基于加速康复外科的集束化管理应用于肝癌肝移植围手术期的效果分析

Effect analysis of cluster management based on Enhanced Recovery After Surgery in perioperative period of liver transplantation for hepatocellular carcinoma

目的研究分析基于加速康复外科(ERAS)的集束化管理应用于肝癌肝移植围手术期的效果。方法选取深圳市第三人民医院2018年6月-2019年11月进行肝移植的肝癌患者109例为研究对象。采用随机数字表法分人对照组(n=54)和观察组(n=55),对照组患者实施常规围手术期管理,观察组患者实施基于ERAS集束化管理,比较两组患者手术时间、术中出血量、输血量、低体温发生率、压疮发生率、住院时间、肿瘤相关指标、术后半年生存率和并发症发生情况。结果观察组手术时间和住院时间均显著短于对照组(P值均<0.05)。观察组术中出血量和输血量均显著少于对照组(P值均<0.05)。观察组低体温发生率和压疮发生.率均显著低于对照组(P值均<0.05)。观察组术后血清甲胎蛋白、谷氨酰胺转肽酶和异常凝血酶原均显著低于对照组(P值均<0.05)。观察组术后半年生存率显著高于对照组(P<0.05)。观察组术后并发症总发生率显著低于对照组(P<0.05)。结论基于ERAS的集束化管理应用于肝癌肝移植围手术期可改善患者手术相关指标,降低并发症发生率和提高患者术后半年生存率。

Objective To study the effect of cluster management based on Enhanced Recovery After Surgery(ERAS)in the perioperative period of liver transplantation for hepatocellular carcinoma.Methods 109 patients with hepatocellular carcinoma who underwent liver transplantation in Shenzhen Third People's Hospital from June 2018 to November 2019 were selected and divided into a control group(n=54)and an observation group(n=55)by the random number table method.The control group was given routine preoperative management,and the observation group was given ERAS-based cluster management.The operation time,intraoperative blood loss,blood transfusion volume,the incidence of hypothermia,the incidence of pressure ulcers,length of hospital stay,tumor-related indicators,half-year postoperative survival rate and incidence of complications were compared between the two groups.Results The operation time and hospital stay in the observation group were significantly shorter than those in the control group(both P<0.05).The volume of intraoperative blood loss and blood transfusion in the observation group were significantly less than that in the control group(both P<0.05).The incidence of hypothermia and pressure ulcers in the observation group were significantly lower than that in the control group(both P<0.05).Serum alpha-fetoprotein,glutamine transpeptidase and abnormal prothrombin in the observation group were significantly lower than those in the control group(all P<0.05).The half-year survival rate of the observation group was significantly higher than that of the control group(P<0.05).The total incidence of postoperative complications in the observation group was significantly lower than that in the control group(P<0.05).Conclusion The application of cluster management based on ERAS in liver transplantation for hepatocellular carcinoma during the perioperative period can improve the surgical indicators of patients,improve the half-year survival rate after operation and reduce the incidence of complications.