基于ERAS理念的静脉血栓栓塞症预防方案在肝癌围手术期的应用

Application of venous thromboembolism prevention regimen based on ERAS concept during perioperative period of liver cancer

目的 探究基于加速康复外科(ERAS)理念的静脉血栓栓塞症(VTE)预防方案在肝癌手术患者围手术期的应用效果。方法 选取2020年6月至2021年12月146例原发性肝癌行择期手术的住院患者作为观察对象,按区组随机化法分为观察组和对照组,每组73例。观察组采用围手术期VTE预防方案进行干预,对照组采用传统围手术期管理方案进行干预。比较两组患者术后排便时间、通气时间、住院时间、住院费用、再入院率情况差异;比较两组术后第1、3天患者疼痛和睡眠质量情况;比较两组术后第3天凝血功能[血浆纤维蛋白原(FIB)、D-二聚体(D-D)、血浆抗凝血酶原Ⅲ(AT-Ⅲ)]水平差异;比较两组术后1个月内VTE发生风险。结果 观察组患者术后排便时间[(73.48±13.39)h vs (98.27±15.04)h]、通气时间[(51.68±10.27) vs (62.72±13.81)h]、住院时间[(9.21±1.20)d vs (11.42±1.25)d]、住院费用[(3.09±0.33)万元vs (3.79±0.42)万元]均明显低于对照组(均P<0.05),两组再入院率差异无统计学意义(P>0.05)。观察组术后第3天NRS评分[(2.32±0.52)分vs (2.74±0.58)分]和PSQI评分[(0.67±0.32)分vs (0.89±0.34)分]均明显低于对照组(均P<0.05),AT-Ⅲ水平明显高于对照组[(85.49±12.32)%vs(81.38±11.65)%,P<0.05];术后观察组VTE中危及以上发生风险低于对照组(50.68%vs 67.12%,P<0.05)。结论 基于ERAS理念的VTE预防方案能够加快肝癌患者术后康复,降低VTE发生风险,减轻患者经济负担。

Objective To explore the application effects of venous thromboembolism(VTE)prevention regimen based on concept of enhanced recovery after surgery(ERAS)on patients with liver cancer during perioperative period.Methods A total of 146 inpatients with primary liver cancer,who received elective surgery in the First Affiliated Hospital of Wenzhou Medical University from Jun.2020 to Dec.2021,were divided into observation group(73 cases)and control group(73 cases)according to the block randomization method.The observation group was intervened with perioperative VTE prevention regimen while the control group was intervened with traditional perioperative management regimen.The postoperative defecation time,ventilation time,hospitalization time,hospitalization expense and readmission rate,pain status and sleep quality status on the 1st day and 3rd day postoperative and coagulation function[plasma fibrinogen(FIB),D-dimer(D-D),plasma antithrombinⅢ(AT-Ⅲ)]on the 3rd day postoperative,and VTE occurrence risk within 1 month postoperative,were compared between the two groups.Results The postoperative defecation time[(73.48±13.39)h vs(98.27±15.04)h],ventilation time[(51.68±10.27)h vs(62.72±13.81)h],hospitalization time[(9.21±1.20)d vs(11.42±1.25)d]and hospitalization expense[(3.09±0.33)ten thousand yuan vs(3.79±0.42)ten thousand yuan]in observation group were significantly less than those in control group(all P<0.05),but there was no statistical difference in the readmission rate between the two groups(P>0.05).The NRS score[(2.32±0.52)vs(2.74±0.58)]and PSQI score[(0.67±0.32)vs(0.89±0.34)]on the 3rd day postoperative were significantly lower in observation group than those in control group(all P<0.05),while the AT-Ⅲlevel was significantly higher than that in control group[(85.49±12.32)%vs(81.38±11.65)%,P<0.05].The risk with medium level and above of postoperative VTE occurrence in observation group was lower than that in control group(50.68%vs 67.12%,P<0.05).Conclusion For patients with liver cancer,VTE prevention regimen based on ERAS concept can speed up the postoperative rehabilitation,reduce the risk of VTE occurrence,and relieve the economic burden.