old received splenectomy combined with pericardial devascularization due to cirrhotic portal hypertension Huai'an First People's Hospital from August 2015 to August 2019.There were 32 patients treated with ERAS during perioperative period(ERAS group)and 30 patients with traditional practice during perioperative period(control group).Intraoperative conditions,incidence of postoperative complications,hospital stay and hospitalization costs were compared between two groups.Results There was no significant difference in intraoperative bleeding,operation time,cardiovascular events,bleeding,infection,liver dysfunction,incidence of portal vein thrombosis,postoperative death and 30-day readmission rate between two groups(P>0.05).However,the electrolyte disturbance rate,the overall complication rate,postoperative pain score,the postoperative hospital stays and the hospitalization cost were lower in ERAS group compared with those in control group(P<0.05,P<0.01).Conclusions For the elderly patients received splenectomy combined with pericardial devascularization,ERAS during the perioperative period can improve patient comfort,and shorten the length and the cost of hospital stay.

关 键 词：加速康复外科 老年 门静脉高压 肝硬化 脾切除 

分 类 号：R473.7[医药卫生—护理学]