基于ERAS理念的心肺功能路径化管理在老年人腹腔镜胆囊切除围术期的应用研究

Application of ERAS Concept-based Cardiopulmonary Function Pathway Management during Perioperative Period of Laparoscopic Cholecystectomy in Elderly Patients

目的探究基于快速康复外科(ERAS)理念的心肺功能路径化管理在老年人腹腔镜胆囊切除围术期的应用效果。方法选取2019年11月—2022年11月收治的150例老年腹腔镜胆囊切除术患者,按随机数字表法分为观察组和对照组,各75例,对照组采用常规围术期干预方案,观察组在此基础上实行基于ERAS理念的心肺功能路径化管理。对比2组术后恢复情况(下床活动时间、首次肛门排气时间、术后住院时间),术前及出院前1 d疼痛情况[视觉模拟评分法(VAS)]和日常生活活动能力[日常生活活动能力量表(ADL)]、心肺功能指标[无氧阀(AT)、最大摄氧量(VO_(2max))、峰值氧脉搏(O_(2)Ppeak)、左心室射血分数(LVEF)]及并发症发生情况。结果观察组下床活动时间、首次肛门排气时间及术后住院时间均短于对照组(P<0.01);出院前1 d观察组VAS评分低于对照组,ADL评分高于对照组(P<0.05,P<0.01);出院前1 d观察组AT、VO_(2max)、O_(2)Ppeak、LVEF均高于对照组(P<0.05,P<0.01)。观察组围术期肺部感染、胸腔积液、心力衰竭总发生率低于对照组(P<0.05)。结论基于ERAS理念的心肺功能路径化管理可有效促进老年腹腔镜胆囊切除术患者术后康复,改善心肺功能,减少并发症。

Objective To explore the application effect of cardiopulmonary function pathway management based on the concept of enhanced recovery after surgery(ERAS)during the perioperative period of laparoscopic cholecystectomy in elderly patients.Methods A total of 150 elderly patients undergoing laparoscopic cholecystectomy in our hospital from November 2019 to November 2022 were selected and divided into observation group(n=75)and control group(n=75)by the random number table method.The control group was given routine perioperative intervention regimen,while the observation group was given ERAS concept-based cardiopulmonary function pathway management on this basis.The postoperative recovery status(the first time of off-bed activity,the time of first anal exhaust,length of postoperative hospital stay),pain status[Visual Analogue Scale(VAS)]and activities of daily living[Activities of Daily Living Scale(ADL)],cardiopulmonary function indicators[anaerobic threshold(AT),maximum oxygen uptake(VO_(2max)),peak oxygen pulse(O_(2)Ppeak),left ventricular ejection fraction(LVEF)]before operation and at 1 d before hospital discharge and complications were compared between groups.Results The first time of off-bed activity,the time of first anal exhaust and the length of postoperative hospital stay in the observation group were shorter than those in the control group(P<0.01).VAS score of observation group was lower than control group,while ADL score was higher than control group at 1 d before discharge(P<0.05,P<0.01).AT,VO_(2max),O_(2)Ppeak and LVEF in observation group were higher than those in control group at 1 d before discharge(P<0.05,P<0.01).The total incidence of perioperative pulmonary infection,pleural effusion and heart failure in observation group was lower than that in control group(P<0.05).No serious complications such as biliary fistula and abdominal infection occurred in the two groups.Conclusion ERAS concept-based cardiopulmonary function pathway management can effectively promote the postoperative rehabilitation of elderly patients undergoing laparoscopic cholecystectomy,improve the cardiopulmonary function and reduce the complications.