Effects of multimodal fast-track surgery on liver transplantation outcomes

BACKGROUND: Fast-track surgery and enhanced recovery after surgery have been applied to many surgical procedures; however, data on fast-track surgery and enhanced recovery after surgery following liver transplantation is limited. This study aimed to conduct a prospective study to determine the effects of fast-track surgery on prognosis after liver transplantation. METHODS: This was a prospective, single-blinded, randomized study. One hundred twenty-eight patients undergoing liver transplantation were selected for the fast-track (FT group, n=54) or conventional process (NFT group, n=74). The primary endpoints were intensive care unit (ICU) stay and hospital stay. The secondary endpoints were as follows: operative time, anhepatic phase time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative complications, readmission rate, and postoperative mortality. RESULTS: There was no significant difference in preoperative demographics between the two groups. The median ICU stay was 2 days (range 1-7 days) in the FT group and 5 days (range 3-12 days) in the NFT group (P<0.01). Furthermore, the hospital stay was also significantly reduced in the FT group (P<0.01). The operative time, anhepatic phase time, intraoperative blood loss, and intraoperative blood transfusion volume were decreased in the FT group compared with the NFT group (P<0.05). Based on Spearman correlation analysis, the ICU stay and hospital stay may be positively correlated with operative time, anhepatic phase time and intraoperative blood loss. There were no differences in the incidence of postoperative complications, readmissions, and postoperative mortality between the two groups. CONCLUSION: Fast-track procedures effectively reduce the ICU stay and hospital stay without adversely affecting prognosis. This study demonstrated that fast-track protocols are safe and feasible in liver transplantation.

Safety of fast-track rehabilitation after gastrointestinal surgery:Systematic review and meta-analysis

AIM:To compare the safety of fast-track rehabilitation protocols(FT) and conventional care strategies(CC),or FT and laparoscopic surgery(LFT) and FT and open surgery(OFT) after gastrointestinal surgery.METHODS:We searched MEDLINE,WHO International Trial Register,Embase and The Cochrane Central Register of Controlled Trials up to 2014 for randomized controlled trials(RCTs) comparing FT and CC or comparing LFT and OFT,with 10 or more randomized participants and about 30 d follow-up.Two reviewers independently extracted data on complications,anastomotic leak,obstruction,wound infection,re-admission between FT and CC or LFT and OFT after gastrointestinal surgery.RESULTS:Twenty-four RCTs of FT vs CC or LFT vs OFT were included.Compared with CC,FT reduced overall complications and wound infection.However,anastomotic leak,obstruction and re-admission were not significantly reduced.The pooled risk ratio(RR) of 0.69(95%CI:0.60-0.78; P < 0.001),pooled RR of 0.71(95%CI:0.57-0.88; P < 0.001),pooled RR of 0.93(95%CI:0.68-1.25; P > 0.05),a pooled RR of 0.87(95%CI:0.67-1.15; P > 0.05) and pooled RR of 0.94(95%CI:0.73-1.22; P > 0.05) respectively.Compared with OFT,LFT reduced complications,with a pooled RR of 0.66(95%CI:0.54-0.81; P < 0.001).CONCLUSION:FTs are safe after gastrointestinal surgery.Additional large,prospective RCTs should be conducted to establish further the safety of this approach.

A 5-Year Review of Gynaecological Oncology Patients Managed by a Fast Track Surgery Program

