ERAS理念对胰十二指肠切除术后拔管及康复的影响

Effects of ERAS concept in extubation and rehabilitation after pancreaticoduodenectomy

目的观察加速康复外科(ERAS)理念在胰十二指肠切除术后拔管中的应用效果及对患者康复进程的影响。方法选取123例胰十二指肠切除术患者,按照随机数字表法分为两组。对照组予以常规管理,干预组实施基于ERAS理念的临床管理,比较两组患者的术后拔管情况、胃肠功能改善情况、机体营养状态、术后康复进程及相关并发症发生情况。结果在不同临床管理模式下,干预组的胃管拔除和引流管拔除时间、拔管不良事件发生率、再插管率均少于对照组,差异具有统计学意义(P<0.05);干预组胃泌素(GAS)、胃动素(MLT)、血清总蛋白(TP)、血清白蛋白(ALB)、血清转铁蛋白(TRF)的水平均高于对照组(P<0.05);干预组的肛门排气、首次排便、自主进食以及住院等时间均短于对照组(P<0.05);干预组的相关并发症发生率低于对照组(P<0.05)。结论基于ERAS理念对胰十二指肠切除术患者实施临床管理能改善术后拔管情况,可降低拔管不良事件、再插管风险,促进胃肠功能、营养状态恢复,并加快术后康复进程,降低并发症发生风险。

Objective To observe the application effect of Accelerated Rehabilitation Surgery(ERAS)concept in extubation after pancreaticoduodenectomy and its impact on the rehabilitation process of patients.Methods 123 patients who underwent pancreaticoduodenectomy were selected and divided into 2 groups,using a random number table method.The control group were received routine management,while the intervention group were implemented clinical management based on the ERAS concept.The postoperative extubation status,improvement of gastrointestinal function,nutritional status,postoperative recovery process,and incidence of related complications were compared between the two groups of patients.Results Under different clinical management modes,the intervention group had lower gastric tube removal time,drainage tube removal time,incidence of adverse events after tube removal,and reintubation rate than the control group,showing a statistically significant difference(P<0.05).The levels of gastrin(GAS),motilin(MLT),total serum protein(TP),serum albumin(ALB),and serum transferrin(TRF)in the intervention group were higher than in the control group(P<0.05).The anal exhaust time,first bowel movement time,autonomous eating time,and hospital stay in the intervention group were lower than in the control group(P<0.05).The incidence of related complications in the intervention group was lower than that in the control group(P<0.05).Conclusion Based on the ERAS concept,implementing clinical management for patients undergoing pancreaticoduodenectomy can improve their postoperative extubation status,reduce adverse events of extubation and the risk of re intubation,promote the recovery of gastrointestinal function and nutritional status,accelerate the postoperative recovery process,and reduce the risk of complications.