结直肠癌患者ERAS方案和术后住院时间的相关性分析

Correlation analysis of ERAS scheme and postoperative stay for patients with colorectal carcinoma

目的研究结直肠癌患者实施ERAS流程后影响术后住院时间的相关因素。方法收集2015年5月～2018年9月间广东省第二人民医院普外二科接受手术治疗的结直肠癌患者411例,将患者根据《结直肠手术应用加速康复外科中国专家共识(2015版)》方案,完成ERAS标准流程。观察术后住院时间与术前肠道准备、术前碳水化合物摄入、预防性抗生素使用、术中预防低体温措施、目标导向性液体治疗、硬膜外置管、术后早期活动、术后早期进食、非甾体镇痛药使用、早期拔除引流管、年龄、性别、体重指数、美国麻醉医师协会麻醉分级、贫血、手术部位、手术方式、手术时间、术后有无ICU监护、并发症发生情况之间的相关性。利用二分类Logistic回归分析各变量与术后住院时间之间的相关性。结果年龄、性别、糖尿病、体重指数、新辅助化疗、术前贫血均与术后住院时间无显著相关性,其P值分别为0.705、0.563、0.078、0.674、0.323、0.782。而术前延长术后住院时间的因素为美国麻醉医师协会麻醉分级≥3分(P<0.001,OR=8.000,95%CI 4.080～15.686)。手术相关因素如手术的方式、手术时间长于180 min与术后住院时间延长密切相关(P=0.025,OR=0.464,95%CI 0.237～0.907;P<0.001,OR=15.370,95%CI 7.828～30.175)。而术后的重症监护室监护治疗并不显著影响术后住院时间(P=0.645,OR=0.791,95%CI 0.291～2.148);术后早期活动延迟与术后住院时间延长相关(P<0.001,OR=12.149,95%CI 5.284～27.931);而术前碳水化合物的摄入也对术后住院时间有影响(P=0.001,OR=0.343,95%CI0.179～0.658),当然其可使术后患者的住院时间缩短(相关系数为?1.050)。而硬膜外置管镇痛、术中液体平衡及术后早期进食及术后并发症与住院时间并无显著关联。结论制定更加高效合理的结直肠癌围手术期ERAS方案可缩短患者住院时间,加速患者康复。

Objective To study the correlative factors which affect postoperative stay after ERAS implementation on patients with colorectal carcinoma. Methods The data were collected from 411 patients with colorectal carcinoma who underwent surgery in our department from May 2015 to September 2018. All patients completed ERAS standard procedure according to Chinese Expert Consensus on Application of Enhanced Recovery Surgery in Colorectal Operation (version 2015). The correlation between postoperative stay and preoperative bowel preparation,preoperative carbohydrate intake,use of preventive antibiotics, perioperative preventive measures for low body temperature, targeted fluid therapy,epidural catheterization,postoperative early mobilization,postoperative early-stage feeding, use of non-steroidal painkiller,early removal of drainage tube,age,gender,body mass index, anesthesia grading in American Society of Anesthesiologists,anemia,surgical site,surgical mode,surgical time,any postoperative ICU monitoring and incidence of complication were observed. Binary Logistic regression analysis was used to analyze correlation between each variant and postoperative stay. Results There was no obvious correlation among age,gender,diabetes,body mass index,new adjuvant therapy,preoperative anemia and postoperative stay and P value was 0.705,0.563,0.078, 0.674,0.323 and 0.782 respectively. Anesthesia grading in American Society of Anesthesiologists which was over or equal to 3(P=0.000,OR=8.000,95% CI 4.080- 15.686) was the factor for prolonged postoperative stay before surgery. Surgery correlative factors such as surgical approach and over 180 min surgical time were closely related to prolonged postoperative stay(P=0.025,OR=0.464,95% CI 0.237-0.907;P<0.001,OR=15.370,95% CI 7.828?30.175). However,postoperative ICU monitoring treatment posed no effect on postoperative stay(P=0.645,OR=0.791,95% CI 0.291-2.148). Delayed postoperative early mobilization was correlated to prolonged postoperative stay(P<0.001,OR=12.149,95% CI 5.284-27.931). Preoperative carbohydrate intake affected postoperative stay(P=0.001,OR=0.343,95% CI 0.179-0.658). It certainly could shorten postoperative stay of the patients(correlation index was -1.050). However,there was no significant correlation between epidural catheterization pain?easing,perioperative fluid balance as well as postoperative early-stage feeding and postoperative complications and postoperative stay. Conclusion More efficient and reasonable perioperative ERAS scheme for colorectal carcinoma could shorten hospital stay and accelerate rehabilitation of patients.