快速康复外科理念对内镜下治疗肝硬化食管胃静脉曲张应用效果

Application of enhanced recovery after surgery in endoscopic therapy of gastroesophageal varices in cirrhosis

目的分析将快速康复外科(ERAS)理念在肝硬化食管胃静脉曲张围手术期管理中应用的安全性和价值。方法选取2021-04-01一2022-08-31于泰安市中心医院行内镜治疗的109例肝硬化食管胃静脉曲张患者作为研究对象,随机分为应用ERAS理念的ERAS组(57例)和对照组(52例)。比较2组患者术后不良反应、术后出血情况、术后血清指标、患者焦虑抑郁状态评分、住院治疗满意度及住院时间的差异。结果干预后,ERAS组患者焦虑自评量表(SAS)评分为(48.00士5.20)分,低于对照组的(52.17±6.44)分,t=3.738,P<0.001;ERAS组患者抑郁自评量表(SDS)评分为(47.84土5.11)分,低于对照组的(51.10士5.11)分,t=3.319,P=0.001。ERAS组患者满意度为98.24%,高于对照组的84.62%,x=0.669,P=0.013;ERAS组患者住院时间为(7.00士1.23)d,短于对照组的(9.29士1.99)d,t=-7.291,P<0.001。ERAS组不良反应发生率为15.79%,高于对照组的11.54%,但差异无统计学意义,x^(2)=0.875,P=0.646。2组患者术后5d、6周、6个月黑便、呕血发生率比较,差异无统计学意义,均P>0.05。2组患者白细胞、谷氨酸、门冬氨酸氨基转移酶、丙氨酸氨基转移酶、肌酐、白蛋白各项血清指标比较,差异无统计学意义,均P>0.05。结论ERAS理念在肝硬化食管胃静脉曲张患者内镜治疗的围手术期应用安全可行。

Objective To analyze the safety and value of the enhanced recovery after surgery(ERAS)in endoscopic therapy of gastroesophageal varices in patients with liver cirrhosis during perioperative period.Methods A total of 1o9 patients with cirrhosis undergoing endoscopic treatment of gastroesophageal varicose in Taian Central Hospital from April 1,2021 to August 31,2022 were selected as the research subjects.The patients were randomly divided into two groups,an ERAS group(57 cases)applying the ERAS concept and a control group(52 cases).The difference of postoperative ad-verse reactions,postoperative bleeding,postoperative serum indicators,anxiety and depression scores of the patients,hospitalization satisfaction and hospital stay between two groups were compared.Results After intervention,the self-rat-ing anxiety scale(SAS)score of patients in the ERAS group was(48.00±5.20)points,lower than the control group's(52.17±6.44)points,t=3.738,P<0.001;the self-rating depression scale(SDS)score of patients in the ERAS group was(47.84±5.11)points,lower than the control group's(51.10±5.11)points,t=3.319,P=0.001.The satisfaction rate of patients in the ERAS group was 98.24%,higher than the control group's 84.62%,x^(2)=0.669,P=0.013;the hospital stay of patients in the ERAS group was(7.00±1.23)d,shorter than the control groups(9.29±1.99)d,t=-7.291,P<0.001.The incidence of adverse reactions in the ERAS group was 15.79%,higher than the control groups 11.54%,but the difference was not statistically significant,x^(2)=0.875,P=0.001.There was no statistically significant difference in the incidence of black stool and vomiting blood between the two groups of patients at 5 days,6 weeks,and 6 months after surgery,with all P>0.05.There was no statistically significant difference in serum indicators such as white blood cells,glutamate,aspartate aminotransferase,alanine aminotransferase,creatinine,and albumin between the two groups of patients,with all P>0.05.Conclusion The ERAS concept is safe and feasible for perioperative endoscopic treatment of esophagogastric varices in patients with liver cirrhosis.