快速康复外科理念在ERCP治疗胆总管结石中的应用

发布时间：2018-05-26 03:41

本文选题：快速康复外科 + 经内镜逆行胰胆管造影　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:本次研究将快速康复外科(ERAS)理念完整的应用于经内镜逆行胰胆管造影(ERCP)治疗胆总管结石的围手术期管理中,并做出了更加符合ERCP特色调整,研究ERAS理念在ERCP治疗胆总管结石中的应用价值。探讨将快速康复外科理念应用于ERCP患者围手术期是否安全可行,能否增加患者的舒适度、加速患者的康复并减少住院费用。方法:收集吉林大学中日联谊医院胃肠内科-内镜中心2015年12月-2017年1月采用ERCP治疗胆总管结石的患者,根据纳入标准共有70例患者符合,将其随机分为两组,并按围手术期处理措施是否采用快速康复外科理念将两组分别定义为快速康复组(32例)和对照组(38例)。比较两组患者术后出现口渴饥饿感、恶心呕吐、腹痛的情况;术后血清淀粉酶、白细胞计数、并发症发生情况;进食时间、开始活动时间、住院时间及住院费用的差异。计数资料采用(?)~2检验进行比较,正态分布的计量资料以均数±标准差(`X±S)表示,两组之间的比较应用独立样本t检验。结果:ERAS组术后口渴饥饿感、恶心呕吐及腹痛的发生率明显低于对照组,差异均具有统计学意义(P0.05);在术后4小时和24小时血清淀粉酶、术后24小时白细胞计数及并发症(胰腺炎、胆管炎、出血、穿孔)发生率的比较上,两组间差异均不具有统计学意义(P0.05);与对照组相比,ERAS组进食时间及开始活动时间更早,住院时间更短,住院费用更低,差异具有统计学意义(P0.05)。结论:1.快速康复外科理念应用于ERCP围手术期处理是安全可行的;2.快速康复外科理念可以明显减少患者ERCP术后口渴饥饿、恶心呕吐、腹痛等不适情况的发生,增加了患者的舒适度;3.快速康复外科理念可以使患者在ERCP术后更早进食和活动,并缩短了住院时间,减少了住院费用,加速了患者康复。
[Abstract]:Objective: to apply the concept of rapid rehabilitation surgery (ERAS) to the management of the perioperative management of choledocholithiasis by endoscopic retrograde cholangiopancreatography (ERCP), and make a more consistent with the ERCP characteristic adjustment, study the application value of ERAS concept in the treatment of choledocholithiasis by ERCP, and discuss the application of the concept of rapid rehabilitation surgery to E. Whether the perioperative period of RCP patients is safe and feasible, can increase the patient's comfort, accelerate the recovery and reduce the cost of hospitalization. Method: collect the patients with choledocholithiasis by ERCP in December 2015 -2017 year of the gastroenterology center of Jilin University Sino Japanese Friendship Hospital, in January year. The machine was divided into two groups, and the two groups were defined as rapid rehabilitation group (32 cases) and control group (38 cases) according to the concept of rapid rehabilitation surgery in the perioperative treatment measures. The thirst, nausea and vomiting, abdominal pain in the two groups were compared, and the serum amylase, white blood cell count, complications, feeding time, opening time after operation in the two groups were compared. The difference between the time of initial activity, the time of hospitalization and the cost of hospitalization. The count data were compared with the (?) ~2 test. The measurement data of the normal distribution were expressed with mean standard deviation (`X + S). The comparison of the two groups was compared with the independent sample t test. Results: the incidence of thirst and hunger, nausea and vomiting and abdominal pain in the ERAS group were significantly lower than that of the control group. The difference was statistically significant (P0.05); the difference between the two groups was not statistically significant (P0.05) in the comparison of the incidence of leukocyte count and complications (pancreatitis, cholangitis, bleeding and perforation) at 4 hours and 24 hours postoperatively, 24 hours after the operation and complications (pancreatitis, cholangitis, bleeding and perforation). Compared with the control group, the time of feeding and beginning of activity in the ERAS group were earlier, and the hospitalization was more than that of the control group. The time is shorter, the cost of hospitalization is lower and the difference is statistically significant (P0.05). Conclusion: 1. the concept of rapid rehabilitation surgery is safe and feasible for the perioperative management of ERCP; the concept of rapid rehabilitation surgery can significantly reduce the incidence of thirst, nausea, vomiting and abdominal pain after ERCP, and increase the comfort of the patients; 3. The concept of fast track surgery can enable patients to eat and exercise early after ERCP, shorten the length of stay, reduce hospitalization expenses and speed up the recovery of patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.42

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