加速康復(fù)外科在開(kāi)腹大肝癌切除病例中的應(yīng)用與研究
發(fā)布時(shí)間：2018-10-21 17:30
【摘要】：目的:本次研究將探討與評(píng)價(jià)圍手術(shù)期擬用ERAS程序在開(kāi)腹大肝癌切除術(shù)病例中是否具有可行性、有效性及安全性。方法:選取西南醫(yī)科大學(xué)附屬醫(yī)院2014年08月01日~2017年04月01日在我院行大肝癌切除術(shù)的患者為研究對(duì)象,總共101例,男性58例,女性43例,并將患者隨機(jī)分為ERAS組與傳統(tǒng)圍手術(shù)期管理組,ERAS組圍手術(shù)期采取加速康復(fù)理念指導(dǎo)下的優(yōu)化處理方案,對(duì)照組圍手術(shù)期采取傳統(tǒng)的處理方案,兩組患者都以共同的出院標(biāo)準(zhǔn)。就兩組患者圍手術(shù)期應(yīng)激指標(biāo)變化情況、達(dá)到出院標(biāo)準(zhǔn)的時(shí)間、術(shù)后患者住院時(shí)間、術(shù)后患者的疼痛VAS評(píng)分、術(shù)后患者胃腸道功能恢復(fù)情況、術(shù)后患者留置鼻胃管時(shí)間、術(shù)后患者留置腹腔引流管時(shí)間、術(shù)后相關(guān)并發(fā)癥等做出比較分析。結(jié)果:(1)基本資料:兩組患者在年齡、性別、體重、身高、BMI、術(shù)前血紅蛋白、術(shù)前ALT、術(shù)前AST、術(shù)前ASA分級(jí)、術(shù)前ECOG評(píng)分、術(shù)前BCLC分級(jí)、術(shù)前肝功能Child-pugh分級(jí)差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(2)術(shù)中肝葉切除術(shù)的類型:兩組患者術(shù)中肝葉切除術(shù)的類型差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(3)術(shù)前評(píng)估中,ERAS組患者饑餓、口渴感發(fā)生率明顯低于傳統(tǒng)圍手術(shù)期管理組,(P值0.001);ERAS組患者恐慌、焦慮感發(fā)生率低于傳統(tǒng)圍手術(shù)期管理組,具有統(tǒng)計(jì)學(xué)意義(P值0.05)。(4)兩組患者在手術(shù)所需時(shí)間、術(shù)中出血量的多少、術(shù)中第一肝門阻斷時(shí)間、術(shù)中有無(wú)輸血方面差異無(wú)統(tǒng)計(jì)學(xué)意義。(5)術(shù)后相關(guān)應(yīng)激指標(biāo):ERAS組術(shù)后第1、3、5天CRP水平明顯低于傳統(tǒng)治療組,兩組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者在術(shù)后IL-6、白細(xì)胞、血糖方面無(wú)統(tǒng)汁學(xué)差異(P0.05)。(6)術(shù)后疼痛感:術(shù)前及術(shù)后第5天VAS評(píng)分兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),加速康復(fù)組術(shù)后當(dāng)天以及術(shù)后第1,3天VAS評(píng)分明顯低于傳統(tǒng)管理組,兩組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(7)術(shù)后拔管時(shí)間:ERAS組患者術(shù)后鼻胃管、導(dǎo)尿管、腹腔引流管拔除時(shí)間明顯短于傳統(tǒng)管理組,兩組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(8)術(shù)后康復(fù):ERAS組患者術(shù)后開(kāi)始進(jìn)食時(shí)間、術(shù)后下床活動(dòng)時(shí)間、術(shù)后肛門排氣時(shí)間、術(shù)后肛門排便時(shí)間明顯短于傳統(tǒng)治療組,兩組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。(9)術(shù)后90天內(nèi)并發(fā)癥發(fā)生率與再入院率:術(shù)后相關(guān)并發(fā)癥以Dindo-Clavien分類法進(jìn)行分級(jí),ERAS組與傳統(tǒng)治療組患者術(shù)后90天內(nèi)并發(fā)癥發(fā)生率及再入院率兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。(10)TRD以及術(shù)后住院日,總住院費(fèi)用:ERAS組患者在TRD、術(shù)后住院日明顯短于傳統(tǒng)治療組,兩組間差異有統(tǒng)計(jì)學(xué)意義(P0.05),ERAS組總住院費(fèi)用明顯少于傳統(tǒng)治療組,兩組間差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:ERAS理念應(yīng)用于大肝癌切除術(shù)病例中能夠加速康復(fù)進(jìn)程,減輕術(shù)后應(yīng)激反應(yīng),縮短住院時(shí)間,減少住院費(fèi)用,然而ERAS組與傳統(tǒng)管理組在控制術(shù)后并發(fā)癥發(fā)生率方面無(wú)明顯差異;總之,圍手術(shù)期擬用ERAS程序在大肝癌切除術(shù)病例中具有可行性、有效性及安全性。
[Abstract]:Objective: to investigate and evaluate the feasibility, efficacy and safety of perioperative ERAS program in patients with large open liver cancer. Methods: 101 patients (58 males and 43 females) who underwent hepatectomy in our hospital from 01 August 2014 to 01 April 2017 in the affiliated Hospital of Southwest Medical University were selected. The patients were randomly divided into ERAS group and traditional perioperative management group. The ERAS group adopted the optimized treatment plan under the guidance of the idea of accelerated rehabilitation during the perioperative period, and the control group adopted the traditional treatment plan during the perioperative period. The two groups of patients were discharged to the same standard. According to the changes of stress index in perioperative period, the time of discharge, the time of hospitalization, the VAS score of postoperative pain, the recovery of gastrointestinal tract function, the time of keeping nasogastric tube. The time of indwelling celiac drainage tube and postoperative complications were compared and analyzed. Results: (1) basic data: age, sex, weight, height, hemoglobin before BMI, preoperative ASA grade before ALT, ECOG score before operation, BCLC grade before operation in both groups. There was no significant difference in preoperative Child-pugh grade of liver function (P0.05). (2). There was no significant difference in the type of intraoperative hepatectomy between the two groups (P0.05). (3). In the preoperative evaluation, the patients in the ERAS group were hungry. The incidence of thirst was significantly lower than that of the traditional perioperative management group (, (P value 0.001); ERAS), and the incidence of anxiety was lower than that of the traditional perioperative management group (P0. 