本文選題：加速康復(fù)外科　切入點(diǎn)：肝切除術(shù)　出處：《蘭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:加速康復(fù)外科是外科技術(shù)和麻醉方法經(jīng)過長時(shí)間發(fā)展后應(yīng)運(yùn)而生的新興學(xué)科,應(yīng)用低損傷的手術(shù)方法和設(shè)備結(jié)合疼痛控制,通過減少患者的應(yīng)激反應(yīng)達(dá)到住院時(shí)間的減少。加速康復(fù)外科的順利實(shí)施,首先需要患者及家屬經(jīng)過合理適度的宣教培訓(xùn),更需要外科、護(hù)理、麻醉科、ICU的通力合作。目的:通過加速康復(fù)外科組與普通治療組臨床效果指標(biāo)的對(duì)比,進(jìn)行研究和評(píng)價(jià),探討兩者術(shù)中方便快速程度及術(shù)后恢復(fù)的優(yōu)劣,為肝臟切除手術(shù)圍術(shù)期的治療措施選擇提供理論依據(jù)與經(jīng)驗(yàn)支持。方法:選取蘭州大學(xué)第一醫(yī)院自2015年6月份至2016年6月份入院的部分醫(yī)療組的肝臟疾病患者作為加速康復(fù)外科實(shí)驗(yàn)組,選取2015年6月份至2016年6月份入院的部分醫(yī)療組的肝臟疾病患者作為對(duì)照組,其中加速康復(fù)外科組(實(shí)驗(yàn)組)共計(jì)病例36例,傳統(tǒng)治療組(對(duì)照組)共計(jì)病例42例,對(duì)比加速康復(fù)外科與傳統(tǒng)治療方案組在肝臟切除手術(shù)后肝功能恢復(fù)情況、術(shù)中出血量、手術(shù)時(shí)間、術(shù)后首次排氣時(shí)間、術(shù)后拔除腹腔引流管時(shí)間,住院時(shí)間、患者滿意度等疾病經(jīng)濟(jì)負(fù)擔(dān)等指標(biāo)。結(jié)果:加速康復(fù)外科組和對(duì)照組手術(shù)時(shí)間分別為(152.30±24.14)min和(148.86±20.55)min,兩組差異無統(tǒng)計(jì)學(xué)意義(P0.05)。加速康復(fù)外科組術(shù)中出血量為(345.44±135.154)ml,腸道首次通氣時(shí)間為(2.75±0.92)天,術(shù)后拔出引流管時(shí)間為(4.06±1.14)天,術(shù)后3天谷丙轉(zhuǎn)氨酶為(65.61±32.81)IU/L,總膽紅素為(21.28±6.21)umol/L,前白蛋白為(145.08±8.00)mg/L,出院時(shí)體重降低(1.53±0.71)kg,住院時(shí)間為(9.28±2.95)d、術(shù)后并發(fā)癥發(fā)生率為5.56%(2/36),住院費(fèi)用為(49123.25±345.78)元,對(duì)照組相應(yīng)指標(biāo)分別為(475.61±136.83)ml,(3.19±0.99)天,(5.38±1.19)天,(163.76±35.58)IU/L,(31.38±7.18)umol/L,(97.00±7.13)mg/L,(2.86±0.32)kg,(12.17±2.78)d、16.67%(7/42),(56321.09±768.08)元,兩組差異均有統(tǒng)計(jì)學(xué)意義(P0.05或0.01)。結(jié)論:加速康復(fù)外科理論用于需行肝切除術(shù)的患者,加速了患者術(shù)后肝功能恢復(fù),減少了術(shù)中出血量,術(shù)后首次排氣時(shí)間明顯縮短、術(shù)后拔除腹腔引流管時(shí)間明顯縮短,縮短了住院時(shí)間、提高了患者滿意度等方面取得了明顯優(yōu)勢(shì),達(dá)到了加速康復(fù)的目的。
[Abstract]:Background: accelerated rehabilitation surgery is a new subject of surgical techniques and anaesthesia developed over a long period of time. It uses low-injury surgical methods and equipment to control pain. To accelerate the successful implementation of rehabilitation surgery, it is necessary for patients and their families to undergo reasonable and moderate education and training, but also for surgery and nursing. Objective: to study and evaluate the clinical effect indexes of accelerated rehabilitation surgery group and general treatment group, and to explore the advantages and disadvantages of the two groups in the quick and convenient operation and the recovery after operation. To provide theoretical basis and empirical support for the choice of perioperative treatment measures for hepatectomy. Methods: selected patients with liver diseases who were admitted to the first Hospital of Lanzhou University from June 2015 to June 2016. In order to accelerate the rehabilitation surgery experimental group, From June 2015 to June 2016, some patients with liver diseases were selected as control group, including 36 cases of accelerated rehabilitation surgery group (experimental group) and 42 cases of traditional treatment group (control group). The recovery of liver function, the amount of intraoperative bleeding, the time of operation, the time of first exhaust after operation, the time of extubation of abdominal cavity and the time of hospitalization were compared between the group of accelerated rehabilitation surgery and the group of traditional treatment. Results: the operative time of accelerated rehabilitation surgery group and control group were 152.30 鹵24.14 min and 148.86 鹵20.55 min, respectively. There was no significant difference between the two groups (P 0.05). The intraoperative blood loss was 345.44 鹵135.154ml in the accelerated rehabilitation surgery group, and the first ventilation time was 2.75 鹵0.92days in the accelerated rehabilitation surgery group. The time of pulling out the drainage tube was 4.06 鹵1.14 days, the total bilirubin was 21.28 鹵6.21 渭 mol / L, the total bilirubin was 21.28 鹵6.21 渭 mol / L, the body weight decreased 1.53 鹵0.71 mg / L, the hospitalization time was 9.28 鹵2.95 / d, the incidence of postoperative complications was 5.56123.25 鹵345.78 yuan. The corresponding indexes of the control group were 475.61 鹵136.83ml / L (3.19 鹵0.99) days 5.38 鹵1.19) days, 163.76 鹵35.58IUP / L = 31.38 鹵7.18umolol / L = 97.00 鹵7.13mg / L / L = 97.00 鹵7.13mg / L / L = 12.86 鹵2.78dg / L = 12.17 鹵2.78dg / L respectively. There was a significant difference between the two groups (P0.05 or 0.01.08). Conclusion: the theory of accelerated rehabilitation surgery can accelerate the recovery of liver function and reduce the blood loss during operation. The first time of exhaust after operation was shortened obviously, the time of extubation of abdominal cavity drainage tube was shortened obviously, the time of hospitalization was shortened, the satisfaction of patients was improved, and the purpose of accelerating rehabilitation was achieved.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.3

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