加速康复外科理念在老年患者腹腔镜胆囊切除围手术期中的应用体会

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

目的:评价加速康复外科理念应用于老年患者腹腔镜胆囊切除围手术期的临床价值。方法:收集2014年10月至2016年11月行腹腔镜胆囊切除术的173例老年患者的临床资料,对照组采用传统围手术期处理;实验组采用加速康复外科措施。比较两组患者术前禁饮禁食时间、术后持续心电监护时间、首次下床时间、首次排气时间、术后阿片类药物使用率、术后并发症、住院时间、住院费用、出院30 d再入院率及死亡率。结果:实验组下床活动时间[(6.99±2.57)h vs.(28.14±4.13)h]、首次排气时间[(20.34±11.75)h vs.(29.74±4.07)h]、术后住院时间[(2.00±1.58)d vs.(5.08±2.58)d]、阿片类药物使用率(1/100 vs.5/73)、住院费用[(12 700.71±1 680.4)元vs.(15 034.09±6 147.0)元]明显优于对照组(P<0.05)。结论:老年患者腹腔镜胆囊切除围手术期应用加速康复外科措施可降低创伤应激,术后胃肠功能恢复快,住院时间明显缩短,住院费用明显下降,临床效果明显。

Objective：To evaluate the clinical value of enhanced recovery after surgery （ERAS） in the perioperative period of elderly patients with laparoscopic cholecystectomy （LC）.Methods：The clinical data of 173 elderly patients who underwent LC in Department of Hepatobiliary Surgery,Affiliated Hospital of Binzhou Medical University from Oct.2014 to Nov.2016 were analyzed retrospectively.Patients in the control group received traditional perioperative management,and those in the ERAS group received ERAS intervention.The differences in preoperative fasting time,continuous postoperative electrocardiograph monitoring time,first postoperative ambulation time,first postoperative exhausting time,postoperative opioid drug use rate,postoperative complications incidence,hospital stay,hospitalization expenses,and the readmission rate and mortality within 30 d after discharge between two groups were analyzed.Results：The postoperative first ambulation time in the ERAS group was shorter than that in the control group [（6.99 ± 2.57） h vs.（28.14 ±4.13） h].The first exhaust time in the ERAS group was earlier than that in the control group [（20.34 ± 11.75） h vs.（29.74 ±4.07） h].The postoperative hospitalization time in the ERAS group was shorter than that in the control group [（2.00 ± 1.58） d vs.（5.08 ±2.58） d].The opioid utilization rate in the ERAS group was significantly lower than that in the control group （1/100 vs.5/73）,and the hospitalization cost in the ERAS group was lower than that in the control group [（12 700.71 ± 1 680.4） yuan vs.（15 034.09 ± 6 147.0） yuan].All these differences between the two groups were statistically significant （P ＜ 0.05）.Conclusions：The application of ERAS in the perioperative period of elderly patients with LC reduces the physical and psychological trauma stress,improves the recovery of gastrointestinal function,significantly shortens the hospital stay,and obviously decreases hospitalization expenses with distinctly clinical effect.