加速康复外科在肝切除术治疗肝胆管结石病的临床应用

发布时间：2018-04-24 03:34

  本文选题：肝胆管结石 + 加速康复外科　； 参考：《南昌大学》2017年硕士论文

【摘要】：目的:探讨加速康复外科(ERAS)在肝切除术治疗肝胆管结石病围手术期的临床应用价值。方法:本文分析2014年12月-2016年5月南昌大学第二附属医院肝胆外科81例肝胆管结石患者,所有病人均行肝部分切除术,围手术期严格按照ERAS理念管理的36例患者作为ERAS组,按照传统模式管理的45例患者作为对照组,比较两组患者术后疼痛评分、围手术期炎性介质变化、术后临床指标以及术后并发症等情况。结果:ERAS组在术后疼痛评分明显低于对照组(P0.05),ERAS组患者术后1、4、7d降钙素原(PCT)水平分别为(2.60±0.46)ng/ml(2.11±1.17)ng/ml(1.04±0.56)ng/ml,对照组分别为(3.78±0.83)ng/ml(2.98±1.73)ng/ml(2.06±0.83)ng/ml,两组比较,差异有统计学意义(P0.05),ERAS组患者术后1、4、7d白介素-6(IL-6)分别是(128.49±15.17)pg/ml(87.93±10.33)pg/ml(33.76±7.54)pg/ml,对照组分别为(264.77±18.25)pg/ml(195.29±12.71)pg/ml(95.39±10.88)pg/ml两组比较,差异有统计学意义(P0.05),ERAS组患者术后1、4、7d C反应蛋白(CRP)分别是(40.35±9.78)mg/L(67.24±6.44)mg/L(32.19±5.35)mg/L对照组分别为(58.36±13.22)mg/L(100.54±10.77)mg/L(50.63±8.72)mg/L两组比较,差异有统计学意义(P0.05),ERAS组术后肛门排气时间明显缩短[(34.4±8.7)h比(57.7±11.8)h,P0.05],术后住院时间明显缩短[(8.4±2.5)d比(11.6±3.3)d,P0.05],而切口感染、胆漏、膈下脓肿、腹胀等术后常见并发症发生率并未增高(P0.05)。结论:加速康复外科(ERAS)理念应用于肝切除术治疗肝胆管结石病的围手术期管理,可以减轻患者术后疼痛、降低围手术期应激反应、缩短术后肛门排气时间、缩短住院时间,有利于患者快速康复。
[Abstract]:Objective: to evaluate the clinical value of accelerated rehabilitation surgery (ERASS) in the perioperative period of hepatectomy for hepatolithiasis. Methods: a total of 81 patients with hepatolithiasis in the second affiliated Hospital of Nanchang University from December 2014 to May 2016 were analyzed. All patients underwent partial hepatectomy. 36 patients who were managed strictly according to the concept of ERAS during the perioperative period were selected as ERAS group. According to the traditional management of 45 patients as the control group, the postoperative pain score, perioperative inflammatory media changes, postoperative clinical indicators and postoperative complications were compared between the two groups. Results the pain score of the control group was significantly lower than that of the control group (P 0.05). Results the levels of procalcitonin protopril were 2.60 卤0.46)ng/ml(2.11 卤1.17)ng/ml(1.04 卤0.56 ng / ml in the control group and 3.78 卤0.83)ng/ml(2.98 卤0.83 0.83)ng/ml(2.98 卤0.83 ng / ml in the control group, respectively. 宸�寮傛湁缁熻�″�︽剰涔�(P0.05),ERAS缁勬偅鑰呮湳鍚，

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