中国普外基础与临床杂志

中国普外基础与临床杂志

多学科多模式干预在胰十二指肠切除术后快速康复中的应用

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目的 探索快速康复外科(enhanced recovery after surgery,ERAS)理念应用于胰十二指肠切除术(pancreatoduodenectomy,PD)围手术期的应用价值。 方法 前瞻性收集 2016 年 1 月至 2017 年 6 月期间在华西医院胰腺外科行开腹 PD 的 227 例患者,根据围手术期处理分为 ERAS 组(51 例)和对照组(176 例),比较 2 组患者的坐起时间、下地时间、开始饮水时间、开始进食时间、排气时间、排便时间、胃管拔除时间、术后住院时间、住院费用、并发症及术后疼痛评分。 结果 ① 术后效果指标:与对照组比较,ERAS 组患者的坐起时间、下地时间、开始饮水时间、开始进食时间、排气时间、排便时间、胃管拔除时间、术后住院时间及住院费用均较短(低),差异均有统计学意义(P<0.05)。② 术后并发症:2 组患者的胰瘘、术后出血、胃排空障碍、胆汁漏、腹腔感染、切口并发症、肺部感染及心脏病发生率比较差异均无统计学意义(P<0.05)。③ 再手术和再入院:2 组患者的再手术率和再入院率比较差异均无统计学意义(P>0.05)。④ 术后疼痛评分:除术后第 6 天 22 时外,术后 2 h、术后 8 h 及术后第 1~6 天各时点(8 点、16 点及 22 点),ERAS 组患者的疼痛评分均低于对照组,差异均有统计学意义(P<0.05)。 结论 ERAS 可在不增加并发症发生率的同时加速 PD 患者的康复,并减轻患者的疼痛。

Objective The objective of this study was to evaluate the effect of enhanced recovery after surgery (ERAS) in the pancreaticoduodenum perioperative period. Method This article conducts the forward-looking analysis on the information of 227 patients undergoing the pancreatoduodenectomy in West China Hospital from June 2010 to June 2017, and then compared the differences between the patients subjected to ERAS (ERAS group) and those subjected to regular measures (control group) with respect to time of setting in sickbed, time of mobilizing out of sickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, postoperative hospitalization duration and expenses, postoperative complication, and postoperative pain scores. Results ① Postoperative indexes: by comparison of the ERAS group and the control group, it is found that the ERAS group had shorter (or lower) time of setting in sickbed, time of mobilizing out of sickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, postoperative hospitalization duration and expenses (P<0.05).② Postoperative complications: of all post-operative complications, pancreatic fistula, post-operative hemorrhage, delayed gastric emptying, biliary fistula, abdominal infection, incision complication, lung infection, and heart complication were without statistically significant differences (P>0.05) between the 2 groups. ③ Reoperation and readmission: there was no significant difference on the incidences of reoperation and readmission between the 2 groups (P>0.05). ④ Postoperative pain scores: except 22:00 of the 6-day after operation, the pain scores in the ERAS group were all lower than those in the control group at 2 h and 8 h after operation, and the time points of 1–6 days after operation (8:00, 16:00, and 22:00), with statistically differences (P<0.05). Conclusion Without increasing the incidence of complications, ERAS may speed up the rehabilitation of patients undergoing the pancreatoduodenectomy and mitigate the pain of patients.

关键词: 快速康复外科; 胰十二指肠切除术; 应用价值

Key words: enhanced recovery after surgery; pancreatoduodenectomy; application significance

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