加速康复外科促进老年胃十二指肠溃疡穿孔患者腹腔镜术后康复的效果

Effect of accelerated rehabilitation surgery on elderly patients with gastric peptic ulcer perforation after laparoscopic surgery

目的观察加速康复外科(ERAS)应用于老年胃十二指肠溃疡穿孔患者腹腔镜术后康复中的效果。方法选择郑州市第九人民医院2018年1月—2020年12月接受腹腔镜手术治疗的老年胃十二指肠溃疡穿孔患者90例为研究对象,根据住院单的单双号分为对照组(单号、45例)与观察组(双号、45例),对照组采用常规围术期干预,观察组在对照组基础上增加ERAS干预。观察并比较两组患者术后恢复相关指标;比较两组患者术后12、24、48 h疼痛程度[视觉模拟评分法(VAS)];记录并比较两组患者术后并发症发生情况。结果观察组的术后肛门排气时间[(1.81±0.32)d]、肛门排便时间[(2.20±0.44)d]、首次下床活动时间[(21.72±2.03)h]均早于对照组[(2.18±0.46)d、(2.52±0.51)d、(42.67±3.12)h],引流管留置时间[(2.17±0.34)d]及住院时间[(6.82±1.05)d]均短于对照组[(3.42±1.64)d、(3.42±1.64)d],差异有统计学意义(P<0.05);观察组术后12、24、48h VAS评分[(4.56±1.02)分、(4.12±0.86)分、(3.54±0.71)分]低于对照组[(5.87±1.07)分、(5.32±0.92)分、(4.24±0.89)分],差异有统计学意义(P<0.05);观察组并发症总发生率为4.44%,低于对照组的22.22%,差异有统计学意义(P<0.05)。结论ERAS应用于老年胃十二指肠溃疡穿孔患者腹腔镜术后中,康复效果显著,可减少并发症的发生,降低术后疼痛程度,缩短住院时间。

Objective To observe the effect of Accelerated Rehabilitation Surgery(ERAS)on the elderly patients with gastric peptic ulcer perforation after laparoscopic surgery.Methods Totally 90 elderly patients with gastric peptic ulcer perforation who were treated by laparoscopy in the Ninth People’s Hospital of Zhengzhou City from January 2018 to December 2020 were selected,the patients were divided into control group(odd number,45 cases)and Observation Group(even number,45 cases).The control group was treated with routine perioperative intervention,and the observation group was treated with ERAS.The indexes of postoperative recovery were observed and compared between the two groups,and the postoperative pain 12,24,48 hours after the two groups were compared.Results In the observation Group,the time of Anal Exhaust[(1.81±0.32)d],time of anal defecation[(2.20±0.44)d],time of first movement out of bed[(21.72±2.03)h]were earlier than those in the Control Group[(2.18±0.46)d,(2.52±0.51)d,(42.67±3.12)h],the indwelling time of drainage tube[(2.17±0.34)d]and hospitalization time[(6.82±1.05)d]were shorter than that of control group[(3.42±1.64)d,(3.42±1.64)d],the difference was significant(P<0.05)Vas scores[(4.56±1.02),(4.12±0.86),(3.54±0.71)]in the observation group were lower than those in the control group[(5.87±1.07),(5.32±0.92),(4.24±0.89)](P<0.05).The total complication rate of the observation group was 4.44%,which was lower than that of the control group(22.22%,P<0.05).Conclusion ERAS is effective in elderly patients with gastric peptic ulcer perforation after laparoscopic surgery.It can reduce complications,postoperative pain and length of hospital stay.