LEER模式下的质量控制体系在原发性肝癌患者围术期的应用

Application of quality control system under LEER mode in perioperative management for patients with primary hepatocellular carcinoma

目的探索LEER模式[少痛(less pain)、早动(early move)、早食(early eat)、安心(reassuring)]下采取的质量控制体系在原发性肝癌患者围手术期的应用价值。方法回顾性分析乐山市人民医院肝胆胰外科2018年1月至2021年6月99例行根治性手术治疗的原发性肝癌患者围术期的临床资料,其中采用传统ERAS模式进行围术期管理的41例患者设为常规组,采用LEER模式下建立的质量控制体系进行围术期管理的58例患者设为LEER组,比较两组患者在术后整体恢复情况、术后并发症发生率及患者就医体验方面的差异。结果与常规组相比,LEER组在住院时间[(9.75±1.29)d vs(8.23±1.52)d,t=6.896,P<0.001]、术后首次下床活动时间[(3.11±0.54)d vs(2.69±0.98)d,t=3.745,P=0.048]、术后肛门排气时间[(2.63±0.98)d vs(2.18±0.53)d,t=2.931,P=0.032]、术后饮食恢复时间[(4.38±1.81)d vs(3.52±1.34)d,t=2.525,P=0.049]、围术期疼痛控制满意度[(4.27±0.41)vs(4.76±0.32),t=1.568,P=0.036],就医体验[(3.98±0.48)vs(4.63±0.51),t=2.827,P=0.041]方面均优于常规组。两组在手术时间、手术出血量、住院费用、术后并发症方面无明显差异(P>0.05)。结论LEER模式下建立的质量控制体系能确保加速康复外科措施精准、系统、全面、高效执行,整体促进术后患者加速康复,缩短住院时间,患者能获得较好的就医体验。

Objective To explore the application value of the quality control system under LEER mode(less pain,early move,early eat,reassuring)in perioperative management for patients with primary hepatocellular carcinoma.Methods A retrospective analysis was conducted in the perioperative clinical data of 99 patients with primary hepatocellular carcinoma who underwent radical surgery treatment in Leshan people's Hospital between Jan.2018 and Jun.2021.Among 99 patients,41 received perioperative management under the traditional enhanced recovery after surgery(ERAS)mode(conventional group),and 58 received perioperative management of quality control system under LEER mode(LEER group).The differences in the postoperative recovery,postoperative complications and medical satisfaction between the two groups were compared.Results Compared with the conventional group,the LEER group was better in terms of the time of hospitalization[(9.75±1.29)d vs(8.23±1.52)d,t=6.896,P<0.001],time of first getting out of bed[(3.11±0.54)d vs(2.69±0.98)d,t=3.745,P=0.048],time of postoperative anal exhaust time[(2.63±0.98)d vs(2.18±0.53)d,t=2.931,P=0.032],time of postoperative diet recovery time[(4.38±1.81)d vs(3.52±1.34)d,t=2.525,P=0.049],satisfaction of perioperative pain control[(4.27±0.41)vs(4.76±0.32),t=1.568,P=0.036],andsatisfaction of medical experience[(3.98±0.48)vs(4.63±0.51),t=2.827,P=0.041].There were no statistical differences in terms of operation time,intraoperative blood loss,hospitalization costs,and postoperative complications between the two groups(P>0.05).Conclusion The quality control system under LEER mode can ensure the precise,systematic,comprehensive and efficient implementation of ERAS,thus can promote the overall postoperative accelerated rehabilitation,shorten the time of hospitalization,and enable patients to obtain better satisfaction of medical experience.