加速康复外科在腹腔镜肝切除围手术期应用的回顾性队列研究

The applications of enhanced recovery after surgery in laparoscopic hepatectomy： a retrospective cohort study

目的探讨加速康复外科流程在腹腔镜肝切除围手术期应用的安全性与有效性。方法回顾性分析2016年9月至2017年8月实施ERAS措施的腹腔镜肝切除手术患者40例（实验组）与2015年9月至2016年8月实施传统处理措施的腹腔镜肝切除手术患者40例（对照组），比较两组术中中心静脉压与出血量，术后血常规与肝功能指标，术后肛门排气、进食、下床活动、引流管拔除时间及消化道反应情况，术后中重度疼痛发生率、患者满意度及并发症发生率，术后住院时间及住院费用。结果（1）与对照组比，实验组通过控制中心静脉压，明显减少术中出血量（t=2.556，P=0.013）。（2）实验组术后1、3、5dWBC、ALT、TBiL峰值降低，而ALB值升高。（3）实验组患者有较短的术后肛门排气（t=3．751，P〈0．001）、进食（t=4．772，P〈0．001）、下床活动时间（t=5．27，P〈0．001），而术后引流管拔除时间无明显差异（t=0．336，P=0．738）。（4）实验组术后中重度疼痛患者数量明显减少（χ2=11．314，P=0．001），且患者满意度显著提高（t=6．816，P〈0．001）。（5）实验组平均住院时间缩短2．8d（16．6±3．0）d比（19．4±6．4）d（t=2．514，P=0．015），平均医疗费用减少0．6万元（5．4±0．7）万元比（6．0±1．5）万元（t=2．338，P=0．023）。结论ERAS流程应用于腹腔镜肝切除围手术期能安全、有效地加速患者术后康复。

Objective To investigate the safety and effectiveness during perioperative period in patients undergoing laparoscopic hepatectomy under ERAS program. Methods A retrospective study was carried out, in 40 patients under ERAS programs from Sep 2016 to Aug 2017 compared with 40 patients in control group from Sep 2015 to Aug 2016 in intraoperative central vein pressure, blood loss, postoperative stress indicators, the incidence of moderate to severe pain, exhaust time, oral feeding time, ambulation time, complications, hospital stays and costs and patient satisfaction. Results Compared with control group, the intraoperative blood loss was decreased by controlling central venous pressure （ t = 2. 556, P = 0. 013 ）, earlier exhaust, oral intake of food and ambulation （ P 〈0. 001 ）, lower incidence rate of moderate to severe pain （X2 = 11. 314, P 〈 0. 001 ）, and higher patient satisfaction （ t = 6. 816, P 〈 0. 001 ） in ERAS group, though there were no significant differences in extubation time （ t = 0. 336, P = O. 738 ）. The average hospital stays were 2. 8 days shorter （ 16. 6 ±3.0 vs. 19.4± 6.4, t = 2. 514, P = 0. 015 ）, and hospital expenses were ￥6 000 less than control group （5.4 ± 0. 7 vs. 6.0 ±1.5, t = 2.338, P = 0.023）. Conclusion ERAS programs applied to patients undergoing laparoscopic hepatectomy can safely and effectivelv accelerate Datient recoverv.