基于加速康复外科理念的肛周日间手术临床路径探索

Exploration of clinical pathway for perianal day surgery based on enhanced recovery after surgery concept

目的 探讨基于加速康复外科(enhanced recovery after surgery, ERAS)理念的肛周日间手术临床路径的应用效果。方法 回顾性收集2023年1月-10月甘肃省人民医院肛肠科行肛周手术患者和日间诊疗中心基于ERAS临床路径行肛周日间手术患者的病例资料。将肛肠科患者作为对照组,日间诊疗中心患者作为路径组。分析两组患者在住院费用、平均住院时间、术前住院时间、手术时间、术中出血量、患者满意度等指标的差异以及术后随访情况。结果 共纳入患者400例,每组各200例。两组性别、年龄差异无统计学意义(P>0.05),路径组的视觉模拟评分法评分低于对照组、Kolcaba舒适量表评分高于对照组(P<0.05)。路径组住院费用、平均住院时间、术前住院时间、手术时间均少于对照组(P<0.05),术中出血量两组比较差异无统计学意义(P>0.05)。路径组和对照组的满意度分别为90.5%、86.0%,两组比较差异无统计学意义(P>0.05)。随访结果显示,肛周日间手术并未增加患者出院后的不适。结论 基于ERAS理念的日间手术临床路径模式更有利于日间手术患者的术后康复、降低医疗成本,进而提升医疗质量水平,提高患者满意度,值得临床推广应用。

Objective To explore the application effect of the clinical pathway for perianal day surgery based on enhanced recovery after surgery(ERAS)concept.Methods The case data of patients who underwent perianal surgery in the Department of Anorectal Surgery of Gansu Provincial Hospital between January and October 2023 and patients who underwent perianal day surgery based on the ERAS clinical pathway in the Ambulatory Surgery&Chemotherapy Centre of Gansu Provincial Hospital were retrospectively collected.The patients in the Department of Anorectal Surgery were defined as the control group,while the patients in the Ambulatory Surgery&Chemotherapy Centre were defined as the pathway group.The differences in indicators such as hospitalization cost,average hospitalization time,preoperative hospitalization time,surgical time,intraoperative bleeding,patient satisfaction,and postoperative follow-up between the two groups of patients were analyzed.Results A total of 400 patients were included,with 200 in each group.The differences between the two groups in gender and age were not statistically significant(P>0.05),the Visual Analogue Scale of the pathway group was lower than that of the control group(P<0.05),and the Kolcaba Comfort Scale score was higher than that of the control group(P<0.05).The hospitalization cost,average hospitalization time,preoperative hospitalization time,and surgical time of the pathway group were all lower than those of the control group(P<0.05),and there was no statistically significant difference in intraoperative bleeding between the two groups(P>0.05).The satisfaction rates of the pathway group and the control group were 90.5%and 86.0%,respectively,and there was no statistically significant difference between the two groups(P>0.05).The follow-up results showed that perianal day surgery did not increase the discomfort of patients after discharge.Conclusions The clinical pathway for day surgery based on ERAS concept is more conducive to the postoperative recovery of patients undergoing day surgery,reducing medical costs,improving medical quality,and increasing patient satisfaction.It is worthy of clinical promotion and application.