加速康复外科促进胃肠道功能恢复在肝移植术后早期的临床应用

Clinical application of enhanced recovery after surgery by promoting gastrointestinal function recovery in the early stage after liver transplantation

目的:观察肝移植术后早期应用促进胃肠道功能恢复的加速康复外科(ERAS)理念的临床效果。方法:以2017年4月—2018年6月在天津市第一中心医院行原位肝移植术的成人患者为研究对象,根据是否采用促进胃肠道功能恢复的ERAS理念将患者分为ERAS组(121例)和非ERAS组(102例)。ERAS组应用ERAS理念,促进术后早期胃肠道功能恢复;非ERAS组给予常规围手术期处理。比较分析两组患者的排气时间、术后2周肝功能及营养指标、术后感染发生率、住院时间、住院费用等。结果:ERAS组术后2周总胆红素(TBil)为18.20(11.95,34.40)μmol/L,较非ERAS组[24.77(15.30,37.64)μmol/L]低(t=2.411,P=0.016),?γ-谷氨酰转肽酶(GGT)为133.30(88.45,196.30)U/L,较非ERAS组[160.90(101.03,271.00)U/L]低(z=-2.062,P=0.039);ERAS组术后2周白蛋白(ALB)为(40.78±4.00)g/L,较非ERAS组[(38.72±4.69)g/L]高(t=3.529,P=0.001);ERAS组排气时间为1.00(1.00,2.00)d,较非ERAS组[3.00(2.00,3.00)d]早(z=8.328,P=0.000);ERAS组患者在ICU住院时间为3.00(2.00,3.00)d,较非ERAS组[3.00(3.00,4.00)d]少(z=-5.103,P=0.000);ERAS组住院时间[27.00(22.00,38.00)d]较非ERAS组[35.00(26.00,74.50)d]短(z=-4.127,P=0.000);ERAS组住院费用[27.90(24.28,32.30)万元]较非ERAS组[32.03(27.39,38.73)万元]少(z=-4.634,P=0.000);在术后并发症中,感染相关的并发症存在明显差异,两组感染率分别为28.1%和40.2%(χ^(2)=3.628,P=0.047)。结论:ERAS术后早期促进胃肠功能恢复的理念在肝移植术后临床应用有效,有助于术后早期肝功能恢复和营养状态改善,减少住院时间及住院费用。

Objective:To observe the clinical effect of promoting gastrointestinal function recovery in enhanced recovery after surgery(ERSA)in the early stage after liver transplantation.Methods:Adult patients who underwent orthotopic liver transplantation in Tianjin First Central Hospital from April 2017 to June 2018 were selected as the research object,and the patients were divided into ERAS group(n=121)and non-ERAS group(n=102)according to whether the concept of promoting gastrointestinal function recovery in enhanced recovery after surgery was adopted.The ERAS group applied the concept of ERAS to optimize the early postoperative recovery of gastrointestinal function.While the non-ERAS group was given routine perioperative treatment.The exhaust time,liver function and nutritional indicatorsin 2 weeks after operation,postoperative infection incidence,hospitalization time,hospitalization expenses,etc.of the two groups of patients were compared and analyzed.Results:The total bilirubin(TBil)of[18.20(11.95,34.40)μmol/L]in the ERAS group was lower than that[24.77(15.30,37.64)μmol/L]of the non-ERAS group at 2 weeks postoperatively(t=2.411,P=0.016).And the γ-glutamyltranspeptidase(GGT)[133.30(88.45,196.30)U/L]in the ERAS group was lower than that[160.90(101.03,271.00)U/L]of the non-ERAS group at 2 weeks postoperatively(z=-2.062,P=0.039).The albumin(ALB)at 2 weeks after the operation in the ERAS group were(40.78±4.00)g/L,which were higher than those in the non-ERAS group at 2 weeks after the operation,which were(38.72±4.69)g/L(t=3.529,P=0.001).The exhaust time[1.00(1.00,2.00)d]of ERAS group was earlier than non-ERAS group[3.00(2.00,3.00)d](z=8.328,P=0.000).The length of the patients′stay in the ICU[3.00(2.00,3.00)d]was decreased in the ERAS group compared with[3.00(3.00,4.00)d]in the non-ERAS group(z=-5.103,P=0.000).The hospital stay in the ERAS group[27.00(22.00,38.00)d]was shorter than that of the non-ERAS group[35.00(26.00,74.50)d](z=-4.127,P=0.000).The cost of hospitalization in the ERAS group was[27.90(24.28,32.30)ten thousand yuan]less than that of the non-ERAS group,which was[32.03(27.39,38.73)ten thousand yuan](z=-4.634,P=0.000).In the postoperative complications,the infection related complications were significantly different,the infection rates in the two groups were 28.1%and 40.2%,respectively(χ^(2)=3.628,P=0.047).Conclusion:The concept of promoting early recovery of gastrointestinal function inenhanced recovery after surgery is effective in clinical application after liver transplantation.It is helpful for early recovery of liver function and nutritional status after operation,and reduces hospitalization time and cost.