围手术期营养支持在急腹症加速康复外科中的应用

Application of perioperative nutritional support in enhanced recovery after surgery

目的探讨围手术期营养支持在急腹症加速康复外科中的价值及优势。方法收集2018年4月至2021年1月福建省晋江市医院收治的急腹症并行手术的患者临床资料,分为基于加速康复外科理念的围手术期综合管理组(KKAS组,78例)和传统围手术期管理组(CPM组,75例),两组患者入院时采用NKS2002进行营养风险评估。比较两组患者术后炎症指标、营养与康复相关指标结果ERAS组和CPM组术前NRS2002评分、手术方式、手术时间、手术出血量等基础资料差异无统计学意义(P>0.05).ERAS组和CPM组患者手术前CRP、白蛋白(Alb)、前白蛋白(PA)差异均无统计学意义(P>0.05)两组患者术后第1天Alb、PA均较术前显著降低,术后第1、3、5、7天的CKP水平均高于手术前,差异有统计学意义(P<0.05)。术后第3天ERAS组的CKP水平低于CPM组,差异有统计学意义(P<0.05)。术后第7天ERAS组的Alb、PA水平高于CPM组,差异有统计学意义(P<0.05)ERAS组术后胃肠功能恢复时间、住院时间、住院费用均少于CPM组,差异有统计学意义(P<0.05).结论围手术期有效的营养支持有助于急腹症患者加速康复。加速康复外科理念的运用可有效改善急腹症患者术后的营养状态,改善患者临床结局。

Objective To explore the value and advantages of perioperative nutritional support in enhanced recovery after surgery(ERAS).Methods The clinical data of patients admitted to Jinjiang City Hospital for acute abdomen and undergoing surgery from April 2018 to January 2021 were collected.They were divided into two groups:the enhanced recovery after surgery group(ERAS group,78 cases)and the traditional perioperative management group(CPM group,75 cases).The nutritional risk assessment of NRS2002 was performed on admission to the two groups.The postoperative inflammatoiy indexes,nutrition and rehabilitation related indexes were compared between the two groups.Results There was no significant difference in preoperative NRS 2002 score,operation method,operation time and blood loss between ERAS group and CPM group(P>0.05).There was no significant difference in C-reactive protein(CRP),albumin(Alb)and prealbumin(PA)between ERAS group and CPM group before operation(P>0.05).The ALb and PA of the two groups on the first clay after operation were significantly lower than those before operation,and the CRP levels on the first,third,fifth and seventh day after operation were higher than those before operation(P<0.05),with significant difference.The CRP level of ERAS group was lower than that of CPM group on the third day after operation,with significant difference(P<0.05).On the 7th day after operation,the levels of Alb and PA in ERAS group were higher than those in CPM group(P<0.05).The recovery time of gastrointestinal function and hospitalization days in ERAS group were significantly reduced,and the total cost of hospitalization was significantly less than that in CPM group(P<0.05).Conclusions Perioperative effective nutritional support is helpful to accelerate the recovery of patients with acute abdomen.The application of enhanced recovery after surgery can effectively improve the nutritional status of patients with acute abdomen,reduce the incidence of complications and improve the clinical outcome of patients.