加速康复外科对腹腔镜手术治疗急性阑尾炎患者术后康复及胃肠功能的影响

Effect of accelerated rehabilitation surgery on postoperative rehabilitation and gastrointestinal function of patients with acute appendicitis treated by laparoscopic surgery

目的探讨加速康复外科对腹腔镜手术治疗急性阑尾炎患者术后康复及胃肠功能的影响。方法选择2021年5-10月在本院行腹腔镜手术治疗的108例急性阑尾炎患者作为研究对象分为常规组与康复组两组,每组各54例。常规组术后采取常规干预,康复组采取加速康复外科理念。比较两组术后首次下床活动时间、排气时间、排便时间及住院时间。比较术后疼痛情况。比较两组治疗前后心理情绪[焦虑自评量表评分(SAS)与抑郁自评量表评分(SDS)]。比较两组患者胃肠激素水平及并发症发生率。结果康复组患者术后首次下床活动时间[(12.55±1.66)h vs(15.66±3.20)h]、排气时间[(12.22±1.25)h vs(16.99±1.94)h]、排便时间[(19.04±3.66)h vs(22.70±4.77)h]、住院时间[(3.30±0.88)h vs(4.50±1.02)h]均短于常规组(P<0.05)。术后第1天两组患者疼痛VAS评分[(3.67±1.21)分vs(3.76±1.10)分]比较,差异无统计学意义(P>0.05),但康复组患者术后第2天[(2.82±0.65)分vs(3.29±0.94)分]和术后第3天[(2.04±0.56)分vs(2.04±0.56)分]疼痛VAS评分显著低于常规组(P<0.05)。两组治疗前SAS[(58.24±2.12)分vs(58.12±2.23)分]和SDS[(55.41±1.24)分vs(55.31±1.40)分]比较,差异无统计学意义(P>0.05),治疗后两组SAS和SDS评分较治疗前显著减少(P<0.05),康复组患者治疗后SAS[(52.21±1.22)分vs(53.32±1.43)分]和SDS[(53.04±1.35)分vs(54.11±1.27)分]评分低于常规组(P<0.05)。康复组患者胃动素和胃泌素水平优于常规组(P<0.05)。康复组与常规组并发症发生率[1.85%vs 7.41%]比较,差异无统计学意义(P>0.05)。结论加速康复外科不仅能有效改善腹腔镜阑尾炎手术患者术后胃肠功能,缩短住院时间,加速术后康复进程,且具有较高安全性。

Objective To investigate the effect of accelerated rehabilitation surgery on postoperative rehabilitation and gastrointestinal function of patients with acute appendicitis treated by laparoscopic surgery.Methods A total of 108 patients with acute appendicitis who underwent laparoscopic surgery in our hospital from May 2021 to October 2021 were selected as study subjects,and they were randomly divided into routine group and rehabilitation group,with 54 cases in each group.Routine intervention was adopted in the routine group,and accelerated rehabilitation surgery was adopted in the rehabilitation group.The time needed till the first time out of bed for activity,exhaust time,defecation time and hospital stay were compared between the two groups.The postoperative pain was compared.The levels of psychological emotion of patients[Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS)]before and after surgery and the incidence of complications were compared between the two groups.Results The first time for activityout of bed[(12.55±1.66)h vs(15.66±3.20)h],exhaust time[(12.22±1.25)h vs(16.99±1.94)h],defecation time[(19.04±3.66)h vs(22.70±4.77)h]and hospital stay[(3.30±0.88)h vs(4.50±1.02)h]in the rehabilitation group were significantly less than those in the routine group(P<0.05).There was no significant difference in pain VASscore[(3.67±1.21)score vs(3.76±1.10)score]between the two groups on the first day after operation(P>0.05),but the pain VAS score on the second day[(2.82±0.65)score vs(3.29±0.94)score]and third day[(2.04±0.56)score vs(2.04±0.56)score]after operation in the rehabilitation group was significantly lower than that in the routine group(P<0.05).There was no significant difference in SAS[(58.24±2.12)score vs(58.12±2.23)score]and SDS[(55.41±1.24)score vs(55.31±1.40)score]score between the two groups before treatment(P>0.05).After treatment,the SAS and SDS scores of the two groups were significantly lower than those before treatment(P<0.05).The SAS[(52.21±1.22)scores vs(53.32±1.43)scores]and SDS[(53.04±1.35)scores vs(54.11±1.27)scores]scores of the rehabilitation group were significantly lower than those of the routine group(P<0.05).The levels of motilin and gastrin in the rehabilitation group were significantly higher than those in the routine group(P<0.05).There was no significant difference in the incidence of complications between the rehabilitation group and the conventional group[1.85%vs 7.41%](P>0.05).Conclusions Accelerated rehabilitation surgery could not only effectively improve the postoperative gastrointestinal function of patients underwent laparoscopic appendicitis,shorten the length of hospital stay and accelerate the process of postoperative rehabilitation,but also has high safety.