本文選題：肝膽管結(jié)石 + 加速康復(fù)外科　； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:探討加速康復(fù)外科(ERAS)在肝切除術(shù)治療肝膽管結(jié)石病圍手術(shù)期的臨床應(yīng)用價值。方法:本文分析2014年12月-2016年5月南昌大學(xué)第二附屬醫(yī)院肝膽外科81例肝膽管結(jié)石患者,所有病人均行肝部分切除術(shù),圍手術(shù)期嚴(yán)格按照ERAS理念管理的36例患者作為ERAS組,按照傳統(tǒng)模式管理的45例患者作為對照組,比較兩組患者術(shù)后疼痛評分、圍手術(shù)期炎性介質(zhì)變化、術(shù)后臨床指標(biāo)以及術(shù)后并發(fā)癥等情況。結(jié)果:ERAS組在術(shù)后疼痛評分明顯低于對照組(P0.05),ERAS組患者術(shù)后1、4、7d降鈣素原(PCT)水平分別為(2.60±0.46)ng/ml(2.11±1.17)ng/ml(1.04±0.56)ng/ml,對照組分別為(3.78±0.83)ng/ml(2.98±1.73)ng/ml(2.06±0.83)ng/ml,兩組比較,差異有統(tǒng)計學(xué)意義(P0.05),ERAS組患者術(shù)后1、4、7d白介素-6(IL-6)分別是(128.49±15.17)pg/ml(87.93±10.33)pg/ml(33.76±7.54)pg/ml,對照組分別為(264.77±18.25)pg/ml(195.29±12.71)pg/ml(95.39±10.88)pg/ml兩組比較,差異有統(tǒng)計學(xué)意義(P0.05),ERAS組患者術(shù)后1、4、7d C反應(yīng)蛋白(CRP)分別是(40.35±9.78)mg/L(67.24±6.44)mg/L(32.19±5.35)mg/L對照組分別為(58.36±13.22)mg/L(100.54±10.77)mg/L(50.63±8.72)mg/L兩組比較,差異有統(tǒng)計學(xué)意義(P0.05),ERAS組術(shù)后肛門排氣時間明顯縮短[(34.4±8.7)h比(57.7±11.8)h,P0.05],術(shù)后住院時間明顯縮短[(8.4±2.5)d比(11.6±3.3)d,P0.05],而切口感染、膽漏、膈下膿腫、腹脹等術(shù)后常見并發(fā)癥發(fā)生率并未增高(P0.05)。結(jié)論:加速康復(fù)外科(ERAS)理念應(yīng)用于肝切除術(shù)治療肝膽管結(jié)石病的圍手術(shù)期管理,可以減輕患者術(shù)后疼痛、降低圍手術(shù)期應(yīng)激反應(yīng)、縮短術(shù)后肛門排氣時間、縮短住院時間,有利于患者快速康復(fù)。
[Abstract]:Objective: to evaluate the clinical value of accelerated rehabilitation surgery (ERASS) in the perioperative period of hepatectomy for hepatolithiasis. Methods: a total of 81 patients with hepatolithiasis in the second affiliated Hospital of Nanchang University from December 2014 to May 2016 were analyzed. All patients underwent partial hepatectomy. 36 patients who were managed strictly according to the concept of ERAS during the perioperative period were selected as ERAS group. According to the traditional management of 45 patients as the control group, the postoperative pain score, perioperative inflammatory media changes, postoperative clinical indicators and postoperative complications were compared between the two groups. Results the pain score of the control group was significantly lower than that of the control group (P 0.05). Results the levels of procalcitonin protopril were 2.60 鹵0.46)ng/ml(2.11 鹵1.17)ng/ml(1.04 鹵0.56 ng / ml in the control group and 3.78 鹵0.83)ng/ml(2.98 鹵0.83 0.83)ng/ml(2.98 鹵0.83 ng / ml in the control group, respectively. 宸紓鏈夌粺璁″鎰忎箟(P0.05),ERAS緇勬?zhèn)ｈ�呮湳鍚，

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