加速康复理念在非介入方式回收下腔静脉滤器患者围术期应用的效果评价  

Evaluation of the application of enhanced recovery after surgery principles in perioperative management for patients undergoing non-interventional retrieval of inferior vena cava filters

作　　者：梁陶媛 王萌萌 马琳 王曦竹 鲁雪梅 田轩 LIANG Taoyuan;WANG Mengmeng;MA Lin;WANG Xizhu;LU Xuemei;TIAN Xuan(Department of Vascular Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院血管外科,北京100035

出　　处：《中国普通外科杂志》2024年第6期961-969,共9页China Journal of General Surgery

基　　金：首都卫生发展科研专项基金资助项目(首发2022-2-2074);北京市属医院科研培育基金资助项目(PX2022015);北京积水潭医院“学科骨干”计划专项基金资助项目(XKGG202213)。

摘　　要：背景与目的:加速康复外科(ERAS)理念是指遵循循证医学原则,在多学科合作的基础上整合优化围手术期干预措施,目前已在多个外科领域开展应用,并得到广泛认可。下腔静脉滤器(IVCF)永久留置可能会引起多种并发症,指南建议在深静脉血栓形成风险降低后尽早回收滤器,但IVCF发生倾斜贴壁或穿孔、移位、粘连等情况,应用腔内手术方式无法施行或难以成功回收IVCF,此类患者可选择非介入的手术方式回收IVCF,包括腹腔镜或开腹IVCF回收术,但手术创伤大,术后并发症发生较多。目前尚无关于将ERAS理念应用于非介入方式IVCF回收方面的报道,因此,本研究探讨在非介入方式回收IVCF患者中采用ERAS理念指导的围术期管理措施的应用效果。方法:回顾性分析34例行非介入方式回收IVCF的患者临床资料,其中20例(2022年1月—2023年6月)围术期管理中应用基于ERAS理念的措施(观察组),14例(2020年7月—2021年12月)采用传统围术期管理措施(对照组)。比较两组患者的基线资料以及术中、术后相关指标。结果:观察组平均年龄大于对照组(51.2岁vs.39.5岁,P<0.05),其余指标包括性别、体质量指数、术前血红蛋白值、既往史、IVCF留置原因、IVCF位置、IVCF种类、尝试介入方式回收次数、IVCF留置时间、IVCF回收手术方式差异均无统计学意义(均P>0.05)。观察组术中出血量、手术时间、术后入ICU治疗人次、留置鼻胃管时间、术后住院时间及术后6 h疼痛视觉模拟评分均低于对照组(均P<0.05);观察组总并发症发生率低于对照组,但差异无统计学意义(25.0%vs.50.0%,P>0.05);观察组患者舒适状况量表得分高于对照组(88.5 vs.82.3,P<0.05),总住院费用低于对照组(4.4万元vs.5.4万元,P<0.05)结论:对非介入方式回收IVCF围术期患者实施ERAS管理措施效果良好,术中各项措施安全有效,在促进患者恢复,减轻疼痛,改善患者治疗体验等方面Background and Aims:The enhanced recovery after surgery(ERAS)concept involves integrating and optimizing perioperative interventions based on evidence-based medical principles and multidisciplinary collaboration.It has been implemented across various surgical fields and has gained widespread recognition.Permanent retention of an inferior vena cava filter(IVCF)can lead to various complications.Guidelines recommend retrieving the filter when the risk of deep vein thrombosis decreases.However,retrieval can be challenging or unsuccessful due to complications such as filter tilt,adherence,perforation,or migration.In such cases,non-interventional surgical methods like laparoscopic or open IVCF retrieval may be employed,though these methods are associated with significant surgical trauma and postoperative complications.There are no reports on the application of ERAS in non-interventional IVCF retrieval.Therefore,this study explores the effectiveness of ERAS-guided perioperative management in patients undergoing non-interventional IVCF retrieval.Methods:The clinical data from 34 patients who underwent non-interventional IVCF retrieval were retrospectively analyzed.Among them,20 patients(from January 2022 to June 2023)received perioperative management based on ERAS principles(observation group),while 14 patients(from July 2020 to December 2021)received traditional perioperative management(control group).Baseline characteristics and intraoperative and postoperative indicators were compared between the two groups.Results:The observation group had a higher average age than the control group(51.2 years vs.39.5 years,P<0.05).Other factors,including sex,body mass index,preoperative hemoglobin level,medical history,IVCF placement reasons,IVCF location,IVCF type,number of interventional retrieval attempts,IVCF indwelling time,and retrieval methods,showed no significant differences between the groups(all P>0.05).The observation group had lower intraoperative blood loss,shorter operative time,fewer ICU admissions,shorter nasogastri

关 键 词：腔静脉滤器 装置取出 术后加速康复 围手术期 

分 类 号：R654.3[医药卫生—外科学]