基于LEER模式的加速康复All in One病房在老年胆囊结石围术期的应用探索

Application of enhanced recovery“All in One”wards perioperative treatment based on LEER mode for eldly patients with cholecystolithiasis

目的评价基于LEER(less pain,early move,early eat,reassuring)模式的加速康复AO(All in One)病房在老年胆囊结石病围术期的应用临床价值。方法回顾性分析2022年1月至2023年2月乐山市人民医院收治的101例胆囊结石老年患者的临床资料,根据围术期病房管理方法不同,将患者分为AO组(48例)和非AO组(n=53例),比较两种病房管理模式下围手术期结局指标。结果两组患者基线资料具有可比性。与非AO组相比,AO组手术治疗率更高(93.4%vs 71.7%,χ^(2)=8.360,P<0.001),术前住院时间更短[(3.67±1.31)d vs(5.76±1.42)d,t=7.660,P<0.001]、术后疼痛评分更低[(3.35±1.24)分vs(6.36±0.78)分,t=14.746,P<0.001]、术后胃肠道功能恢复时间更短[(1.52±1.46)d vs(2.58±0.54)d,t=4.29,P<0.001]、术后住院时间更短[(3.58±1.36)d vs(5.37±1.26)d,t=6.866,P<0.001]、外科住院费用更低[(11342.52±1124.53)元vs(14372.24±1738.24)元,t=10.281,P<0.001]、患者满意度更高[(97.25±2.15)分vs(88.73±3.06)分,t=16.033,P<0.001],差异均有统计学意义。两组在手术时间、术中出血量及术后并发症发生率方面比较,差异无统计学意义(P>0.05)。结论基于LEER模式建立的加速康复AO病房能够提高老年胆囊结石患者的手术治疗率,加快术后康复,缩短住院时间,提高患者满意度。

Objective To evaluate the application value of enhanced recovery“All in One”wards perioperative treatment based on LEER(less pain,early move,early eat,reassuring)mode for eldly patients with cholecystolithiasis.Methods The clinical data of 101 elderly patients with cholecystolithiasis,who admitted to Leshan People’s Hospital between Jan.2022 and Feb.2023,were retrospectively analyzed.According to different perioperative managements,patients were divided into AO group(48 cases)and non-AO group(n=53 cases).The perioperative outcome were compared between the two groups.Results The baseline data in the two groups were comparable.Compared with the non-AO group,the AO group had higher surgical treatment rate(93.4%vs 71.7%,χ^(2)=8.360,P<0.001),shorter preoperative hospitalization time[(3.67±1.31)d vs(5.76±1.42)d,t=7.660,P<0.001],lower postoperative pain score[(3.35±1.24)vs(6.36±0.78),t=14.746,P<0.001],shorter postoperative gastrointestinal function recovery time[(1.52±1.46)d vs(2.58±0.54)d,t=4.29,P<0.001],shorter postoperative hospitalization time[(3.58±1.36)d vs(5.37±1.26)d,t=6.866,P<0.001],lower surgical hospitalization cost[(11342.52±1124.53)yuan vs(14372.24±1738.24)yuan,t=10.281,P<0.001],and higher satisfaction of patients[(97.25±2.15)vs(88.73±3.06),t=16.033,P<0.001],the differences were all statistically significant.There was no significant difference in terms of operation time,intraoperative blood loss and postoperative complications incidence(P>0.05).Conclusion This priliminary study shows that,for eldly patients with cholecystolithiasis,enhanced recovery AO ward based on LEER mode can improve the operative treatment rate,accelerate postoperative rehabilitation,shorten the hospitalization time,and improve the patients’satisfaction.