Introduction: The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital. Methods: A 5-year surgical audit of the period commencing 2008 and concluding 2012. All patients undergoing laparotomy were included in the audit without exclusions. Approval was granted by the local Ethics Review Committee. Results: Four hundred and twenty-seven patients underwent laparotomy for suspected or confirmed gynaecological malignancy and were managed by Fast Track Surgery (FTS) principles. Average age was 54.8 years and average weight and BMI were 73.4 kg and 28.1 respectively. Ultimately 254 (59%) patients had confirmed malignancy. Average surgery duration was 2.36 hours and average estimated blood loss (EBL) at surgery was 262 mL. Median and mean LOS was 3.0 and 3.5 days respectively with 125 (29%) patients discharged on day 2. Overall transfusion rate was 5%. Other adverse events in decreasing frequency were hospital readmission (3.7%), significant wound infection (3%) and unplanned High Dependency Unit (HDU) admission (1.4%). All other adverse events were uncommon with rates <0.5%. Factors associated with a short LOS included year of surgery, age, performance status, malignant vs benign pathology, the use of COX-2 inhibitors, operation time, incision type, transfusion, and radical hysterectomy, at least 1 complication, if patients tolerated early oral feeding (EOF). In multivariable analysis, year, age, performance status, the use of COX-2 inhibitors, operation time and incision type were significant. Factors associated with readmission included the use of COX-2 inhibitors, operation time, performance of a lymph node dissection, return to operating theatre, operation category at least 1 complication, and in multivariable analysis lymph node dissection and the occurrence of at least 1 complication were significant. Conclusions: This 5-year audit is important in establishing a contemporary incidence and the prevalence rate of serious adverse events for patients with suspected or confirmed gynaecological cancer undergoing laparotomy and managed by FTS principles. The community can be reassured that the incidence of serious adverse events is low when managed by FTS principles.

Early discharge after major gynaecological surgery: advantages of fast track surgery

Introduction: Fast Track Surgery (FTS) programs have been adopted by many specialties with documented improved patient outcomes and reduced length of stay (LOS). Methods: We initiated a FTS program in January 2008 and present our experience up to and including November 2010 on patients whose LOS was 2 days. Results: During the study period 242 patients had a laparotomy performed. Overall 54(22.3%) patients were discharged on day 2. In the first year of initiating our FTS program 10% were discharged on day 2, 25% in year 2 and 31% in year 3. Twenty-two patients (41%) had malignant pathology and of these, 16 (73%) had local or regional spread and 6 (27%) had distant spread. Forty patients (74%) had vertical midline incisions (VMI) performed. Surgery was classified as complex in 40 cases (74%) and 6 (11%) patients underwent staging lymph node dissection. Average patient BMI was 26.1 with 44% of patients considered overweight or obese. There were no intraoperative complications recorded. When compared to 188 patients whose LOS was greater than 2 days, the early discharge cohort were more likely to have benign pathology, more likely to be younger, to have a transverse incision, to have received COX II inhibitors, to have a lower net haemoglobin (Hb) change and to tolerate early oral feeding. Conclusions: Increased clinical experience with FTS enables over 31% patients undergoing laparotomy to be safely discharged on day 2 without an increase in the read-mission rate or morbidity.

Effect of fast track surgery care on knee joint function in patients with knee joint replacement surgery: A systematic review

目的:系统评价加速康复外科护理对膝关节置换术患者膝关节功能的影响。方法:计算机检索电子数据库TheCochraneLibrary、PubMed、EBSCO、CINAHL、知网、万方、维普及中国生物医学数据库,获取国内外关于加速康复外科护理在膝关节置换术中应用的随机对照试验,由2人根据纳入排除标准独立筛选文献并提取数据,采用RevMan5.3对纳入研究进行Meta分析。结果:共纳入8篇RCT文献,共计患者635例。Meta分析结果显示:(1)与常规护理相比,加速康复外科护理能提高膝关节置换患者特种外科医院膝关节评分,根据资料收集时间的不同,对膝关节特殊手术医院评分进行亚组分析,结果显示:加速康复外科护理提高膝关节置换患者术后2个月、3个月、6个月、1年的膝关节特殊手术医院评分[2个月:加权均数差(WMD)=15.20,95%CI:13.58-16.82,P<0.01;3个月:WMD=9.42,95%CI:7.80-11.04,P<0.01;6个月:WMD=11.01,95%CI:9.73-12.28,P<0.01;1年:WMD=10.78,95%CI:9.33-12.24,P<0.01];(2)与常规护理相比,加速康复外科护理能提高膝关节置换患者美国膝关节学会评分中膝评分(WMD=9.23,95%CI:0.86-17.6,P<0.05)。(3)与常规护理相比,加速康复外科护理降低术后深静脉血栓、便秘、肺部感染、泌尿系感染等并发症的发生。结论:与常规护理相比,加速康复外科护理能促进患者膝关节功能恢复、降低术后深静脉血栓、便秘、肺部感染、泌尿系感染的发生。但尚需进一步开展严谨的大样本、多中心的随机对照试验加以验证。

