快速康复外科在肝脾破裂围手术期应用中的研究

Application value of fast track surgery management in perioperative period of patients with rupture of liver and spleen

目的探讨快速康复外科(FTS)新理念在肝脾创伤性破裂患者救治中的应用价值。方法对2011年10月—2014年12月解放军第五十九医院收治的符合入选标准的76例患者,按照自愿及随机原则,分为观察组(48例)和对照组(28例),2组患者年龄、性别、体重指数(BMI)、致伤原因、入院C反应蛋白(CRP)水平、基本用药及手术方式等一般资料差异无统计学意义,具有可比性。对照组采用传统的围术期处理方法,观察组采用FTS指导下处理措施,包括尽量不留置各种导管、采用快通道麻醉技术、强化镇痛及保温、采取限制性液体治疗策略、术后早期下床活动、早期进食等;分析比较2组术前、术后第1天及第5天CRP水平,术后苏醒及拔管时间、术后每日VAS疼痛评分、胃肠功能恢复时间、住院天数及诊疗费用,对比分析2组并发症等情况。结果 76例患者均治愈,与对照组相比,观察组术后第1天及第5天应激水平降低,苏醒及拔管时间提前,日均VAS疼痛评分降低,肛门排气排便时间提前、住院天数减少、诊疗费用明显降低(P<0.05),术后不良反应及并发症发生情况组间比较差异无统计学意义(P>0.05)。结论 FTS理念在肝脾破裂创伤患者救治中的应用,安全、有效,可缩短救治周期,减少医疗投入,加速此类创伤患者康复进程。

Objective To investigate the safety and effectiveness of fast track surgery（ FTS） management in the perioperative period of patients with hepatic and splenic injury without hemorrhagic shock by trauma. Methods Total 76 patients meeting the criteria in our hospital from January,2011 to December,2014 were recruited,48 patients undergoing fast track surgery in perioperative period were assigned into the trial group,28 patients using traditional protocol into the control group. Two groups were comparable on more characteristics. The C-reactive protein（ CRP） levels before the operation and at 1th and 5th day after the operation,postoperative recovery time and timeto extubation,daily average VAS score,postoperative bowelventing,hospital stay time,cost of medical treatment and incidence of complications were compared.Results All 76 patients were cured. When compared with the control group,the CRP level at 1th and 5th day after the operation in the trial group was decreased,postoperative recovery time and time to extubation were shortened,daily average VAS score was improved,postoperative bowel venting was early recovered,hospital stay time and the cost of medical treatment was decreased（ P〈0. 05）. The postoperative complications and comfortless of the two groups showed no difference（ P〈0. 05）. Conclusion Fast track surgery management in perioperative period of hepatic and splenic injury by trauma patients is safe and efficient,which could accelerate the recovery after the surgery.