發(fā)布時(shí)間：2018-06-05 23:08

  本文選題：營(yíng)養(yǎng)支持治療 + 圍手術(shù)期�。� 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景和目的加速康復(fù)外科(enhanced recovery after surgery,ERAS),是近二十年發(fā)展的外科理念,通過(guò)簡(jiǎn)化和改進(jìn)圍手術(shù)期有關(guān)措施,以減少手術(shù)及相關(guān)措施對(duì)機(jī)體的應(yīng)激為基本理念,達(dá)到使機(jī)體的生理功能維持穩(wěn)定的目的,從而使機(jī)體迅速?gòu)谋皇中g(shù)擾亂的狀態(tài)恢復(fù)過(guò)來(lái),減少并發(fā)癥,縮短術(shù)后康復(fù)時(shí)間。需急診手術(shù)的外科急腹癥患者,由于疾病本身造成的進(jìn)食障礙,應(yīng)激反應(yīng),加之手術(shù)創(chuàng)傷、術(shù)后禁食等因素,多合并嚴(yán)重營(yíng)養(yǎng)不良或有潛在的營(yíng)養(yǎng)風(fēng)險(xiǎn),從而導(dǎo)致住院時(shí)間延長(zhǎng)、并發(fā)癥多以及病程恢復(fù)緩慢等特點(diǎn),使預(yù)后差。營(yíng)養(yǎng)狀況與術(shù)后患者的病死率和并發(fā)癥發(fā)生率有著密切的關(guān)系,對(duì)營(yíng)養(yǎng)不良或有營(yíng)養(yǎng)風(fēng)險(xiǎn)患者進(jìn)行合理的臨床營(yíng)養(yǎng)支持可改善其術(shù)后臨床結(jié)局,如減少并發(fā)癥,縮短住院時(shí)間等。本研究旨在探討ERAS理念下圍手術(shù)期營(yíng)養(yǎng)支持與傳統(tǒng)圍手術(shù)期管理相比,對(duì)急腹癥患者營(yíng)養(yǎng)狀態(tài)及臨床結(jié)局改善的意義。方法按照連續(xù)采樣的方法選取2015年3月至2016年3月于鄭州大學(xué)第一附屬醫(yī)院急診外科行急診手術(shù)的急腹癥490例納入研究,按病種分類,各類患者按簡(jiǎn)單隨機(jī)法隨機(jī)分為兩組,即加速康復(fù)外科組(ERAS組)及傳統(tǒng)圍手術(shù)期管理(conservative perioperative management,CPM)組(CPM組),其中ERAS組(287例)接受加速康復(fù)策略進(jìn)行圍手術(shù)期管理,CPM組(203例)按傳統(tǒng)圍手術(shù)期管理方法治療。比較兩組患者相關(guān)生化指標(biāo)和臨床指標(biāo)。統(tǒng)計(jì)處理采用SPSS 21.0進(jìn)行統(tǒng)計(jì)分析,計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差(?x±s)表示,計(jì)量資料的組間、組內(nèi)比較采用t檢驗(yàn),重復(fù)測(cè)量資料組間比較采用方差分析,組間率的比較采用χ2檢驗(yàn),等級(jí)資料組間比較采用秩和檢驗(yàn),以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果兩組患者性別構(gòu)成、年齡差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),疾病構(gòu)成、術(shù)前營(yíng)養(yǎng)狀況、手術(shù)方式亦無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。與CPM組比較,ERAS組患者術(shù)后血漿白蛋白、前白蛋白水平明顯改善(P0.05),術(shù)后腸功能恢復(fù)時(shí)間縮短,術(shù)后并發(fā)癥發(fā)生率降低,住院時(shí)間縮短(P0.05),術(shù)后WHO疼痛分級(jí)降低(P0.05)。結(jié)論行急診手術(shù)的急腹癥患者通過(guò)加速康復(fù)外科理論下的圍手術(shù)期營(yíng)養(yǎng)支持,可有效改善患者營(yíng)養(yǎng)狀態(tài),加速術(shù)后康復(fù),減少并發(fā)癥,縮短住院時(shí)間,優(yōu)化臨床結(jié)局。
[Abstract]:Background and objective to accelerate the enhancement of recovery after Surgeryeras in rehabilitation surgery is a surgical concept developed in the last two decades. By simplifying and improving the relevant measures during the perioperative period, the basic idea is to reduce the stress caused by surgery and related measures. The aim is to keep the physiological function of the body stable, so that the body can recover quickly from the disturbed state of operation, reduce the complications and shorten the time of postoperative rehabilitation. Surgical acute abdomen patients who need emergency surgery, due to eating disorders, stress reactions, surgical trauma, postoperative fasting and other factors caused by the disease itself, are often associated with severe malnutrition or have a potential nutritional risk. The result of prolonged hospitalization, more complications and slow recovery of the course of disease and so on, make the prognosis poor. Nutritional status is closely related to the mortality and complication rate of postoperative patients. Proper clinical nutritional support for patients with malnutrition or nutritional risk can improve the postoperative clinical outcome, such as reducing complications. Shorten the length of stay in hospital, etc. The purpose of this study was to explore the significance of perioperative nutritional support in improving the nutritional status and clinical outcome of patients with acute abdomen compared with traditional perioperative management under the concept of ERAS. Methods from March 2015 to March 2016, 490 patients with acute abdomen undergoing emergency surgery in the first affiliated Hospital of Zhengzhou University were selected according to the method of continuous sampling. The patients were randomly divided into two groups according to the type of disease. ERAs group and traditional perioperative management group (ERAS group, 287 cases) received accelerated rehabilitation strategy for perioperative management, 203 cases were treated with traditional perioperative management method. The related biochemical indexes and clinical indexes were compared between the two groups. SPSS 21.0 was used for statistical analysis. The measurement data were expressed as mean 鹵standard deviation. T test was used for intra-group comparison of measurement data, analysis of variance was used for comparison of repeated measurement data, and 蠂 2 test was used for comparison of rate between groups. Rank sum test was used to compare the grade data between groups, with P0.05 as the difference was statistically significant. Results there was no significant difference in sex and age between the two groups (P 0.05). The constitution of the disease, the nutritional status before operation and the operation mode were not statistically significant (P 0.05). Compared with CPM group, the plasma albumin and prealbumin level in ERAS group were significantly improved (P 0.05), the recovery time of intestinal function was shortened, the incidence of postoperative complications was decreased, the hospitalization time was shortened and the postoperative WHO pain grade was decreased (P 0.05). Conclusion the patients with acute abdomen undergoing emergency surgery can effectively improve their nutritional status, accelerate postoperative rehabilitation, reduce complications, shorten hospital stay and optimize clinical outcomes by accelerating the perioperative nutritional support under the theory of rehabilitation surgery.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R656.1

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本文編號(hào)：1983802