Fast Track Gynaecologic Surgery in the Overweight and Obese Patient

Introduction: To review the outcomes of overweight and obese patients undergoing laparotomy and managed with a Fast Track Surgical (FTS) protocol. Methods: Between January 2008 and May 2010 patients having a laparotomy and managed on a FTS protocol were identified. They were compared to patients with a normal body mass index (BMI). Data was collected in a real time fashion and analysis undertaken in a retrospective fashion. Results: 194 patients were identified, 94 (48.4%) classified as normal BMI, 51 (26.3%) as overweight and 49 (25.3%) as obese. A vertical midline incision was performed in 170 (88%) patients. When comparing the group of overweight/obese patients (n = 100) to those with a normal BMI (n = 94) there was no significant difference in the number of benign or malignant pathologies, FIGO stage, age, insurance status, complexity of surgery, operation duration, blood loss, haemoglobin change, or need for transfusion. The proportion of patients successfully fast tracked and able to tolerate early oral feeding was similar. Patients classified as overweight or obese were significantly more likely to have a poorer performance status, have un?dergone vertical midline incision and to have had COX II inhibitors withheld. The median length of stay (LOS) was 3 days for the patients with a normal BMI and also 3 days for those overweight or obese. Conclusions: Overweight and obese patients undergoing a fast track surgical protocol after laparotomy for gynaecological surgery have similar out comes when compared to patients of normal body mass index.

Fast-track surgery could improve postoperative recovery in radical total gastrectomy patients

AIM: To assess the impact of fast-track surgery (FTS) on hospital stay, cost of hospitalization and complications after radical total gastrectomy. METHODS: A randomized, controlled clinical trial was conducted from November 2011 to August 2012 in the Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University. A total of 122 gastric cancer patients who met the selection criteria were randomized into FTS and conventional care groups on the first day of hospitalization. All patients received elective standard D2 total gastrectomy. Clinical outcomes, including duration of flatus and defecation, white blood cell count, postoperative pain, duration of postoperative stay, cost of hospitalization and complications were recorded and evaluated.Two specially trained doctors who were blinded to the treatment were in charge of evaluating postoperative outcomes, discharge and follow-up. RESULTS: A total of 119 patients finished the study, including 60 patients in the conventional care group and 59 patients in the FTS group. Two patients were excluded from the FTS group due to withdrawal of consent. One patient was excluded from the conventional care group because of a non-resectable tumor. Compared with the conventional group, FTS shortened the duration of flatus (79.03 ± 20.26 hvs 60.97 ± 24.40 h, P = 0.000) and duration of defecation (93.03 ± 27.95 h vs 68.00 ± 25.42 h, P = 0.000), accelerated the decrease in white blood cell count [P < 0.05 on postoperative day (POD) 3 and 4], alleviated pain in patients after surgery (P < 0.05 on POD 1, 2 and 3), reduced complications (P < 0.05), shortened the duration of postoperative stay (7.10 ± 2.13 dvs 5.68 ± 1.22 d,P = 0.000), reduced the cost of hospitalization (43783.25 ± 8102.36 RMBvs 39597.62 ± 7529.98 RMB,P = 0.005), and promoted recovery of patients. CONCLUSION: FTS could be safely applied in radical total gastrectomy to accelerate clinical recovery of gastric cancer patients.

