临床路径联合加速康复外科在慢性胆囊炎伴胆囊结石患者中的应用效果

Clinical pathway combined with enhanced recovery after surgery in patients with chronic cholecystitis and gallstones

目的 探讨加速康复外科(ERAS)对慢性胆囊炎伴胆囊结石患者行腹腔镜胆囊切除临床路径的影响。方法 回顾性分析2017年6—12月安徽省淮南市第一人民医院普外科收治的慢性胆囊炎伴胆囊结石行腹腔镜胆囊切除术的94 例患者的临床资料,所有患者入院后均纳入临床路径管理。根据围手术期是否行ERAS分为研究组(n=45),对照组(n=49)。研究组患者围手术期采用加速康复外科模式,对照组采用传统围手术期管理方案。比较两组患者术前住院天数、手术时间、术中出血量、总住院天数、术后并发症、住院费用、术后住院天数、临床路径完成率及正负性变异率间的差异。计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验;计数资料组间比较采用χ2检验或Fisher确切概率法。结果 研究组患者术前住院天数、手术时间、术中出血量、总住院天数、术后并发症分别为(3.3±1.2) d、(63.1±24.3) min、(9.4±3.9) ml、(7.1±1.5) d、1 例,对照组分别为(3.2±1.5) d、(68.4±25.4) min、(9.5±2.9) ml、(8.4±1.8) d、2 例;两组相比差异均无统计学意义(均P>0.05)。研究组患者术后住院天数、住院费用、缩短住院天数正性变异率分别为(2.9±0.8) d、(9 407.2±500.9) 元、64.4%(29/45),对照组分别为(4.5±1.1) d、(10 594.9±792.3) 元、36.7%(18/49);两组相比差异均有统计学意义(P<0.05)。结论 慢性胆囊炎伴胆囊结石行腹腔镜胆囊切除术,在施行临床路径过程中联合加速康复外科,可缩短术后住院天数、降低住院费用,增加临床路径正性变异率,而不增加术后并发症。

Objective To investigate the effect of enhanced recovery after surgery (ERAS) on the clinical pathway of laparoscopic cholecystectomy in patients with chronic cholecystitis and gallstones. Methods From June 2017 to December 2017, 94 patients with chronic cholecystitis and cholecystolithiasis underwent laparoscopic cholecystectomy in the Department of General Surgery of First Hospltal of Huainan City were analyzed retrospectively. All patients were included in clinical pathway management. According to whether the perioperative period was combined with ERAS, there were 45 cases in the study group and 49 cases in the control group. The study group was combined with ERAS during perioperative period, while the control group received traditional perioperative management. The preoperative hospitalization days, operative time, intraoperative bleeding volume, total hospitalization days, postoperative complications, hospitalization costs, postoperative hospitalization days, clinical pathway completion rate and positive and negative variation rates were compared between the two groups. The measurement data were expressed by (Mean±SD), and the comparisons between groups were performed by t test;Comparisons of count data were analyzed using chi-square test or Fisher exact probability. Results Preoperative hospitalization days, operation time, intraoperative bleeding volume, total hospitalization days and postoperative complications in the study group were (3.3±1.2) d, (63.1±24.3) min, (9.4±3.9) ml, (7.1±1.5) d and 1 case respectively, while those in the control group were (3.2±1.5) d, (68.4±25.4) min, (9.5±2.9) ml, (8.4±1.8) d and 2 cases respectively, and the differences between the two groups ware not statistically significant (P>0.05). Postoperative hospitalization days, hospitalization expenses and shortened hospitalization days in the study group were (2.9±0.8) d, (9 407.2±500.9) yuan and 64.4%(29/45) respectively, while those in the control group were (4.5±1.1) d, (10 594.9±792.3) yuan and 36.7%(18/49) respectively. The difference between the two groups was statistically significant (P<0.05). Conclusion Laparoscopic cholecystectomy for chronic cholecystitis with cholecystolithiasis combined with ERAS during the implementation of clinical pathway can shorten postoperative hospital stay, reduce hospitalization costs, increase the positive variation rate of clinical pathway without increasing postoperative complications.