多学科多模式干预在胰十二指肠切除术后快速康复中的应用

Application of multi-subjects and multi-modes intervention in the enhanced recovery after pancreaticoduodenectomy

目的探索快速康复外科(enhanced recovery after surgery,ERAS)理念应用于胰十二指肠切除术(pancreatoduodenectomy,PD)围手术期的价值。方法前瞻性收集2016年1月至2017年6月期间在华西医院胰腺外科行开腹PD的227例患者,根据围手术期处理分为ERAS组(51例)和对照组(176例),比较2组患者的坐起时间、下床活动时间、开始饮水时间、开始进食时间、排气时间、排便时间、胃管拔除时间、术后住院时间、住院费用、并发症及术后疼痛评分。结果 (1)术后效果指标:与对照组比较,ERAS组患者的坐起时间、下床活动时间、开始饮水时间、开始进食时间、排气时间、排便时间、胃管拔除时间、术后住院时间及住院费用均较短(较低),差异均有统计学意义(P<0.05)。(2)术后并发症:2组患者的胰瘘、术后出血、胃排空障碍、胆汁漏、腹腔感染、切口并发症、肺部感染及心脏并发症发生率比较差异均无统计学意义(P>0.05)。(3)再手术和再入院:2组患者的再手术率和再入院率比较差异均无统计学意义(P>0.05)。(4)术后疼痛评分:除术后第6天22时外,术后2 h、术后8 h及术后第1–6天各时点(8、16及22时),ERAS组患者的疼痛评分均低于对照组,差异均有统计学意义(P<0.05)。结论 ERAS可在不增加并发症发生率的同时加速PD患者的康复,并减轻患者的疼痛。

Objective The objective of this study is to evaluate the effect of enhanced recovery after surgery （ERAS） in the perioperative period of pancreatoduodenectomy. Methods This article conducted the forward-looking analysis on the information of 227 patients undergoing the pancreatoduodenectomy in West China Hospital from January 2016 to June 2017, and then compared the differences between the patients subjected to ERAS （ERAS group） and thosesubjected to regular measures （control group） with respect to time of setting in sickbed, time of mobilizing out ofsickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses, postoperative complications, and postoperative pain scores. Results ① Postoperative indexes： by comparison of the ERAS group and the control group, it was found that the ERAS group had shorter （or lower） time of setting in sickbed, time of mobilizing out of sickbed, time of starting drink water, time of resumption of diet, exhaust time, defecation time, the time of nasogastric tube, postoperative hospitalization duration and expenses （P〈0.05）. ② Postoperative complications： of all postoperative complications, including pancreatic fistula, postoperative hemorrhage, delayed gastric emptying, biliary fistula, abdominal infection, incision complication, lung infection, and heart complication were without statistically significant differences （P〉0.05） between the 2 groups.③ Reoperation and readmission： there was no significant difference on the incidences of reoperation and readmission between the 2 groups （P〉0.05）. ④ Postoperative pain scores： except 22 ： 00 of the 6-day after operation, the pain scores in the ERAS group were all lower than those in the control group at 2 h and 8 h after operation, and the time points of 1-6 days after operation （8 ： 00, 16 ： 00, and 22 ： 00）, with statistically differences （P〈0.05）. Conclusion Without increasing the incidence of complications, ERAS may speed up the rehabilitation of patients undergoing the pancreatoduodenectomy and mitigate the pain of patients.