加速康复外科理念在胰十二指肠切除术围手术期的应用

Application of enhanced recovery after surgery in the perioperative management of pancreaticoduodenectomy

目的观察加速康复外科(enhanced recovery after surgery,ERAS)措施在胰十二指肠切除术围手术期应用的效果,总结在ERAS指导下的围手术期多模式镇痛、营养干预、呼吸道管理、血栓预防等护理措施对患者术后康复的影响。方法回顾性分析温州医科大学附属第一医院2019年5月到2020年7月肝胆外科收治的48例行胰十二指肠切除术患者的临床资料。其中围手术期采用传统管理模式21例(传统组),采用加速康复外科管理模式27例(ERAS组),护理上传统组采用普外科常规护理方法,ERAS组患者实施护患共享决策健康教育、围手术期营养管理、多模式镇痛、制定呼吸功能锻炼及早期活动计划等护理方法,比较两组患者术后恢复和并发症情况。结果ERAS组相比传统组术后首次排便时间[(3.3±1.4)d vs(6.3±2.4)d,P<0.05]、胃管拔除时间([4.3±1.2)d vs(10.6±4.9)d,P<0.05]、第一次肠内营养时间([3.8±1.0)d vs(10.0±4.7)d,P<0.05]更早,术后发热时间[(4.5±2.2)d vs(7.9±4.8)d,P<0.05]、术后使用抗生素时间[(10.6±3.3)d vs(20.0±6.6)d,P<0.05]、住院时间[(18.4±2.0)d vs(31.1±3.7)d,P<0.05]更短,住院费用更低[(9.57±1.47)万元vs(15.12±2.83)万元,P<0.05]。ERAS组术后肺部感染发生率[7.4%(2/27)vs 33.3%(7/21),P<0.05]和深静脉血栓发生率[3.7%(1/27)vs 23.8%(5/21),P<0.05]更低,差异均具有统计学意义。结论加速康复外科措施应用于胰十二指肠切除术围手术期管理显著缩短了患者住院时间,减少了医疗费用,降低了术后并发症(肺部感染、深静脉血栓、胃排空障碍)的发生率,实施过程中不断优化围手术期营养管理、疼痛管理、呼吸功能锻炼、深静脉血栓预防等护理措施,并促进了护患关系和谐。

Objective To observe the effects of enhanced recovery after surgery(ERAS)in the perioperative management of pancreaticoduodenectomy,and to summarize the impact of perioperative multi-modal analgesia,nutritional intervention,respiratory tract management,thrombus prevention and other measures under the guidance of ERAS on postoperative rehabilitation of patients.Methods A retrospective analysis was conducted in 48 patients who underwent pancreaticoduodenectomy in the First Affiliated Hospital of Wenzhou Medical University from May 2019 to Jul.2020.For perioperative care,21 cases received traditional management(traditional group),and 27 cases received ERAS management(ERAS group),such as perioperative nutrition,multi-modal analgesia,respiratory function exercises and early activity plans.Results Comparison with traditional group,the postoperative defecation time[(3.3±1.4)d vs(6.3±2.4)d,P<0.05],gastric tube removal time[(4.3±1.2)d vs(10.6±4.9)d,P<0.05],first enteral nutrition time[(3.8±1.0)d vs(10.0±4.7)d,P<0.05]in ERAS group were all earlier;the postoperative fever duration[(4.5±2.2)d vs(7.9±4.8)d,P<0.05],postoperative antibiotic useage duration[(10.6±3.3)d vs(20.0±6.6)d,P<0.05],hospital costs[(9.57±1.47)×103 yuan vs(15.12±2.83)×103 yuan,P<0.05],and hospitalization duration[(18.4±2.0)d vs(31.1±3.7)d,P<0.05]in ERAS group were all shorter;and the postoperative incidences of pulmonary infection[7.4%(2/27)vs 33.3%(7/21),P<0.05]and deep vein thrombosis[3.7%(1/27)vs 23.8%(5/21),P<0.05)in ERAS group were lower.Conclusion Application of ERAS in perioperative management of pancreaticoduodenectomy can shorten the hospitalization duration,reduce the medical expenses and postoperative complications(pulmonary infection,postoperative deep vein thrombosis,gastric emptying).In the implementation process,perioperative nutritional management,pain management,respiratory function exercise,deep vein thrombosis prevention and other measures are continuously optimized,and the harmonious relationship between nurses and patients are becoming more harmonious.