05). (4). There was no significant difference in the first hepatic portal occlusion time and blood transfusion during the operation. (5) postoperative stress index: the level of CRP in the ERAS group was significantly lower than that in the traditional treatment group on the 1st day, 3th day after operation, and 5 days after operation. The difference between the two groups was statistically significant (P0.05). There was no significant difference in blood glucose between the two groups (P0.05). (6): there was no significant difference in VAS score between the two groups before and after 5 days (P0.05). The VAS score in the accelerated rehabilitation group was significantly lower than that in the traditional management group on the postoperative day and the 1st day after the operation (P0.05). There was significant difference between the two groups (P0.05). (7) postoperative extubation time: ERAS group patients after nasal and gastric tube, catheter, abdominal drainage tube extraction time was significantly shorter than the traditional management group. The difference between the two groups was statistically significant (P0.05). (8) postoperative rehabilitation: the ERAS group patients began to eat time after surgery, the time to get out of bed, postoperative anal exhaust time, postoperative anal defecation time was significantly shorter than the traditional treatment group. The difference between the two groups was statistically significant (P0.05). (9) the incidence of complications within 90 days after operation and readmission rate: the postoperative complications were classified by Dindo-Clavien classification, and the incidence of complications and re-entry in the ERAS group and the traditional treatment group within 90 days after operation. There was no significant difference in hospital rate between the two groups (P0.05). (10) TRD and postoperative hospitalization days. Total hospitalization cost: the hospitalization days of ERAS group were significantly shorter than that of the traditional treatment group after TRD, and the difference between the two groups was statistically significant (P0.05). The total hospitalization cost of the), ERAS group was significantly lower than that of the traditional treatment group (P0.05). Conclusion: the idea of ERAS can accelerate the rehabilitation process, reduce the stress response, shorten the hospitalization time and reduce the hospitalization cost in patients with large liver cancer. However, there was no significant difference in the incidence of postoperative complications between the ERAS group and the traditional management group. In short, the perioperative ERAS procedure was feasible, effective and safe in patients with large liver cancer.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7
本文編號(hào)：2285837
[Abstract]:Objective: to investigate and evaluate the feasibility, efficacy and safety of perioperative ERAS program in patients with large open liver cancer. Methods: 101 patients (58 males and 43 females) who underwent hepatectomy in our hospital from 01 August 2014 to 01 April 2017 in the affiliated Hospital of Southwest Medical University were selected. The patients were randomly divided into ERAS group and traditional perioperative management group. The ERAS group adopted the optimized treatment plan under the guidance of the idea of accelerated rehabilitation during the perioperative period, and the control group adopted the traditional treatment plan during the perioperative period. The two groups of patients were discharged