Fast-track program vs traditional care in surgery for gastric cancer

AIM:To systematically review the evidence for the effectiveness of fast-track program vs traditional care in laparoscopic or open surgery for gastric cancer.METHODS:PubMed,Embase and the Cochrane library databases were electronically searched for published studies between January 1995 and April 2013,and only randomized trials were included.The references of relevant studies were manually searched for further studies that may have been missed.Search terms included"gastric cancer","fast track"and"enhanced recovery".Five outcome variables were considered most suitable for analysis:postoperative hospital stay,medical cost,duration to first flatus,C-reactive protein(CRP)level and complications.Postoperative hospital stay was calculated from the date of operation to the date of discharge.Fixed effects model was used for meta-analysis.RESULTS:Compared with traditional care,fasttrack program could significantly decrease the postoperative hospital stay[weighted mean difference(WMD)=-1.19,95%CI:-1.79--0.60,P=0.0001,fixed model],duration to first flatus(WMD=-6.82,95%CI:-11.51--2.13,P=0.004),medical costs(WMD=-2590,95%CI:-4054--1126,P=0.001),and the level of CRP(WMD=-17.78,95%CI:-32.22--3.35,P=0.0001)in laparoscopic surgery for gastric cancer.In open surgery for gastric cancer,fast-track program could also significantly decrease the postoperative hospital stay(WMD=-1.99,95%CI:-2.09--1.89,P=0.0001),duration to first flatus(WMD=-12.0,95%CI:-18.89--5.11,P=0.001),medical cost(WMD=-3674,95%CI:-5025--2323,P=0.0001),and the level of CRP(WMD=-27.34,95%CI:-35.42--19.26,P=0.0001).Furthermore,fast-track program did not significantly increase the incidence of complication(RR=1.39,95%CI:0.77-2.51,P=0.27,for laparoscopic surgery;and RR=1.52,95%CI:0.90-2.56,P=0.12,for open surgery).CONCLUSION:Our overall results suggested that compared with traditional care,fast-track program could result in shorter postoperative hospital stay,less medical costs,and lower level of CRP,with no more complications occurring in both laparoscopic and open surgery for gastric cancer.

Assessing outcomes after fast track surgical management of corpus cancer

Objective: The aim of the study was to audit the outcomes of patients with corpus cancer managed with a fast track surgery (FTS) program. Design: Clinical audit of outcomes after laparotomy for corpus cancer and managed by FTS principles. Setting: Tertiary hospital, University based subspecialty gynaecological oncology practice. Population or Sample: Consecutive patients with uterine corpus cancer. There were no exclusions. Methods: Three year audit of FTS Database. Main Outcome Measures: Ability to tolerate early oral feeding (EOF), length of stay (LOS), perioperative complication rate and readmission rate. Results: Sixty six patients were operated upon whose median age was 59.5 years. Forty six (70%) had stage I disease, 7 (11%) stage II, 9 (14%) stage III and 4 (6%) had stage IV disease. Twenty seven (41%) had lymph node sampling performed. Median operating time was 2.5 hours. Mean BMI was 30 kg/m2 (Range: 18 - 47). Fifty patients (76%) were classified as over-weight or obese. Twenty four patients (36%) had a “non-zero” performance status. Mean intraoperative EBL was 227 ml. Median LOS was 3.0 days. There were 3 (5%) intraoperative complications. There were no intraoperative ureteric, bowel or vascular injuries. Postoperatively, 13 (20%) patients experienced a total of 24 adverse events. Only 2 (3%) patients experienced complications greater than grade 2. Conclusion: This audit shows that in an unselected group of patients undergoing laparotomy as management for their uterine malignancy and managed by a FTS protocol, overall excellent results can be achieved.

Fast Track Surgery and Its Outcome in Colorectal Surgery in a Tertiary Care Hospital

Background: Fast track surgery is an evidence-based multidisciplinary approach. The underlying principle is to enable patients to recover from surgery and leave the hospital sooner by minimizing the stress responses on the body during surgery. Our aim was to compare the outcome of fast-track protocol and conventional methods in colorectal surgery. Method: It was an observational cross-sectional study carried out at the Department of Surgery in different tertiary level hospitals, Dhaka Bangladesh during the period January 2014 to December 2017. Among this population, 50 patients were placed in the fast-track program (Group A) from January 2014 to December 2015 and 50 patients were in the conventional method (Group B), from January 2016 to December 2017. The fast-track patients were selected after receiving ethical approval from the Bangladesh College of Physician & Surgeons. Data analysis was done using the statistical package for social science (SPSS) for windows version 20. Results: The average age of the patients was 45.24 ± 16.65 years (range: 11 - 70 years) in the fast track group (Group A) and 43.24 ± 17.76 years in the conventional method (Group B). The majority were female between two groups, with 56% in group A and 52% in group B. General and surgical complications occurred in 9 (18%) patients and 11 (22%) patients respectively in group A. On the other hand in group B general and surgical complications occurred in 10 (20%) patients and 13 (26%) patients respectively. The average hospital stay was 9.24 ± 5.99 days in group A and the average hospital stay was 10.10 ± 6.04 days in group B. Conclusion: Making the decision to adopt fast-track surgery will challenge current traditional practice for all members of the multidisciplinary team across the whole local health community.

Fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for colorectal malignancy: A meta-analysis

AIM:To evaluate the fast-track rehabilitation protocol and laparoscopic surgery(LFT)vs conventional care strategies and laparoscopic surgery(LCC).METHODS:Studies and relevant literature comparing the effects of LFT and LCC for colorectal malignancy were identified in MEDLINE,the Cochrane Central Register of Controlled Trials and EMBASE.The complications and re-admission after approximately 1 mo were assessed.RESULTS:Six recent randomized controlled trials(RCTs)were included in this meta-analysis,which related to 655 enrolled patients.These studies demonstrated that compared with LCC,LFT has fewer complications and a similar incidence of re-admission after approximately 1 mo.LFT had a pooled RR of 0.60(95%CI:0.46-0.79,P<0.001)compared with a pooled RR of 0.69(95%CI:0.34-1.40,P>0.5)for LCC.CONCLUSION:LFT for colorectal malignancy is safe and efficacious.Larger prospective RCTs should be conducted to further compare the efficacy and safety of this approach.

Fast track clinical pathway implications in esophagogastrectomy

AIM:To investigate the feasibility of fast track clinical pathway for esophageal tumor resections. METHODS:One hundred and fourteen patients with esophageal carcinoma who underwent esophagogastrectomy from January 2006 to October 2007 in our department were studied.Fast track clinical pathway included analgesia control,fluid infusion volume control,early ambulation and enteral nutrition. Nasogastric tube was removed 3 d after operation and chest tube was removed 4 d after operation as a routine,and full liquid diet 5 d after operation. RESULTS:Among 114 patients(84 men and 30 women),26 patients underwent fast track surgery,including 17 patients over 65 years old and 9 under 65(P=0.014);18 patients who had preoperative complications could not bear fast track surgery(P< 0.001).No significant differences in tolerance of fast track surgery were attributed to differences in gender,differentiated degree or stage of tumor,pathological type of tumor,or operative incision.The median length of hospital stay was 7 d(5-28 d),4%patients were readmitted to hospital within 30 d of discharge.Three patients died and postoperative mortality was 2.6%. All 3 patients had no determinacy to fast track surgery approach.CONCLUSION:The majority of patients with esophageal carcinoma can tolerate fast track surgery. Patients younger than 65 or who have no preoperative diseases have the best results.Median length of hospital stay has been reduced to 7 d.

Key details of the duodenal-jejunal bypass in type 2 diabetes mellitus rats

AIM: To investigate which surgical techniques and perioperative regimens yielded the best survival rates for diabetic rats undergoing gastric bypass. METHODS: We performed Roux-en-Y gastric bypass with reserved gastric volume, a procedure in which gastrointestinal continuity was reestablished while excluding the entire duodenum and proximal jejunal loop. We observed the procedural success rate, long-term survival, and histopathological sequelae associated with a number of technical modifications. These included: use of anatomical markers to precisely identify Treitz's ligament; careful dissection along surgical planes; careful attention to the choice of regional transection sites; reconstruction using full-thickness anastomoses; use of a minimally invasive procedure with prohemostatic pretreatment and hemorrhage control; prevention of hypo-thermic damage; reduction in the length of the procedure; and accelerated surgical recovery using fast-track surgical modalities such as perioperative permissive underfeeding and goal-directed volume therapy. RESULTS: The series of modif ications we adopted reduced operation time from 110.02 ± 12.34 min to 78.39 ± 7.26 min (P < 0.01), and the procedural success rate increased from 43.3% (13/30) to 90% (18/20) (P < 0.01), with a long-term survival of 83.3% (15/18) (P < 0.01). CONCLUSION: Using a number of fast-track and damage control surgical techniques, we have successfully established a stable model of gastric bypass in diabetic rats.

