复元方联合快速康复外科理念在腹膜后腹腔镜微创手术围手术期中的应用评价

Application of Fuyuan Decoction combined with ERAS concept in the perioperative period of retroperitoneal laparoscopic minimally invasive surgery

目的探讨复元方联合快速康复外科理念(ERAS)在腹膜后腹腔镜微创手术围手术期中的应用价值。方法将90例拟行腹膜后腹腔镜微创手术的患者随机分为治疗组和对照组,每组45例。两组均行腹膜后腹腔镜微创手术,对照组采用外科常规围手术期管理,治疗组基于ERAS理念进行围手术期管理并口服中药复元方。比较两组患者术后普食时间、引流管留置时间、首次排气时间、首次排便时间、术后住院时间,以及C反应蛋白(CRP)、白蛋白(Alb)水平的变化情况,观察术后并发症、不良反应的发生情况。结果 (1)治疗组术后普食时间、引流管留置时间、首次排气时间、首次排便时间、术后住院时间均短于对照组,差异有统计学意义(P<0.05)。(2)术后第1天、术后第4天与手术前组内比较,两组CRP水平升高(P<0.05),Alb水平降低(P<0.05);术后第4天与术后第1天组内比较,两组CRP水平降低(P<0.05),Alb水平升高(P<0.05)。术后第4天组间比较,治疗组CRP水平低于对照组(P<0.05),Alb水平高于对照组(P<0.05)。(3)治疗组、对照组术后并发症发生率分别为4.44%、8.89%,治疗组术后并发症发生率低于对照组(P<0.05)。(4)治疗组、对照组不良反应发生率分别为6.67%、13.33%,治疗组不良反应发生率低于对照组(P<0.05)。结论复元方联合ERAS理念在腹膜后腹腔镜微创手术围手术期中有很好的应用价值,有助于控制炎症反应,改善机体应激状态,促进胃肠功能恢复,进而加速术后康复。

Objective To explore the application value of Fuyuan Decoction combined with the concept of enhanced recovery after surgery(ERAS) in the perioperative period of retroperitoneal laparoscopic minimally invasive surgery. Methods Ninety patients undergoing retroperitoneal laparoscopic minimally invasive surgery were randomly divided into treatment group and control group with 45 cases each. Both groups underwent retroperitoneal laparoscopic minimally invasive surgery. The traditional perioperative management was given to the control group, and perioperative management based on the concept of ERAS combined with Fuyuan Decoction was given to the treatment group. Days that general diet was allowed after surgery, drainage tube indwelling duration, first exhaust time, first defecation time, postoperative hospital stay, and changes in level of C-reactive protein(CRP) and albumin(Alb) were compared between the two groups. Postoperative complications and adverse reactions were also observed. Results(1)After treatment, days that general diet was allowed after surgery, drainage tube indwelling duration, first exhaust time, first defecation time, and postoperative hospital stay in the treatment group were significantly shorter compared with those in the control group and the difference was statistically significant(P<0.05).(2)Comparing test results on the first day and the fourth day after surgery with test results before surgery, CRP levels of the two groups both increased(P<0.05) and Alb levels both decreased(P<0.05). Comparing test results on the fourth day after surgery with test results on the first day,CRP levels of the two groups both decreased( P<0.05) and Alb levels both increased( P<0.05). On the fourth day after surgery,CRP level of the treatment group was significantly lower than that of the control group( P<0.05) and Alb level of the treatment group was significantly higher than that of the control group( P<0.05).(3)The postoperative complication rate of the treatment group was4.44%,which was significantly lower than 8.89% in the control group( P<0.05).(4) The incidence of adverse reactions in the treatment group and the control group were 6. 67% and 13. 33%,respectively. The incidence of adverse reactions in the treatment group was lower than that in the control group( P<0.05). Conclusion Fuyuan Decoction combined with ERAS concept has good application value in perioperative period of retroperitoneal laparoscopic minimally invasive surgery,as it is helpful to control inflammatory reaction,improve body stress responses,promote gastrointestinal function recovery,and further accelerate postoperative rehabilitation.