本文選題：加速康復(fù)外科 + 結(jié)直腸癌��； 參考：《遵義醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:通過(guò)術(shù)前營(yíng)養(yǎng)不良篩查,對(duì)中重度營(yíng)養(yǎng)不良的結(jié)直腸癌患者營(yíng)養(yǎng)治療后,應(yīng)用加速康復(fù)外科模式,探討加速康復(fù)外科應(yīng)用于術(shù)前中重度營(yíng)養(yǎng)不良的結(jié)直腸癌患者的可行性、安全性。方法:選取貴州省人民醫(yī)院普外科在2015年1月至2017年1月期間確診的結(jié)直腸癌患者,應(yīng)用患者主觀整體評(píng)估(The Patient-Generated Subjective Global Assessment,PG-SGA)進(jìn)行術(shù)前營(yíng)養(yǎng)不良篩查,選取評(píng)分≥4分中重度營(yíng)養(yǎng)不良的患者59例,進(jìn)行7-10天的營(yíng)養(yǎng)治療,根據(jù)患者意愿及排除標(biāo)準(zhǔn),納入加速康復(fù)外科(Enhanced Recovery After Surgery,ERAS)模式(下稱ERAS組)的21例,傳統(tǒng)外科模式(下稱傳統(tǒng)組)的32例,分析ERAS組及傳統(tǒng)組在圍手術(shù)期血清白蛋白水平、手術(shù)時(shí)間、術(shù)中出血、肛門(mén)排氣時(shí)間、術(shù)后惡心嘔吐、切口感染、肺部感染、吻合口瘺及術(shù)后住院時(shí)間、住院費(fèi)用之間存在的差異。結(jié)果:術(shù)前1天及術(shù)后第7天,ERAS組與傳統(tǒng)組的血清白蛋白水平變化均無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05);術(shù)后第4天,ERAS組明顯高于傳統(tǒng)組(P0.05);傳統(tǒng)組血清白蛋白水在術(shù)后第4天降低,術(shù)后第7天恢復(fù),在圍手術(shù)期的變化有統(tǒng)計(jì)學(xué)差異(P0.05),而ERAS組在圍手術(shù)期的變化則無(wú)明顯統(tǒng)計(jì)差異(P0.05)。ERAS組與傳統(tǒng)組在手術(shù)時(shí)間及術(shù)中出血量方面均無(wú)統(tǒng)計(jì)學(xué)差異。ERAS組術(shù)后肛門(mén)排氣時(shí)間明顯比傳統(tǒng)組提前,惡心嘔吐的例數(shù)比傳統(tǒng)組明顯減少,兩組在肛門(mén)排氣時(shí)間及惡心嘔吐上存在明顯統(tǒng)計(jì)學(xué)差異(P0.05)。ERAS組術(shù)后切口感染有1例,肺部感染有2例,吻合口瘺為0例;傳統(tǒng)組術(shù)后切口感染有2例,肺部感染有3例,吻合口瘺均為1例,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。ERAS組術(shù)后住院時(shí)間比傳統(tǒng)組明顯減少,住院費(fèi)用比傳統(tǒng)組明顯降低,兩組在術(shù)后住院時(shí)間及住院費(fèi)用上存在明顯統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:中重度營(yíng)養(yǎng)不良的結(jié)直腸癌患者,術(shù)前經(jīng)過(guò)營(yíng)養(yǎng)治療,加速康復(fù)外科模式的應(yīng)用并沒(méi)有增加切口感染、肺部感染及吻合口瘺的發(fā)生率,并且能夠維持術(shù)后血清蛋白穩(wěn)定;肛門(mén)排氣時(shí)間提前;術(shù)后惡心嘔吐機(jī)率下降;住院時(shí)間縮短;住院費(fèi)用減少,是安全可行的。
[Abstract]:Objective: to apply the accelerated rehabilitation surgery mode after nutritional treatment in patients with moderate and severe malnutrition by preoperative malnutrition screening. To explore the feasibility and safety of accelerated rehabilitation surgery in patients with moderate and severe malnutrition before operation. Methods: patients with colorectal cancer diagnosed in general surgery department of Guizhou Provincial people's Hospital from January 2015 to January 2017 were selected, and the Patient-Generated Subjective Global assessment PG-SGA was used to screen malnutrition before operation. Fifty-nine patients with moderate or severe malnutrition with score 鈮，

本文編號(hào)：1966516