急腹症围手术期营养支持治疗在加速康复中的作用

发布时间：2018-06-05 23:08

本文选题：营养支持治疗 + 围手术期　；参考：《郑州大学》2017年硕士论文

【摘要】：背景和目的加速康复外科(enhanced recovery after surgery,ERAS),是近二十年发展的外科理念,通过简化和改进围手术期有关措施,以减少手术及相关措施对机体的应激为基本理念,达到使机体的生理功能维持稳定的目的,从而使机体迅速从被手术扰乱的状态恢复过来,减少并发症,缩短术后康复时间。需急诊手术的外科急腹症患者,由于疾病本身造成的进食障碍,应激反应,加之手术创伤、术后禁食等因素,多合并严重营养不良或有潜在的营养风险,从而导致住院时间延长、并发症多以及病程恢复缓慢等特点,使预后差。营养状况与术后患者的病死率和并发症发生率有着密切的关系,对营养不良或有营养风险患者进行合理的临床营养支持可改善其术后临床结局,如减少并发症,缩短住院时间等。本研究旨在探讨ERAS理念下围手术期营养支持与传统围手术期管理相比,对急腹症患者营养状态及临床结局改善的意义。方法按照连续采样的方法选取2015年3月至2016年3月于郑州大学第一附属医院急诊外科行急诊手术的急腹症490例纳入研究,按病种分类,各类患者按简单随机法随机分为两组,即加速康复外科组(ERAS组)及传统围手术期管理(conservative perioperative management,CPM)组(CPM组),其中ERAS组(287例)接受加速康复策略进行围手术期管理,CPM组(203例)按传统围手术期管理方法治疗。比较两组患者相关生化指标和临床指标。统计处理采用SPSS 21.0进行统计分析,计量资料用均数±标准差(?x±s)表示,计量资料的组间、组内比较采用t检验,重复测量资料组间比较采用方差分析,组间率的比较采用χ2检验,等级资料组间比较采用秩和检验,以P0.05为差异有统计学意义。结果两组患者性别构成、年龄差异无统计学意义(P0.05),疾病构成、术前营养状况、手术方式亦无统计学意义(P0.05)。与CPM组比较,ERAS组患者术后血浆白蛋白、前白蛋白水平明显改善(P0.05),术后肠功能恢复时间缩短,术后并发症发生率降低,住院时间缩短(P0.05),术后WHO疼痛分级降低(P0.05)。结论行急诊手术的急腹症患者通过加速康复外科理论下的围手术期营养支持,可有效改善患者营养状态,加速术后康复,减少并发症,缩短住院时间,优化临床结局。
[Abstract]:Background and objective to accelerate the enhancement of recovery after Surgeryeras in rehabilitation surgery is a surgical concept developed in the last two decades. By simplifying and improving the relevant measures during the perioperative period, the basic idea is to reduce the stress caused by surgery and related measures. The aim is to keep the physiological function of the body stable, so that the body can recover quickly from the disturbed state of operation, reduce the complications and shorten the time of postoperative rehabilitation. Surgical acute abdomen patients who need emergency surgery, due to eating disorders, stress reactions, surgical trauma, postoperative fasting and other factors caused by the disease itself, are often associated with severe malnutrition or have a potential nutritional risk. The result of prolonged hospitalization, more complications and slow recovery of the course of disease and so on, make the prognosis poor. Nutritional status is closely related to the mortality and complication rate of postoperative patients. Proper clinical nutritional support for patients with malnutrition or nutritional risk can improve the postoperative clinical outcome, such as reducing complications. Shorten the length of stay in hospital, etc. The purpose of this study was to explore the significance of perioperative nutritional support in improving the nutritional status and clinical outcome of patients with acute abdomen compared with traditional perioperative management under the concept of ERAS. Methods from March 2015 to March 2016, 490 patients with acute abdomen undergoing emergency surgery in the first affiliated Hospital of Zhengzhou University were selected according to the method of continuous sampling. The patients were randomly divided into two groups according to the type of disease. ERAs group and traditional perioperative management group (ERAS group, 287 cases) received accelerated rehabilitation strategy for perioperative management, 203 cases were treated with traditional perioperative management method. The related biochemical indexes and clinical indexes were compared between the two groups. SPSS 21.0 was used for statistical analysis. The measurement data were expressed as mean 卤standard deviation. T test was used for intra-group comparison of measurement data, analysis of variance was used for comparison of repeated measurement data, and 蠂 2 test was used for comparison of rate between groups. Rank sum test was used to compare the grade data between groups, with P0.05 as the difference was statistically significant. Results there was no significant difference in sex and age between the two groups (P 0.05). The constitution of the disease, the nutritional status before operation and the operation mode were not statistically significant (P 0.05). Compared with CPM group, the plasma albumin and prealbumin level in ERAS group were significantly improved (P 0.05), the recovery time of intestinal function was shortened, the incidence of postoperative complications was decreased, the hospitalization time was shortened and the postoperative WHO pain grade was decreased (P 0.05). Conclusion the patients with acute abdomen undergoing emergency surgery can effectively improve their nutritional status, accelerate postoperative rehabilitation, reduce complications, shorten hospital stay and optimize clinical outcomes by accelerating the perioperative nutritional support under the theory of rehabilitation surgery.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.1

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