Day surgery in strabismus operation under general anesthesia

Background:The purpose of this study is to summarize the application of day surgery combined with fast track program in strabismus operation under general anesthesia.Methods:The clinical data of 2,000 cases of strabismus patients who had underwent surgery in day surgery or traditional hospitalization in the duration from 2015 to 2016 was retrospectively analyzed.The safety and efficacy were assessed by comparing the average length of stay in hospitals,anesthesia recovery time,patient satisfaction and number of adverse events.Results:Compared with the traditional group,the average length of stay in hospital and recovery time in day surgery group were significantly lower(P<0.001)and the satisfaction of patient was improved(P<0.05),which were statistically significant difference.Moreover,no adverse events occurred among these patients.Conclusions:The application of day surgery in strabismus operation under general anesthesia is feasible,which can reduce the recovery time and shorten the hospital stay of patients safely and effectively,and their satisfaction was improved at the same time.

继发性甲状旁腺功能亢进症患者加速康复外科护理服务需求的项目特征与关联性分析

目的探讨继发性甲状旁腺功能亢进症(SHPT)患者加速康复外科(FTS)护理服务需求的项目特征与关联性,以期为临床治疗提供参考。方法将2021年1月—2023年1月于河北医科大学第三医院接受FTS护理服务的100例SHPT患者作为研究对象,收集患者FTS护理服务项目需求;并以资料饱和为原则对患者进行半结构式访谈,采用Python中Apriori模块分析不同SHPT患者FTS护理服务需求项目的特征及关联性,计算项/项集的支持度、置信度和提升度;使用Colaizzi分析法进行质性研究分析。结果量性研究显示:FTS护理服务需求总数为52项,包括健康教育、心理护理、饮食护理、康复训练、用药护理、并发症预防护理6类;各项集支持度均>0.02,用药护理和康复训练支持度最高。质性研究结果显示:患者FTS护理服务需求共凝练出4个主题,分别为疾病知识技能需求、用药知识需求、康复护理需求、心理社会支持需求。结论SHPT患者存在不同的FTS护理服务需求,各项目间具有促进作用,管理过程中可根据项目关联特点,设置合理的服务项目,提高FTS护理服务水平。

Fast track surgery accelerates the recovery of postoperative insulin sensitivity

Background Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity. This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection. Methods Controlled, randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up. Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups： a fast track group （35 cases） and a conventional care group （35 cases）. All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters （complication rates, return of gastrointestinal function and postoperative length of stay）, stress index and insulin sensitivity were evaluated in both groups perioperatively. Results Sixty-two patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group. We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation. Conclusion Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.

Clinical Application of Fast-Track Surgery with Chinese Medicine Treatment in the Devascularization Operation for Cirrhotic Portal Hypertension

Objective： To investigate the clinical effect of fast-track surgery combined with Chinese medicine treatment in devascularization operation for cirrhotic esophageal varices. Methods： Seventy-two patients with cirrhotic esophageal varices were selected from January 2009 to June 2013, and randomly assigned to a conventional group and a fast-track group （fast-track surgery combined with Chinese medicine treatment） using a randomized digital table, 36 cases in each group. Operation and anesthesia recovery time, postoperative hospitalization and quality of life were recorded and compared between groups during the perioperative period. Results： Compared with the conventional group, the fast-track group had longer operation time （253.6±46.4 min vs. 220.6±51.0 min） and anesthesia recovery time （50.5 ± 15.9 rain vs. 23.5± 9.6 min; P〈0.01）; less bleeding （311.3±46.8 mL vs. 356.2 ± 57.5 mL; P〈0.01） and less transfusion （1932.3 ± 106.9 mL vs. 2045.6 ± 115.4 mL; P〈0.01）; as well as faster recovery of gastrointestinal function, shorter postoperative hospitalization and higher quality of life. There were no serious postoperative complications and no further bleeding occurred. Conclusion： Fast-track surgery combined with Chinese medicine treatment is a safe and feasible approach to accelerate the recovery of patients with cirrhotic portal hypertension in perioperative period of devascularization operation.