to the same standard. According to the changes of stress index in perioperative period, the time of discharge, the time of hospitalization, the VAS score of postoperative pain, the recovery of gastrointestinal tract function, the time of keeping nasogastric tube. The time of indwelling celiac drainage tube and postoperative complications were compared and analyzed. Results: (1) basic data: age, sex, weight, height, hemoglobin before BMI, preoperative ASA grade before ALT, ECOG score before operation, BCLC grade before operation in both groups. There was no significant difference in preoperative Child-pugh grade of liver function (P0.05). (2). There was no significant difference in the type of intraoperative hepatectomy between the two groups (P0.05). (3). In the preoperative evaluation, the patients in the ERAS group were hungry. The incidence of thirst was significantly lower than that of the traditional perioperative management group (, (P value 0.001); ERAS), and the incidence of anxiety was lower than that of the traditional perioperative management group (P0. 05). (4). There was no significant difference in the first hepatic portal occlusion time and blood transfusion during the operation. (5) postoperative stress index: the level of CRP in the ERAS group was significantly lower than that in the traditional treatment group on the 1st day, 3th day after operation, and 5 days after operation. The difference between the two groups was statistically significant (P0.05). There was no significant difference in blood glucose between the two groups (P0.05). (6): there was no significant difference in VAS score between the two groups before and after 5 days (P0.05). The VAS score in the accelerated rehabilitation group was significantly lower than that in the traditional management group on the postoperative day and the 1st day after the operation (P0.05). There was significant difference between the two groups (P0.05). (7) postoperative extubation time: ERAS group patients after nasal and gastric tube, catheter, abdominal drainage tube extraction time was significantly shorter than the traditional management group. The difference between the two groups was statistically significant (P0.05). (8) postoperative rehabilitation: the ERAS group patients began to eat time after surgery, the time to get out of bed, postoperative anal exhaust time, postoperative anal defecation time was significantly shorter than the traditional treatment group. The difference between the two groups was statistically significant (P0.05). (9) the incidence of complications within 90 days after operation and readmission rate: the postoperative complications were classified by Dindo-Clavien classification, and the incidence of complications and re-entry in the ERAS group and the traditional treatment group within 90 days after operation. There was no significant difference in hospital rate between the two groups (P0.05). (10) TRD and postoperative hospitalization days. Total hospitalization cost: the hospitalization days of ERAS group were significantly shorter than that of the traditional treatment group after TRD, and the difference between the two groups was statistically significant (P0.05). The total hospitalization cost of the), ERAS group was significantly lower than that of the traditional treatment group (P0.05). Conclusion: the idea of ERAS can accelerate the rehabilitation process, reduce the stress response, shorten the hospitalization time and reduce the hospitalization cost in patients with large liver cancer. However, there was no significant difference in the incidence of postoperative complications between the ERAS group and the traditional management group. In short, the perioperative ERAS procedure was feasible, effective and safe in patients with large liver cancer.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7
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