快速康复外科理念在腹腔镜辅助全胃切除术患者围手术期麻醉管理中的应用效果

Application Effect of Fast Track Surgery in Perioperative Anesthesia Management of Patients with Laparoscopic Assisted Total Gastrectomy

目的探讨快速康复外科理念(FTS)在腹腔镜辅助全胃切除术患者围手术期麻醉管理中的应用效果。方法选择2016年10月至2018年10月130例于我院行腹腔镜辅助全胃切除术的患者,按照随机数字表法分为观察组和对照组,每组65例。对照组采用传统围手术期麻醉管理,观察组采用FTS指导下的围手术期麻醉管理。记录两组不同时段的血皮质醇以及血糖水平变化情况;记录患者术毕麻醉恢复情况以及术后恢复情况;比较两组术后疼痛情况。结果两组患者手术切皮时、标本取出时、术毕时血皮质醇、血糖水平均较本组麻醉前升高(P<0.05);观察组患者标本取出时、术毕时的血皮质醇、血糖水平均明显低于对照组(P<0.05)。与对照组相比,观察组患者的自主呼吸恢复时间、定向力恢复时间、拔管时间、指令睁眼时间、首次肛门排气时间、首次肛门排便时间、住院时间均明显缩短,住院总费用、术后并发症发生率均明显降低(P<0.05)。结论FTS在腹腔镜辅助全胃切除术患者围手术期麻醉管理中的应用效果显著,其对抑制手术应激、缩短麻醉恢复时间、促进术后康复、缩短住院时间、减少医疗费用及术后并发症、降低术后疼痛等均具有重要的临床意义,安全可行,具有明显的优越性。

Objective To study the application effect of fast track surgery(FTS)in perioperative anesthesia management of patients with laparoscopic assisted total gastrectomy.Methods From October 2016 to October 2018,130 patients undergoing laparoscopic assisted total gastrectomy in our hospital were randomly divided into the observation group and the control group,65 cases in each group.The control group used traditional perioperative anesthesia management,and the observation group used perioperative anesthesia management under the guidance of FTS.The changes in blood cortisol and blood glucose levels of the two groups at different time periods were recorded;the patient's recovery from anesthesia and postoperative recovery after the operation were recorded;the postoperative pain of the two groups was compared.Results The blood cortisol and blood glucose levels of the two groups of patients were higher than those before anesthesia at the time of surgical skin incision,specimen removal,and after operation(P<0.05);the blood cortisol and blood glucose levels of the observation group were significantly lower than those of the control group when the specimen was taken out and after the operation(P<0.05).Compared with the control group,spontaneous breathing recovery time,orientation recovery time,extubation time,commanded eye opening time,first anal exhaust time,first anal defecation time,and hospitalization time were significantly shortened,the total cost of hospitalization and the incidence of postoperative complications were significantly reduced of patients in the observation group(P<0.05).Conclusion FTS has a significant effect in the perioperative anesthesia management of patients with laparoscopic assisted total gastrectomy.It has important clinical significance for suppressing surgical stress,shortening the recovery time from anesthesia,promoting postoperative recovery,shortening hospital stay,reducing medical expenses and postoperative complications,and reducing postoperative pain,etc.It is safe and feasible,and has obvious advantages.