优化加速康复方案在腹腔镜胆囊切除术中的应用

Application of optimized program of enhanced recovery after surgery in laparoscopic cholecystectomy

目的探讨优化加速康复(ERAS)方案在腹腔镜胆囊切除术(LC)中的应用价值。方法本前瞻性研究对象为2016年11月至2017年4月在内蒙古赤峰市医院行LC的158例患者。患者均签署知情同意书,符合医学伦理学规定。按住院号单双号分组,单号为ERAS组(78例),双号为对照组(80例)。ERAS组男21例,女57例;平均年龄(52±11)岁;采用优化ERAS方案。对照组男27例,女53例;年龄(51±11)岁;采用传统治疗方案。两组患者围手术期指标比较采用t检验或Wilcoxon秩和检验。结果 ERAS组患者的术后6 h疼痛、恶心呕吐评分分别为3(2,5)、1(0,5)分,明显低于对照组的4(2,4)、4(0,4)分(Z=-1.613,-3.590;P<0.05)。ERAS组术后患者排气时间、术后补液量、术后住院时间、住院费用分别为(17±8) h、(2 346±823)ml、(1.47±0.72)d、(1.04±0.12)万元,明显少于对照组的(21±9)h、(3 438±1 149)ml、(2.19±1.05)d、(1.13±0.15)万元(t=-0.045,-0.399,-0.003,-0.239;P<0.05)。ERAS组的术后满意度评分为(1.95±0.22)分,明显高于对照组的(1.75±0.44)分(t=3.625,P<0.05)。两组均无围手术期死亡和并发症发生。结论优化加速康复方案在LC中的应用安全、有效、可行,具有恢复快、花费低优势。超前多模式镇痛可明显减轻患者术后早期的疼痛。

Objective To investigate the application value of optimized program of enhanced recovery after surgery（ERAS） in laparoscopic cholecystectomy（LC）. Methods In this prospective study, 158 patients undergoing LC in Chifeng Municipal Hospital, Inner Mongolia Autonomous Region from November 2016 to April 2017 were enrolled. The informed consents of all patients were obtained and the local ethical committee approval was received. Patients were divided into the ERAS（odd number, n=78） and control groups（even number, n=80） according to the hospitalization number. In ERAS group, 21 patients were male and 57 were female, aged（52±11） years on average. The optimized ERAS program was implemented. In control group, 27 cases were male and 53 female, aged（51±11） years on average. The traditional treatment was adopted. Perioperative parameters were compared between two groups by t test or Wilcoxon rank-sum test. Results In ERAS group, the scores of pain, nausea and vomiting 6 h after operation were 3（2, 5） and 1（0, 5）, significantly lower than 4（2,4） and 4（0,4） in control group（Z=-1.613,-3.590; P0.05）. In ERAS group,the postoperative exhaust time,postoperative fluid volume,postoperative length of hospital stay,and hospitalization expense were（17±8）h,（2 346±823）ml,（1.47±0.72）d and（10.4±1.2）thousand yuan respectively,significantly less than（21±9）h,（3 438±1 149）ml,（2.19±1.05）d and（11.3±1.5）thousand yuan in control group（t=-0.045,-0.399,-0.003,-0.239;P0.05）.The score of postoperative satisfaction in ERAS group was 1.95±0.22,significantly higher than 1.75±0.44 in control group（t=3.625,P0.05）.No perioperative death and complications occurred in two groups.Conclusions Optimized ERAS program is safe,effective and feasible in LC,which possesses advantages of quick recovery and low cost.Advanced multimodal analgesia can significantly alleviate the early postoperative pain of patients.