快速康复外科在胃肠外伤中的应用

Application of Fast Track Surgery in Gastrointestinal Tract Injury

目的探讨在急诊胃肠外伤中采用快速康复外科(FTS)的安全性、可行性及有效性。方法回顾性选择2007年7月至2013年7月期间武冈市人民医院普外科收治的符合纳入和排除标准的61例行胃肠外伤修补术患者的临床资料,2007年7月至2010年7月期间收治的胃肠外伤患者作为对照组(n=32),2010年7月至2013年7月期间收治的胃肠外伤患者作为FTS组(n=29),比较2组患者术后胃肠功能恢复时间、住院时间、伤口感染、肺部感染及死亡情况。结果 FTS组的平均胃肠功能恢复时间(2.21 d比3.16 d,P=0.000)和住院时间(7.45 d比9.78 d,P=0.000)均明显短于对照组,FTS组的肺部感染率明显低于对照组〔3.4%(1/29)比21.9%(7/32),P=0.033〕,2组伤口感染率〔3.4%(1/29)比15.6%(5/32),P=0.111〕和死亡率〔0(0/29)比3.1%(1/32),P=0.337〕比较差异无统计学意义。结论 FTS应用于那些就诊及时且受伤局限的胃肠外伤患者的治疗是安全、有效的,可促进术后胃肠功能恢复,缩短住院时间,并不增加术后并发症率及死亡率。

Objective To investigate the safety,feasibility,and efficacy of fast track surgery（FTS） in gastrointestinal tract injury.Methods The data of 61 patients with gastrointestinal tract injury from July 2007 to July2013 were retrospectively analyzed,among whom 29 patients were received FTS（FTS group） and 32 patients were received conventional care（control group）.The first flatus and defecation time,hospital stay,rates of wound infection and lung infection,and the mortality were compared between these two groups.Results The average first flatus and defecation time and the average hospital stay in the FTS group were significantly shorter than those in the control group（2.21 d versus 3.16 d,P=0.000;7.45 d versus 9.78 d,P=0.000）.The rate of lung infection in the FTS group were significantly lower than that in the control group[3.4%（1/29） versus 21.9%（7/32）,P=0.033）.The rate of wound infection and the mortality had no significant differences between the FST group and the control group[3.4%（1/29） versus 15.6%（5/32）,P=0.111;0（0/29） versus 3.1%（1/32）,P=0.337）.Conclusions FTS is safe and effective among those gastrointestinal tract injury patients who visited the hospital in time and injury limited.FTS could promote defecate,shorter the hospital stay,and don＇t increase the complications and mortality.