加速康复外科在腹腔镜袖状胃切除术围手术期的应用价值  

Application value of enhanced recovery after surgery in perioperative period of laparoscopic sleeve gastrectomy

作　　者：沈宏丹 陈炯煌[2] 李雯 杨斐敏[1] 郑素芬[1] 高启胜 于卫华[2] 朱玲华[2] 潘红英[1] Shen Hongdan;Chen Jionghuang;Li Wen;Yang Feimin;Zheng Sufen;Gao Qisheng;Yu Weihua;Zhu Linghua;Pan Hongying(Department of Nursing,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Department of General Surgery,Sir Run Run Shaw Hospital,Affiliated with the Zhejiang University School of Medicine,Hangzhou 310016,China;School of Public Health,Hangzhou Medical College,Hangzhou310063,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院护理部,杭州310016 [2]浙江大学医学院附属邵逸夫医院普通外科,杭州310016 [3]杭州医学院公共卫生学院,杭州310063

出　　处：《中华消化外科杂志》2024年第8期1073-1079,共7页Chinese Journal of Digestive Surgery

基　　金：浙江省自然科学基金(LQ24H160021);浙江省卫健委项目(2022KY842)。

摘　　要：目的探讨加速康复外科(ERAS)在腹腔镜袖状胃切除术(LSG)围手术期的应用价值.方法采用回顾性队列研究方法.收集2021年1月至2023年12月浙江大学医学院附属邵逸夫医院收治的1181例行LSG患者的临床资料;男242例,女939例;年龄为(31±8)岁.1181例患者中,598例围手术期应用传统理念进行管理,设为对照组;583例围手术期应用ERAS理念进行管理,设为ERAS组.正态分布的计量资料以(x)±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用Mann-Whitney秩和检验.计数资料以绝对数和百分比表示,组间比较采用χ^(2)检验或Fisher确切概率法.重复测量资料采用重复测量方差分析,将基线评分作为协变量进行校正,当存在交互作用时进行简单效应分析,多重比较采用Bonferroni法检验.结果(1)术后情况.对照组患者回病房后即刻至术后第3天晨的疼痛数字评分法(NRS)评分由(5.35±0.93)分变化至(2.57±0.83)分,ERAS组患者上述指标由(3.15±0.93)分变化至(0.70±0.65)分,两组NRS变化趋势比较,差异有统计学意义(=66.58,F_(组间)=1765.85,F_(交互)=6.90,P<0.05).将回病房后即刻评分作为基线进行校正,简单效应分析结果显示:术后第1天晨NRS评分ERAS组比对照组低1.89分(P<0.05),术后第2天晨NRS评分ER AS组比对照组低1.53分(P<0.05),术后第3天晨N RS评分ERAS组比对照组低1.76分(P<0.05).对照组患者回病房后即刻至术后第3天晨的恶心情况由497例减少至97例,ERAS组患者上述指标由198例减少至11例,两组患者上述指标比较,差异均有统计学意义(χ^(2)=294.45,398.76,209.39,73.00,P<0.05).对照组患者回病房后即刻至术后第3天晨的呕吐情况由243例减少至41例,ERAS组患者上述指标由51例减少至2例,两组患者上述指标比较,差异均有统计学意义(χ^(2)=160.54、149.37、71.76、35.69,P<0.05).对照组和ERAS组患者术后住院时间分别为(3.22±0.65)d和(2.17�Objective To investigate the application value of enhanced recovery after surgery(ERAS)in perioperative period of laparoscopic sleeve gastrectomy(LSG).Method The retrospective cohort study was conducted.The clinical data of 1181 patients undergoing LSG in the Sir Run Run Shaw Hospital,Affiliated with the Zhejiang University School of Medicine from January 2021 to December 2023 were collected.There were 242 males and 939 females,aged(31±8)years.Of 1181 patients,598 cases receiving routine perioperative care were divided into the control group,and 583 cases receiving perioperative care with ERAS were divided into the ERAS group.Measurement data with normal distribution were represented as Mean+sD,and the independent sample t test was used for comparison between the groups.Measurement data with skewed distribution were represented as M(Q_(1),Q_(3)),and the Mann-Whitney rank sum test was used for comparison between the groups.Count data were expressed as absolute numbers or percentages,and the chi-square test or Fisher exact probability were used for comparison between the groups.Repeated measurement data were analyzed using the repeated ANOVA,with baseline scores as covariates.Simple effects analysis was conducted in case of interaction,and multiple comparisons were adjusted using the Bonferroni method.Results(1)Postoperative outcomes.The numerical rating scale(NRS)scores for pain at immediate return to the ward and on the third postoperative mornings changed from 5.35+0.93 to 2.57±0.83 in the control group,versus changed from 3.15±0.93 to 0.70±0.65 in the ERAS group,showing significant difference between the two groups(_(Ftime)=66.58,F_(group)=1765.85,F_(interaction)=6.90,P<0.05).After adjusting NRS scores for pain at immediate return to the ward as the baseline,results of simple effects analysis showed that on the third postoperative mornings,the NRS scores in the ERAS group were lower by 1.89,1.53,and 1.76 respectively compared to the control group(P<0.05).Cases with nausea at immediate return to the ward and

关 键 词：加速康复外科 减重代谢手术 腹腔镜袖状胃切除术 手术后恶心呕吐 手术后疼痛 

分 类 号：R656.61[医药卫生—外科学]