加速康复外科技术在腹腔镜胆囊切除围术期的应用

The application of enhanced recovery after surgery in the perioperative period of laparoscopic cholecystectomy

目的探讨加速康复外科(ERAS)理念在腹腔镜胆囊切除(LC)围术期的临床应用价值。方法选取2013年9月至2016年9月收治的80例行LC的患者,随机将其分为加速康复组(ERAS组)和对照组,对照组患者围术期采用传统处理方案,ERAS组患者围术期采用加速康复外科处理方案。采用SPSS 18.0软件进行统计学分析,术后并发症发生率等计数资料采用χ2检验分析;术后首次下床活动、进食、通气时间、住院天数和总费用等计量资料用(x珋±s)表示,采用t检验,P<0.05差异有统计学意义。结果 ERAS组与对照组比较:术后并发症发生率明显降低[8.8%比29.4%,P<0.01];术后首次下床活动时间[(9.3±2.1)比(15.3±3.2)h,P<0.01]、进食时间[(20.5±7.8)比(31.3±9.7)h,P<0.01]、通气时间[(10.6±4.5)比(12.9±5.1)h,P<0.05]明显提前,术后住院天数显著缩短[(5.5±1.3)比(7.4±1.5)d,P<0.01],住院治疗总费用显著下降[(10 573.4±568.1)比(11 702.1±1 179.3)元,P<0.05]。以上差异均有统计学意义。结论 ERAS技术在腹腔镜胆囊切除术围术期应用安全可行,具有术后并发症发生率低、恢复快、住院时间短、总费用少等优点。

Objective To investigate the application of laparoscopic cholecystectomy （ LC ） combined with enhanced recovery after surgery （ ERAS） during perioperative period. Methods The clinical date of 80 patients who underwent LC in The No2 People＇s Hospital of Lian Yun Gang City between September 2013 to September 2016 were collected.40 patients managed with ERAS program were allocated to the ERAS group, 40 patients managed with traditional perioperative treatment were allocated to the traditional group.The data of the two groups were compared with statistical software SPSS 18.0.Count data as the incidence of complication were analyzed using the chi -square test.Measurement data as the time of bowel flatus and taking food and out of bed movement 、hospital stay and cost were analyzed using the Student＇s t test. Results Compared with the control group, the ERAS group was associated with significantly lower incidence of comlipation [8.8% vs.29.4%, P 〈0.01〗, shorter time of movement[（9.3 ±2.1） vs. （15.3 ±3.2） hours, P 〈0.01] and taking food[（20.5 ±7.8） vs.（31.3 ±9.7） hours, P 〈0.01] and bowel flatus[（10.6 ±4.5） vs.（12.9 ±5.1） hours, P 〈0.05] and hospital stay [（5.5 ±1.3） vs. （7.4 ±1.5） days, P 〈0.01], less medical cost[（10573.4 ±568.1） vs. （11702.1 ±1179.3） RMB yuans, P 〈0.05]. Conclusions The application of ERAS in the perioperative period of laparoscopic cholecystectomy is a safe and feasible method which have the advantages of low incidence of complication , quick recovery,short duration of hospital stay and less hospital expenses .