加速康复外科在老年腹股沟疝无张力修补日间手术中的应用

Enhanced recovery after surgery on daytime surgery among elderly patients with inguinal hernia repair

目的探讨加速康复外科(ERAS)在老年腹股沟疝日间手术无张力修补中的有效性。方法前瞻性选取2017年7月至2018年6月,绍兴市人民医院行腹股沟疝无张力修补日间手术80例老年患者纳入本随机对照研究,按SPSS 19.0随机数字表法分为试验组和对照组,每组患者40例。试验组进入日间手术流程,围手术期采用ERAS方法处理;对照组采用常规日间手术处理。观察2组间相关手术并发症、手术康复情况和卫生经济学指标。结果最终试验组37例,对照组38例完成了研究。试验组术后恶心呕吐、术后6 h切口疼痛VAS评分分别为1(2.7%)、23.96,明显低于对照组7(18.4%)、51.67,差异有统计学意义(χ~2=4.862、Z=-5.643,P=0.027、<0.001);试验组术后尿潴留、阴囊水肿、血肿/血清肿及局部感觉异常分别为1(2.7%)、2(5.4%)、0、3(8.1%),与对照组5(13.2%)、5(13.2%)、1(2.6%)、3(7.9%)比较,差异均无统计学意义(P>0.05)。试验组术后住院时间、住院费用及完成日间手术例数分别为(1.65±0.48)d、(9304.83±613.28)元、37(100.00%),与对照组(2.45±0.80)d、(10817.53±1473.48)元、27(71.05%)均明显少于对照组,差异均有统计学意义(t=-5.270、t=-5.776、χ~2=12.551,P=0.028、<0.001、<0.001)。结论ERAS理念应用于老年腹股沟疝无张力修补日间手术中,使患者痛苦更小、恢复更快、医疗费用更省,不增加并发症发生率,有较大的推广和应用价值。

Objective To investigate the application value of enhanced recovery after surgery on daytime surgery among elderly patients with open tension-free inguinal hernia repair.Methods The clinical data of 80 elderly patients with inguinal hernia who underwent tension-free hernioplasty in Shaoxing People's Hospital from July 2017 to June 2016 were included in this prospective randomized controlled study.The 80 patients were randomly divided into experimental group and control group.The experimental group were treated with ERAS planning during peri-operation.The control group were treated with the management of daytime surgery.The incidence of complications postoperative recovery and medical economics indices were compared between the two groups.Results In the end,there were 37 patients in the experimental group and 38 patients in the control group completed the experiment.The incident rates of nausea and emesis,incision pain at the 6 hours post-operation were significantly lower in the experiment group compared with the control group(P<0.05).There were no significant differences in the incident rates of uroschesis,incision infection,seroma/hematoma,scrotal edema,recurrence and nerve paresthesia between the two groups(P>0.05).Hospital stay and hospitalization cost in the experimental group were obviously superior to those in the control group(P<0.01).Conclusion Application of ERAS to peri-operation of tension-free repair in elderly patients with inguinal hernia on daytime surgery is safe and effective,it can accelerate the postoperative recovery of patients,shorten the hospital stay and less cost,and is worthy of promotion and application.