加速康复外科理念对老年腹腔镜肝癌切除患者术后营养及谵妄的影响

Significance research of management by ERAS on postoperative nutrition and delirium in elderly patients undergoing laparoscopic liver cancer resection

目的:探讨加速康复外科理念(ERAS)对老年腹腔镜肝癌切除患者术后营养状况及谵妄的影响。方法:2016年1月至2018年12月,85例接受腹腔镜肝癌切除手术老年患者,其中55例围手术期应用加速康复外科理念管理(观察组),30例应用传统围手术期理念处理(对照组)。比较术后2 d、7 d、14 d两组患者血浆白蛋白(ALB)、血清前白蛋白(PAB)、血浆转铁蛋白(TRF)的检测结果及1 d、3 d、5 d的谵妄评定量表(CAM-CR)评分。结果:观察组术后2 d、7 d的ALB、PAB、TRF水平高于对照组(P<0.05),术后14 d的ALB、PAB、TRF水平与对照组无差异;术后1 d、3 d、5 d的CAM-CR评分,观察组低于对照组(P<0.05)。观察组术后发生谵妄4例(7.3%),对照组术后发生谵妄7例(23.3%)(P<0.05)。结论:ERAS理念应用于接受腹腔镜肝癌切除术的老年患者能明显改善患者术后营养状况,降低术后谵妄发生率。

Objective:To investigate the effect of management by ERAS on postoperative nutrition and delirium in elderly patients undergoing laparoscopic liver cancer resection.Methods:A total of elderly patients undergoing laparoscopic liver cancer resection were enrolled from January 2016to December 2018.Of these,55 were treated with the ERAS management during the perioperative period study group)and 30 were treated with the traditional management(control group).The results of plasma albumin(ALB),serum prealbumin(PAB),and plasma transferrin(TRF)were compared on the 2st,7rd,and 14th day after surgery.CAM-CR on 1st,3rd,and 5th day after surgery was also compared.Result:Compared with control group;ALB,PAB and TRF of control group on the 2st and 7rd day after operation are lower(P<0.05).The ALB,PAB,TRF levels of the observation group at 14 days after operation were not different from the control group(P>0.05).The CAM-CR scores on the 1st,3rd,and 5th day after surgery were lower in the observation group than in the control group(P<0.05).There were 4 cases of delirium in the study group and 7 cases in the control group.The incidence of the two groups was statistically significant(P<0.05).Conclusion:The ERAS management applied to elderly patients undergoing laparoscopic liver cancer resection can significantly improve postoperative nutritional status and reduce the incidence of postoperative delirium.