加速康复外科理念联合腹腔镜手术在急腹症治疗中的应用

Enhanced recovery after surgery combined with laparoscopic surgery for acute abdomen

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念联合腹腔镜手术在普外科急腹症治疗中的应用效果。方法选择2018年8月至2019年4月北京市垂杨柳医院连续收治的102例因急腹症急诊行腹腔镜手术的患者,采用随机数字表法分为观察组和对照组,每组51例。观察组采用ERAS理念进行围术期管理,对照组采用传统围术期管理模式。比较两组术后首次肛门排气时间、首次排便时间、首次进流食时间、首次下床活动时间、术后第1天疼痛数字评分、术后住院时间、手术前后炎症反应指标(外周血白细胞计数、C反应蛋白水平)、术后并发症发生情况。结果观察组患者术后首次肛门排气时间、首次排便时间、首次进流食时间、首次下床活动时间、术后住院时间短于对照组,术后第1天疼痛数字评分低于对照组,差异均有显著性(P<0.05)。两组术前外周血白细胞计数、C反应蛋白水平比较差异无显著性(P>0.05),术后外周血白细胞计数、C反应蛋白水平均低于术前,且观察组明显低于对照组,差异均有显著性(P<0.05)。观察组术后并发症发生率(11.8%)明显低于对照组(52.1%),差异有显著性(P<0.05)。结论应用ERAS理念对急腹症腹腔镜手术患者进行围术期管理安全、可行,其效果优于传统的围术期管理模式,能够有效减轻应激反应,促进胃肠功能恢复,减少并发症,缩短住院时间,值得临床应用。

Objective To investigate the effectiveness of enhanced recovery after surgery(ERAS)program combined with laparoscopic surgery for acute abdomen.Method 102 consecutive patients with acute abdomen were treated with laparoscopic surgery from August 2018 to April 2019 in Beijing Chuiyangliu Hospital,including acute appendicitis,acute cholecystitis and gastroduodenal ulcer perforation.They were randomly assigned to observation group(n=51)or control group(n=51).Observation group was managed with ERAS program,and control group with conventional program.Postoperative first anal exhaust time,eating liquid diets time,the first leaving bed time,pain degree of the first postoperative day according to Numerical Rating Scale(NRS),hospital stay,perioperative white blood cells count(WBC),perioperative C-reactive protein(CRP)and complications were compared between the two groups.Result Compared with the control group,postoperative first anal exhaust time,eating liquid diets time,the first leaving bed time,pain degree of the first postoperative day and hospital stay decreased significantly in the observation group(P<0.05).Preoperative WBC and CRP had no significant difference between the two groups(P>0.05).WBC and CRP decreased significantly in the first and third postoperative day(P<0.05),and complications also decreased significantly in the observation group(P<0.05).Conclusion ERAS is a safe,feasible and effective program in laparoscopic surgery for acute abdomen.It is superior to conventional management.It can reduce stress responses effectively,promote quick recovery of gastrointestinal functions,decrease the occurrence of complications and shorten hospital stay.It is worth spreading in the clinic.