加速康复外科理念在基层医院食管癌围手术期的应用体会

Application of Accelerated Rehabilitation Surgery in Patients with Radical Resection of Esophageal Cancer in Primary Hospitals

目的探讨加速康复外科在基层医院食管癌开胸根治术患者中的实施重点和可实施环节及其实施效果。方法 2015年6月至2017年2月收治72例食管鳞状细胞癌患者按入院时间分为加速康复外科组(ERAS组)42例和对照组30例,两组患者均由同一组手术医生施行食管癌根治术。ERAS组根据加速康复外科理念在患者术前呼吸、咳嗽训练,术中麻醉、补液、保温,术后镇痛、营养支持、功能锻炼方面均给予确切干预措施,对照组按既往惯例施行根治性手术,术后常规补液抗感染。比较两组术后肛门首次排气、排便时间,住院时间,并发症发生情况,术后第4天1分钟最远扶墙行走距离。结果两组均顺利施行手术。ERAS组患者首次排气时间、首次排便时间、住院时间、术后第4天1分钟最远扶墙行走距离均优于对照组,差异有统计学意义(P<0.05),对照组术后并发肺部感染5例,ERAS组并发肺部感染2例,两组均未发生吻合口瘘。结论加速康复外科能有效减轻食管癌根治术患者术后并发症、促进患者康复,基层医院可根据医院实际为患者制定有效加速康复外科措施。

Objective To investigate the key points, implementation steps and implementation effect of accelerated reha- bilitation surgery in patients with radical resection of esophageal cancer in primary hospitals. Methods From June 2015 to Febru- ary 2017, 72 patients with esophageal squamous cell carcinoma were divided into the observation group （42 cases） and the control group （30 cases） according to the time of admission. The two groups of patients underwent radical resection of esophageal carcino- ma by the same group of Surgeons. The observation group was given exact intervention measures, such as preoperative respiration, cough training, intraoperative anesthesia, fluid infusion, heat preservation, and postoperative analgesia, nutritional support and functional exercise, according to the concept of accelerated rehabilitation surgery, while patients in the control group underwent radical surgery according to past practice, and after operation the conventional fluid infusion was used to prevent infection. The postoperative first exhaust time, the first defecation time, hospitalization time, complications, and at the fourth days after operation the longest walking distance on the supporting wall for 1 minutes, and the heart rate changes after 20 minutes walking on the sup- porting wall for 1 minutes of the two groups were compared. Results The operation was performed smoothly in the two groups. The first exhaust time, the first defecation time, the hospitalization time, and at the fourth days after operation the longest walking dis- tance on the supporting wall for 1 minutes, and the heart rate changes after 20 minutes walking on the supporting wall for 1 minutes of the observation group were better than those of the control group, and the difference was statistically significant （ P 〈 0.05 ）. In the control group, 5 cases were complicated with pulmonary infection, and 2 cases in the observation group were complicated with pulmonary infection, and there was no anastomotic leakage in the two groups. Conclusion Accelerated rehabilitation surgery can effectively reduce the postoperative complications and promote the rehabilitation of patients with radical resection of esophageal cancer, and the primary hospitals can make effective measures to accelerate rehabilitation surgery for patients according to the ac- tual situation of the hospital.