肾移植加速康复外科方案的构建与应用研究

Construction and application of accelerated rehabilitation surgery scheme for kidney transplantation

目的 探讨加速康复外科方案的构建及其在肾移植围术期中的应用效果.方法 选取2017年2月至2018年1月实施常规围手术期管理的肾移植患者49例为常规组,2018年2月至2019年6月实施加速康复外科方案的肾移植患者49例为观察组.比较两组患者术后出血、切口感染、尿路感染、肺部感染、排斥反应及尿漏等并发症的发生率;尿管留置时间、首次下床活动时间及首次排便时间等早期康复情况;比较两组患者术后住院时间、住院费用及30 d内再入院率.结果 观察组并发症发生率为4.08% (2/49),明显低于常规组的22.45% (11/49),差异有统计学意义(x2=7.184,P=0.007).观察组尿管留置时间[(2.51±1.12)d]、首次下床活动时间[(1.96±1.08)d]及首次排便时间[(2.56±1.16)d]等早期康复情况均显著优于常规组[(4.96±1.40)d、(4.82±1.36)d及(4.84±1.38)d],差异均有统计学意义(t=9.663、11.650、8.943,均P=0.000).观察组术后住院时间[(19.53±2.38)d]及住院自费费用[(3.57±0.32)万元]均明显低于常规组[(26.49±3.42)d及(4.98±0.82)万元],差异均有统计学意义(t=11.812、11.327,均P=0.000).观察组30 d内再入院率为2.04% (1/49),明显低于常规组的18.37% (9/49),差异有统计学意义(x2=7.127,P=0.008).结论 加速康复外科方案的构建及其在肾移植围术期中的有效实施,能够显著降低肾移植患者术后并发症的发生率,加速患者的早期康复,缩短术后住院时间,减少住院费用,降低30 d内再入院率.

Objective To explore the construction and application in kidney-transplant recipienls of accelerated rehabilitation surgery scheme.Methods From February 2017 to January 2018,49 kidney-transplant recipients who received routine preoperative management in the First Afiliated Hospital of Wenzhou Medical University were selected as regular group,while another 49 kidney-transplant recipients who received acelerated rehabilitation surgery scheme in our hospital from February 2018 to June 2019 were selected as observation group.The incidences of complications such as postoperative bleeding,infection of incisional wound and urinary tract,pulmonary infection,rejection reaction and urine leakage between the two groups were compared.The early rehabilitation progress such as preserved time of dwelling catheter,leaving bed time and first defecation time between the two groups were compared.The postoperative hospitalization time,hospitalization expense and the rate of readmission within 30 days were compared.Results The ineidence of complications of the observation group was 4.08%(2/49),which was significantly lower than that of the regular group[22.45%(11/49)](χ2=7.184,P=0.007).The preserved time of dwelling eatheter[(2.51±1.12)d],leaving bed time[(1.96±1.08)d]and the first defecation time[(2.56±1.16)d]of the observation group were significantly better than those of the regular group[(4.96±1.40)d,(4.82±1.36)d and(4.84±1.38)d](t=9.663,11.650,8.943,all P=0.000).The postoperative hospitalization time[(19.53±2.38)d]and hospitalization expense[(35.7±3.2)thousand CNY]of the observation group were significantly lower than those of the regular group[(26.49±3.42)d and(49.8±8.2)thousand CNY](t=11.812.11.327,all P=0.000).The readmission rate within 30 days of the observation group[2.04%(1/49)]was significantly lower than that of the regular group[18.37%(9/49)],the diference was stistically significant(χ2=7.127,P=0.008).Conclusion The construction and efective application of accelerated rehabilitation surgery scheme in kidney-transplant recipients can reduce the incidence of complication in recipients after transplantation,accelerate their rehabilitation in early stage,shorten the hospitalization time,reduce the hospitalization expense and lower the readmission rate after 30 days.