结直肠癌患者围手术期快速康复的因素分析

Compliance analysis of enhanced recovery after surgery in patients with colorectal cancer

目的当依从于术前、术中、术后三个不同阶段的快速康复(Enhanced Recovery After Surgery,RAS)方案时,是否均有利于改善结直肠手术患者的短期预后。方法收集2015年5月1日至2018年4月30日间本院普外二科接受手术治疗的结直肠癌患者411例。制定围手术期快速康复执行策略,并定义依从性的概念。对于基线人口统计学数据及与ERAS各子方案的依从性及术后恢复指标予以前瞻性地收集。使用二分类Logistic回归分析来评估最佳恢复与ERAS各条目的依从性的关系。在单独的模型中评估术前、术中和术后护理阶段依从性对最佳恢复的独立影响。结果经腹腔镜手术的患者,ERAS方案的依从性高,与开腹手术的患者相比差异有统计学意义(P<0.01)。术后阶段执行方案的依从率却只有40.6%。在患者基本特征及疾病分布校正的情况下,最佳恢复与使用腹腔镜方法、麻醉评分及ERAS方案的整体顺从性有显著的相关性。同时,术后阶段的ERAS方案的依从性是整个ERAS方案成功的关键,其与最佳恢复有7倍的相关性[OR=7.039(4.481-11.060),P<0.001]。结论术后阶段的ERAS方案是ERAS理念执行最为重要的部分。ERAS理念无论是在腹腔镜手术还是开腹手术围手术期均可促进患者恢复,但ERAS理念联合腹腔镜操作可使患者的获益更大。

Objective To explore whether it is beneficial to improve the short-term prognosis of patients undergoing colorectal surgery when enhanced recovery after surgery(ERAS)program was adopted before, during, and after the operation. Methods A total of 411 patients with colorectal cancer who underwent surgeryat our department from May 1st, 2015 to April 30th, 2018 were collected. An ERAS program and its implementation strategies were developed. The concept of compliance was defined. The baseline demographic data and adherence data of ERAS sub-scenarios were prospectively collected. A binary logistic regression analysis was used to assess the relationship between optimal recovery and compliance with ERAS entries. The independent effects of preoperative, intraoperative, and postoperative care compliance on optimal recovery were assessed in a separate model. Results The patients undergoing laparoscopic surgery had high adherence to the ERAS regimen, with a statistical difference from the patients undergoing open surgery (P < 0.01). The adherence rate of the implementation plan after the operation was only 40.6%. In the case of patient basic characteristics and disease distribution correction, optimal recovery correlated with overall compliance with the use of laparoscopic methods, anesthesia scores, and ERAS protocols. The compliance of the ERAS protocol after the operation was the key to the success of the entire ERAS protocol, with a 7-folded correlation with optimal recovery [OR = 7.039 (4.481 to 11.060), P < 0.001]. Conclusion The ERAS program after oepration is the most important part of the ERAS concept implementation. The ERAS concept can promote patient recovery both during and after laparoscopic surgery, but the ERAS concept combined with laparoscopic surgery can benefit patients more.