日归手术管理模式下疝修补术的加速康复实践分析  

Analysis of enhanced recovery practice in hernia repair under the same-day surgery management model

作　　者：孙义元 马洪升[1] 雷文章[2] 宋应寒 Sun Yiyuan;Ma Hongsheng;Lei Wenzhang;Song Yinghan(Day Surgery Center of West China Hospital,Sichuan University,Chengdu,610041,China;Day Surgery Center of West China Tianfu Hospital,Sichuan University,Chengdu,610041,China;Department of Gastrointestinal Hernia,West China Hospital,Sichuan University,Chengdu,610041,China)

机构地区：[1]四川大学华西医院日间手术中心,成都610041 [2]四川大学华西医院胃肠疝外科,成都610041 [3]四川大学华西天府医院日间手术中心,成都610041

出　　处：《中华疝和腹壁外科杂志（电子版）》2024年第1期37-41,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：四川省科技计划项目重点研发项目(2022YFS0230)。

摘　　要：目的探讨日归手术模式下疝修补术的加速康复临床实践效果,分析评价其可行性和安全性。方法采用回顾性研究方法,收集2022年3月至2023年3月四川大学华西天府医院日间手术中心收治的671例接受疝修补术患者的围手术期及随访资料。分析患者术后观察时间、当日停台率、过夜率、转科率、术后非计划镇痛使用率、出院后24 h疼痛评分、术后并发症、出院后1个月内再就诊和再入院率、出院后满意度等。观察临床疗效并总结经验。结果研究共纳入671名患者,男性573例,女性98例,全身麻醉140例,局部麻醉531例。所有患者术后观察时间2.35(0.04,22.33)h;当日停台率0.45%(3/671),过夜率9.84%(66/671),日归率90.16%(605/671),无转科病例。无非计划镇痛病例,出院24 h VAS疼痛评分为1(0,3)分。11例患者出现不同程度并发症,予保守治疗,1例发生补片感染,经补片取出术后痊愈。院内术后并发症发生率0.15%(1/671),再就诊率1.04%(7/671),再住院率0.45%(3/671)。术后1个月随访整体满意度为99.7%(669/671),术后随访6个月无复发病例。结论局部麻醉和全身麻醉下疝修补术均可以在日间手术中心安全地进行,在合理运用加速康复理念和多团队协作的情况下,可以纳入日归手术模式进行管理。Objective To explore the clinical practice effect of accelerated rehabilitation of hernia repair surgery under the same-day surgery mode and to analyze and evaluate its feasibility and safety.Methods A retrospective study was used to collect the perioperative and follow-up data of 671 patients who received hernia repair from March 2022 to March 2023 in the Ambulatory Surgery Center of West China Tianfu Hospital,Sichuan University,and analyze the postoperative data of the patients.We analyzed the postoperative observation time,day-stop rate,overnight rate,transfer rate,unplanned analgesic use rate,24-hour pain score after discharge,postoperative complications,re-visit and re-admission within one month after discharge,and satisfaction after discharge.To observe clinical efficacy and summarize experience.Results A total of 671 patients were included in the study,including 573 males and 98 females,140 under general anesthesia,and 531 under local anesthesia.The postoperative observation time of all patients was 2.35(0.04,22.33)hours.The day-stop rate was 0.45%(3/671),overnight rate was 9.84%(66/671),the daily return rate was 90.16%(605/671),and no transfer cases.All patients had no unplanned analgesia.The VAS pain score was 1(0,3)after discharge 24 hours.11 patients had complications of varying degrees and were treated conservatively;and 1 patient had a patch infection,which recovered after patch removal.The incidence of postoperative complications in the hospital was 0.15%(1/671).The re-visit and re-admission rates within one month after discharge were 1.04%(7/671)and 0.45%(3/671),respectively.The overall satisfaction rate was 99.7%(669/671)after one month of follow-up,and there were no recurrence cases in six months of follow-up.Conclusion Hernia repair under local and general anesthesia can be safely performed in a day surgery center and can be included in the same-day surgery mode for management under the condition of rational use of the concept of accelerated recovery and multi-team collaboration.

关 键 词：疝 腹股沟 日归手术 单中心 日间手术 疝修补术 

分 类 号：R473.6[医药卫生—护理学]