加速康复外科在肝胆外科胆肠吻合术围术期的应用价值

Application value of enhanced recovery after surgery(ERAS) in patients received bilioenteric anastomosis during perioperative period

目的探讨加速康复外科(ERAS)在肝胆外科胆肠吻合术围术期的应用价值。方法选取2012年12月-2014年12月合肥市某医院收治的60例肝胆管结石患者为研究对象,随机分为观察组与对照组,每组30例。患者均行胆肠吻合术进行治疗,观察组患者采用ERAS围术期处理方案,对照组患者采用传统围术期处理方案。比较2组患者术后恢复情况,主要包括肛门排气时间、排便时间、下床活动时间、腹腔引流管拔除时间、住院时间和并发症发生情况。同时检测并比较2组患者术后第1天、第3天及第6天血清C反应蛋白(CRP)、前白蛋白(PA)及总胆红素(TBIL)水平。结果观察组患者术后肛门排气时间、排便时间、下床活动时间、腹腔引流管拔除时间、住院时间均短于对照组,差异均有统计学意义(P<0.05);观察组患者术后咽喉疼痛、恶心呕吐发生率低于对照组,差异有统计学意义(P<0.05);观察组患者术后第1天、第3天及第6天血清CRP水平低于对照组,差异有统计学意义(P<0.01),观察组患者术后第3天及第6天血清PA水平高于对照组,差异有统计学意义(P<0.01)。结论在肝胆外科胆肠吻合术围术期采用ERAS处理方案,可减轻患者因手术因素导致的不良应激反应,促进患者胃肠功能恢复及术后康复,缩短住院时间,值得临床推广应用。

Objective To discuss application value of enhanced recovery after surgery（ERAS） in patients received bilioenteric anastomosis during perioperative period. Methods From December 2012 to December 2014 a total of 60 patients with hepatic caculus in hospital of Hefei were selected and randomly divided into observation group （n=30）and control group （n = 30）. All the patients were recieved bilioenteric anastomosis and ERAS was applied during perioperative period for the observation group, while the control group were treated traditionally. In the comparison between 2 groups after surgery, time of anal exhaust,defecation time, postoperative activity out of bed days, time of removing peritoneal drainage tube, hospital stays and complications. Meanwhile C-reactive protein（CRP）, prealbumin（PA） and total bilirubin（TBIL） levels of 2 groups were detected and compared on 1 day, 3 days, and 6 days after surgery. Results The time of anal exhaust,defecation time, postoperative activity out of bed days, time of removing peritoneal drainage tube, hospital stays of observation group were shorter than the control group and the difference was significant（P〈0.05） ; the incidence rate of throat ache and nausea/vomiting of observation were lower than the control group and the difference was significant（P〈0.05） ;on the 1st , 3rd and 6th day after the surgery the CRP levels of observation group were lower than the control group and the difference was significant（P〈0.01） ; on the 3rd day and 6th day after the surgery the PA levels of observation were higher than the control group and the difference was significant（P〈0.01）. Conclusion Application of ERAS could reduce the bad stress reaction of patients during perioperative period and promote recovery of gastrointestinal function and postoperative rehabilitation, therefore shorten hospital stays, which is worth clinical expansion.