基于倾向性评分匹配法分析ERAS在胰腺手术的安全性及近期疗效

The Safety and Short-Term Efficacy of Enhanced Recovery after Surgery in Pancreatic Operations with Propensity Score Matching

目的评估加速康复外科(enhanced recovery after surgery,ERAS)应用于胰腺手术围手术期的安全性及近期疗效。方法采用倾向性评分匹配分析我院2014年1月至2018年11月实施的95例胰腺手术患者的临床疗效,其中纳入ERAS流程(ERAS组)54例,纳入传统处理流程(传统组)41例,对两组病例进行1∶1的倾向性评分匹配,匹配后每组各37例患者。结果两组患者的基线资料经倾向性评分匹配后平衡良好,结果显示:①术后临床指标:ERAS组术后首次下床活动时间、进食时间、排便时间、导尿管拔除时间、术后住院时间及术后住院费用与传统组比较均有明显差异(P<0.05)。②术后疼痛:ERAS组术后中重度疼痛发生率为37.8%(14/37),传统组为70.3%(26/37),差异有统计学意义(P<0.05)。③术后并发症:两组术后总并发症发生率分别为18.9%(7/37)和32.4%(12/37),差异无统计学意义(P>0.05)。ERAS组与传统组各有1例因术后严重并发症而导致死亡,各有1例因术后出血行再次手术(P>0.05)。结论ERAS应用于胰腺手术围手术期安全有效,值得临床推广应用。

Objective To evaluate the safety and short-term efficacy of enhanced recovery after surgery(ERAS)in the perioperative period of pancreatic operations.Methods The clinical data of 95 patients with pancreatic surgery performed in our hospital from January 2014 to November 2018 were analyzed using propensity score matching(PSM).Among them,54 patients were included in the ERAS procedure(ERAS group)during perioperative period,and 41 patients were included in the traditional treatment procedure(the control group).The 1∶1 propensity score matching was performed on the two groups,with 37 patients in each group after matching.And the clinical efficacy of the two groups was evaluated after the matching.Results The baseline data of the two groups were well balanced after the propensity scores were matched.①Postoperative clinical indicators such as the first ambulation time,eating time,defecation time,catheter removal time,postoperative hospitalization time and postoperative hospitalization cost in ERAS group and the traditional group were significantly different(P<0.05).②The incidence of moderate and severe pain was 37.8%(14/37)in ERAS group and 70.3%(26/37)in the control group,and the difference was statistically significant(P<0.05).③The incidence of total postoperative complications in ERAS group and the control group was 18.9%(7/37)and 32.4%(12/37)respectively,with no significant difference(P>0.05).There was one patient died from severe postoperative complications,and one patient had reoperation due to postoperative bleeding in each group(P>0.05).Conclusion ERAS is safe and effective in the perioperative period of pancreatic surgery,and it is worthy of clinical application.