加速康复外科在肝脏切除术围手术期应用的临床研究

发布时间：2018-03-21 05:49

本文选题：加速康复外科　切入点：肝切除术　出处：《兰州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:加速康复外科是外科技术和麻醉方法经过长时间发展后应运而生的新兴学科,应用低损伤的手术方法和设备结合疼痛控制,通过减少患者的应激反应达到住院时间的减少。加速康复外科的顺利实施,首先需要患者及家属经过合理适度的宣教培训,更需要外科、护理、麻醉科、ICU的通力合作。目的:通过加速康复外科组与普通治疗组临床效果指标的对比,进行研究和评价,探讨两者术中方便快速程度及术后恢复的优劣,为肝脏切除手术围术期的治疗措施选择提供理论依据与经验支持。方法:选取兰州大学第一医院自2015年6月份至2016年6月份入院的部分医疗组的肝脏疾病患者作为加速康复外科实验组,选取2015年6月份至2016年6月份入院的部分医疗组的肝脏疾病患者作为对照组,其中加速康复外科组(实验组)共计病例36例,传统治疗组(对照组)共计病例42例,对比加速康复外科与传统治疗方案组在肝脏切除手术后肝功能恢复情况、术中出血量、手术时间、术后首次排气时间、术后拔除腹腔引流管时间,住院时间、患者满意度等疾病经济负担等指标。结果:加速康复外科组和对照组手术时间分别为(152.30±24.14)min和(148.86±20.55)min,两组差异无统计学意义(P0.05)。加速康复外科组术中出血量为(345.44±135.154)ml,肠道首次通气时间为(2.75±0.92)天,术后拔出引流管时间为(4.06±1.14)天,术后3天谷丙转氨酶为(65.61±32.81)IU/L,总胆红素为(21.28±6.21)umol/L,前白蛋白为(145.08±8.00)mg/L,出院时体重降低(1.53±0.71)kg,住院时间为(9.28±2.95)d、术后并发症发生率为5.56%(2/36),住院费用为(49123.25±345.78)元,对照组相应指标分别为(475.61±136.83)ml,(3.19±0.99)天,(5.38±1.19)天,(163.76±35.58)IU/L,(31.38±7.18)umol/L,(97.00±7.13)mg/L,(2.86±0.32)kg,(12.17±2.78)d、16.67%(7/42),(56321.09±768.08)元,两组差异均有统计学意义(P0.05或0.01)。结论:加速康复外科理论用于需行肝切除术的患者,加速了患者术后肝功能恢复,减少了术中出血量,术后首次排气时间明显缩短、术后拔除腹腔引流管时间明显缩短,缩短了住院时间、提高了患者满意度等方面取得了明显优势,达到了加速康复的目的。
[Abstract]:Background: accelerated rehabilitation surgery is a new subject of surgical techniques and anaesthesia developed over a long period of time. It uses low-injury surgical methods and equipment to control pain. To accelerate the successful implementation of rehabilitation surgery, it is necessary for patients and their families to undergo reasonable and moderate education and training, but also for surgery and nursing. Objective: to study and evaluate the clinical effect indexes of accelerated rehabilitation surgery group and general treatment group, and to explore the advantages and disadvantages of the two groups in the quick and convenient operation and the recovery after operation. To provide theoretical basis and empirical support for the choice of perioperative treatment measures for hepatectomy. Methods: selected patients with liver diseases who were admitted to the first Hospital of Lanzhou University from June 2015 to June 2016. In order to accelerate the rehabilitation surgery experimental group, From June 2015 to June 2016, some patients with liver diseases were selected as control group, including 36 cases of accelerated rehabilitation surgery group (experimental group) and 42 cases of traditional treatment group (control group). The recovery of liver function, the amount of intraoperative bleeding, the time of operation, the time of first exhaust after operation, the time of extubation of abdominal cavity and the time of hospitalization were compared between the group of accelerated rehabilitation surgery and the group of traditional treatment. Results: the operative time of accelerated rehabilitation surgery group and control group were 152.30 卤24.14 min and 148.86 卤20.55 min, respectively. There was no significant difference between the two groups (P 0.05). The intraoperative blood loss was 345.44 卤135.154ml in the accelerated rehabilitation surgery group, and the first ventilation time was 2.75 卤0.92days in the accelerated rehabilitation surgery group. The time of pulling out the drainage tube was 4.06 卤1.14 days, the total bilirubin was 21.28 卤6.21 渭 mol / L, the total bilirubin was 21.28 卤6.21 渭 mol / L, the body weight decreased 1.53 卤0.71 mg / L, the hospitalization time was 9.28 卤2.95 / d, the incidence of postoperative complications was 5.56123.25 卤345.78 yuan. The corresponding indexes of the control group were 475.61 卤136.83ml / L (3.19 卤0.99) days 5.38 卤1.19) days, 163.76 卤35.58IUP / L = 31.38 卤7.18umolol / L = 97.00 卤7.13mg / L / L = 97.00 卤7.13mg / L / L = 12.86 卤2.78dg / L = 12.17 卤2.78dg / L respectively. There was a significant difference between the two groups (P0.05 or 0.01.08). Conclusion: the theory of accelerated rehabilitation surgery can accelerate the recovery of liver function and reduce the blood loss during operation. The first time of exhaust after operation was shortened obviously, the time of extubation of abdominal cavity drainage tube was shortened obviously, the time of hospitalization was shortened, the satisfaction of patients was improved, and the purpose of accelerating rehabilitation was achieved.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3

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