超快通道麻醉在心脏体外循环手术中的应用

超快通道麻醉(ultra-fast-track anesthesia,UFTA)指在手术后立即恢复患者的自主呼吸并拔除气管导管,已成为心脏外科手术的一个重要议题。这种方法旨在通过缩短机械通气时间,降低术后并发症的风险,加快康复进程,从而优化医疗资源的使用并改善患者的预后。本综述围绕加强康复外科(enhanced recovery after surgery,ERAS)的理念,探讨UFTA在心脏手术中的应用,分析其优点、潜在风险与局限性,并探索现有研究进展和未来的发展方向,以便为临床实践和未来研究提供指导和启示。

快速康复外科干预在口腔癌术后口腔皮瓣修复术患者中的应用效果

目的探讨快速康复外科(FTS)干预在口腔癌术后口腔皮瓣修复术患者中的应用效果。方法将2019年1月至2020年5月接受常规干预的49例口腔癌术后口腔皮瓣修复术患者纳入常规组,2020年6月至2022年1月接受FTS干预的49例口腔癌术后口腔皮瓣修复术患者纳入FTS组。比较两组患者的手术相关指标、疼痛程度[视觉模拟评分法(VAS)]、吞咽功能及并发症发生情况。结果FTS组患者引流管拔除时间、恢复进食时间、卧床时间、输液时间、住院时间均明显短于常规组(P﹤0.01)。术后6、24、48、72 h,FTS组患者的VAS评分均明显低于常规组(P﹤0.01)。术后2周,FTS组患者的吞咽功能明显优于常规组(P﹤0.01)。FTS组患者的术后并发症总发生率低于常规组(P﹤0.05)。结论FTS干预可促进口腔癌术后口腔皮瓣修复术患者快速恢复,降低疼痛程度及并发症发生率,改善吞咽功能。

瑞马唑仑快通道麻醉在改善心脏瓣膜手术患者术后恢复的作用

目的评价瑞马唑仑快通道麻醉对心脏瓣膜手术患者术后早期恢复质量的改善情况,为临床优化快通道麻醉和术后快速康复(ERAS)方案提供参考依据。方法选择全麻体外循环下行正中开胸心脏瓣膜置换和(或)成形术的择期手术患者,在常规麻醉评估和快通道麻醉适应证评估基础上,严格按照纳入标准和排除标准入组研究对象228例,随机分为两组:瑞马唑仑组、异丙酚组,每组114例。瑞马唑仑组患者麻醉诱导与麻醉维持均使用瑞马唑仑,对照组患者则使用异丙酚。记录患者的一般资料、手术资料等;记录术前1 d、术后1 d、术后3 d和出院前1 d的QoR-15评分;记录入室后主要时间点的血流动力学指标、麻醉后低血压及心动过缓的发生情况、手术持续时间、麻醉持续时间、术后机械通气时间、ICU停留时间、术后住院时间等;以及围术期心血管不良事件的发生率以及术后近期并发症的发生率等。结果(1)两组间一般资料及术前1 d的QoR-15评分比较,差异无统计学意义(P>0.05)。(2)瑞马唑仑组的QoR-15评分在出院前1 d与异丙酚组相比有所增高,差异有统计学意义(P<0.05),但差异小于最小临床差异即小于8,无明显的临床获益。(3)气管插管后1 min及切皮后1 min异丙酚组心率减慢并且MAP明显降低,组间比较差异有统计学意义(P<0.05);其余时刻的心率、MAP差异无统计学意义(P>0.05)。术中低血压和心动过缓发生率瑞马唑仑组低于异丙酚组,差异有统计学意义(P<0.05)。术后机械通气时间、ICU停留时间、术后住院时间以及再次插管率瑞马唑仑组均短于异丙酚组,并且快通道麻醉成功率高于异丙酚组,差异有统计学意义(P<0.05)。围术期并发症发生率方面两组差异无统计学意义。结论与常用的静脉麻醉药异丙酚相比,瑞马唑仑快通道麻醉方案虽未明显改善心脏瓣膜手术患者术后恢复质量评分,但瑞马唑仑在维持循环稳定、提高快通道麻醉成功率、缩短术后ICU停留时间和术后住院时间等方面具有明显优势。对于心脏手术患者来说,瑞马唑仑是可供选择的静脉麻醉药。