加速康复外科应用于腹腔镜胆囊切除术围手术期的效果研究

Efficacy research of enhanced recovery after surgery on Laparoscopic cholecystectomy during perioperative period

目的探讨加速康复外科理念在腹腔镜胆囊切除术围手术期应用价值.方法回顾性研究2018年1月至2019年1月在安徽省第二人民医院普外科一病区因胆囊良性疾病接受腹腔镜胆囊切除术的82例患者临床病例资料.按照患者围手术期管理流程的不同分为加速康复外科模式组(42例)和传统模式组(40例),分别对两组患者术后排气时间、出院时间、治疗费用及相关临床常见并发症等指标进行统计分析.结果加速康复外科模式组与传统模式组术后肛门排气时间分别为(18.7±3.7)h及(22.5±5.9)h,下床活动时间分别为(7.9±0.3)h及(13.1±1.4)h,术后进食时间分别为(5.9±0.3)h及(24.3±3.7)h,术后住院时间分别为(3.3±0.5)d及(5.2±0.6)d,住院总费用分别为(9842±532)元及(11321±654)元,差异有统计学意义.加速外科模式组在术后疼痛、发热、腹胀、恶心呕吐等不良反应及并发症发生率方面明显降低.结论加速康复外科理念应用于腹腔镜胆囊切除术围手术期,是安全、可靠、经济的,可加快患者术后康复速度,降低术后不良反应及相关并发症发生率,减轻患者经济负担,具有重要的临床应用价值,值得在我国大力推广.

Objective To explore the application value of the concept of accelerated rehabilitation surgery in the perioperative period of laparoscopic cholecystectomy.Methods The clinical data of 82 patients who received laparoscopic cholecystectomy due to benign gallbladder diseases in the first ward of general surgery department of anhui second people’s hospital from January 2018 to January 2019 were retrospectively studied.According to whether the perioperative management process of patients has the five basic elements of the accelerated rehabilitation surgery model,the patients were divided into the accelerated rehabilitation surgery model group(42 cases)and the traditional surgery model group(40 cases).The postoperative exhaust time,discharge time,treatment cost and related common clinical complications of the patients in the two groups were statistically analyzed.Results Accelerate rehabilitation surgery model group and the traditional mode of postoperative anal exhaust time,respectively(18.7±3.7)h and(22.5±5.9)h,ambulation time,respectively(7.9±0.3)h and h(13.1±1.4),postoperative time of food intake,respectively(5.9±0.3)h and h(24.3±3.7),postoperative length of hospital stay(3.3±0.5)respectively d and d(5.2±0.6),hospitalization cost RMB(9842±532)and yuan(11321±654),the difference was statistically significant.The incidence of postoperative pain,fever,abdominal distension,nausea and vomiting and other adverse reactions and complications were significantly reduced in the accelerated surgery group.Conclusion It is safe,reliable and economical to apply the concept of accelerated surgical rehabilitation in the perioperative period of laparoscopic cholecystectomy.It can speed up the postoperative recovery of patients,reduce the incidence of postoperative adverse reactions and related complications,and reduce the economic burden of patients.It has important clinical application value and is worth to be popularized in China.