摘要
目的探讨行腹腔镜胆总管探查取石伴T管引流术病人在围手术期应用加速术后康复(enhanced recovery after surgery,ERAS)的疗效及影响因素分析。方法回顾性分析在2019年9月至2021年9月在湖北医药学院附属人民医院确诊为胆总管结石并行腹腔镜下胆总管探查取石伴T管引流术的病人,在其中选取100例病人纳入研究,按照其围手术期处理措施分成研究组(ERAS组,52例)和对照组(传统外科护理组,48例),比较两组病人的手术治疗情况、术后并发症发生情况以及手术前后相关实验室指标的变化情况,并将研究组根据术后住院时间中位数分为两组,≤7 d为A组(32例),>7 d为B组(20例),通过单因素及多因素分析影响完成ERAS的相关因素。结果研究组与对照组基线资料之间具有可比性。研究组在术后引流管拔除时间、术后下床时间、术后肛门排气时间、术后总输液量、住院时间、住院费用、术前禁食水时间、术后禁食水时间、夜晚睡眠时间、术后第一次疼痛评分、出院满意度评分指标上均优于对照组,差异均有统计学意义(均P<0.05);研究组在胆漏发生情况上明显少于对照组,差异有统计学意义(P<0.05);研究组术后直接胆红素较术前下降幅度明显大于对照组,白蛋白较术前下降幅度明显小于对照组,差异均有统计学意义(均P<0.05)。单因素分析显示,A组与B组在年龄、术后肛门排气时间、夜晚睡眠时间方面差异均有统计学意义(P值分别为0.001,0.015,0.005);多因素分析显示,A组与B组在术后肛门排气时间[OR=1.447,95%CI(1.024,2.045),P=0.036]、夜晚睡眠时间[OR=0.016,95%CI(0.001,0.332),P=0.007]方面差异均有统计学意义,为实施ERAS的影响因素。结论ERAS可以提高行腹腔镜胆总管探查取石伴T管引流术病人围手术期的恢复,提高术后生活质量,减轻病人经济负担。
Objective To explore the efficacy and influencing factors of enhanced recovery after surgery(ERAS)in patients undergoing laparoscopic common bile duct exploration and T-tube drainage.Methods From September 2019 to September 2021,retrospective analysis was performed for 100 patients of common bile duct stones at Affiliated People's Hospital of Hubei Medical College.Laparoscopic common bile duct exploration and T-tube drainage were performed.Based upon perioperative measures,they were divided into experimental group(postoperative enhanced recovery,n=52)and control group(traditional surgical nursing,n=48).Two groups were compared in terms of surgical outcomes and postoperative complications.According to the changes of parameters,group A(n=32)had postoperative hospital stay≤7 days and group B(n=20)>7 days.Univariate and multivariate analyses were utilized for examining the effects of ERAS.Results Baseline data of both groups were comparable.In experimental group,postoperative drainage tube removal time,postoperative out-of-bed time,postoperative exhaust time total postoperative infusion volume,length of hospital stay,hospitalization expenses,postoperative stopping infusion time,postoperative fasting time,preoperative fasting time,night sleep time and initial postoperative pain score and discharge satisfaction scores were all better than those in control group(P<0.05).The incidence of bile leakage was significantly lower in experimental group than that in control group(P<0.05).A reduction of direct bilirubin was significantly greater in experimental group than that in control group and a decline of albumin was significantly less than that in control group(P<0.05).Univariate analysis revealed statistically significant inter-group differences in age,postoperative exhaust time and night sleep time(P=0.001,0.015,0.005).And multivariate analysis indicated that postoperative exhaust time(OR=1.447,95%CI:1.024-2.045,P=0.036)and night sleep time(OR=0.016,95%CI:0.001-0.332,P=0.007)were influencing factor for implementing ERAS.And inter-group difference was statistically significant.Conclusion ERAS measures can improve perioperative recovery of patients after laparoscopic common bile duct exploration and lithotomy with T-tube drainage.It boosts the postoperative quality-of-life and lowers the economic burden of patients.
作者
关惠元
涂华华
封彦青
刘书铭
蔡庆和
Guan Huiyuan;Tu Huahua;Feng Yanqing;Liu Shuming;Cai Qinghe(Postgraduate Training Base,Affiliated People's Hospital,Hubei Medical College,Jinzhou Medical University,Hubei Shiyan 442000,China;Department of Hepatobiliary&Pancreatic Surgery,Affiliated Shiyan People's Hospital,Hubei Medical College,Hubei Shiyan 442000,China)
出处
《腹部外科》
2023年第2期128-133,共6页
Journal of Abdominal Surgery
关键词
加速术后康复
胆总管结石
腹腔镜手术
疗效分析
Enhanced recovery after surgery
Choledocholithiasis
Laparoscopy
Curative effect analysis
作者简介
关惠元,硕士研究生在读,主要从事肝胆外科临床方面的研究,Email:3218877536@qq.com;通信作者:蔡庆和,Email:316738720@qq.com。
