加速康复外科技术在腹腔镜胆囊切除术患者中的应用价值研究

发布时间：2018-04-26 10:28

本文选题：胆囊切除术 + 腹腔镜　；参考：《中国全科医学》2017年24期

【摘要】：目的观察加速康复外科(ERAS)技术对腹腔镜胆囊切除术患者负性情绪、营养指标及预后的影响,以期为ERAS技术在腹腔镜胆囊切除术患者中的应用提供理论依据。方法选取2014年5月—2016年5月在兰州市第二人民医院普外科住院行腹腔镜胆囊切除术的患者500例为研究对象。按照围术期诊治措施的不同,将患者分为ERAS组(250例,采用ERAS技术)和对照组(250例,采用传统方法)。记录两组患者入院时、术前1 h、术后24 h及术后48 h负性情绪得分、营养指标[前清蛋白(PA)、清蛋白(ALB)、尿素氮(BUN)、血浆游离氨基酸(PFAA)水平],预后指标[术后恢复情况(肠鸣音恢复时间、排气时间、排便时间)、并发症(胆囊窝积液、胆漏、术后出血、腹腔感染)发生情况、住院时间及住院费用]。结果治疗方法与时间在负性情绪得分上存在交互作用(P0.05);治疗方法、时间在负性情绪得分上主效应显著(P0.05);ERAS组术前1 h、术后24 h、术后48 h负性情绪得分低于对照组(P0.05)。治疗方法与时间在PA、ALB、BUN、PFAA水平上存在交互作用(P0.05);治疗方法、时间在PA、ALB、BUN、PFAA水平上主效应显著(P0.05);ERAS组术后24 h、术后48 h PA、ALB、BUN、PFAA水平高于对照组(P0.05)。ERAS组患者肠鸣音恢复时间、排气时间、排便时间均短于对照组(P0.05)。ERAS组住院时间短于对照组,住院费用低于对照组(P0.05)。结论 ERAS技术有助于缓解患者的负性情绪,改善营养状态,加快患者康复,进而缩短住院时间,减少医疗费用。
[Abstract]:Objective to observe the effect of accelerated rehabilitation surgery on negative emotion, nutritional index and prognosis in patients undergoing laparoscopic cholecystectomy, and to provide theoretical basis for the application of ERAS technique in laparoscopic cholecystectomy. Methods from May 2014 to May 2016, 500 patients who underwent laparoscopic cholecystectomy in general surgery department of Lanzhou second people's Hospital were selected as study objects. According to the difference of perioperative diagnosis and treatment, the patients were divided into ERAS group (250 cases) and control group (250 cases) and control group (250 cases). The scores of negative emotion at admission, 1 hour before operation, 24 hours after operation and 48 hours after operation were recorded. Nutritional index [Pablo, ALBN, urea nitrogen bun, plasma free amino acid, PFAA], prognostic index [recovery after operation (recovery time of bowel sound, time of exhaust, time of defecation, complications (accumulation of gallbladder fossa, bile leakage, postoperative hemorrhage), The incidence of abdominal infection, the duration of hospitalization and the cost of hospitalization]. Results there was an interaction between treatment method and time in negative emotion score (P 0.05), and the main effect of time on negative emotion score was significantly lower in ERAS group than that in control group at 1 hour before operation, 24 hours after operation and 48 hours after operation, which was significantly lower than that in control group (P 0.05). There was an interaction between the treatment method and time at the level of PFAA of PAA ALB BUNN PFAA, and the main effect of treatment method was significant at the level of PAALBU BUNPFAA at 24 h after operation, and 48 h after operation, the level of BUNPFAA was higher than that of the control group (P0.05). The time of bowel sound recovery and the time of venting, and the time of venting were significantly higher in the treatment group than those in the control group (P 0.05). The time of defecation was shorter than that of control group (P 0.05). The hospitalization time of ERAS group was shorter than that of control group, and the hospitalization cost was lower than that of control group (P 0.05). Conclusion ERAS technique can relieve the negative emotion, improve the nutritional status, accelerate the recovery of patients, shorten the hospitalization time and reduce the cost of medical treatment.
【作者单位】：甘肃省兰州市第二人民医院功能科;甘肃省兰州市第二人民医院普外科;甘肃省人民医院普外科;
【基金】：甘肃省自然科学基金资助项目(145RJZA057) 兰州市人才创新创业项目(2015-RC-17)
【分类号】：R657.4

【参考文献】