加速康复外科减少胃癌患者术后重症监护病房住院时间的临床观察

doi:10.6040/j.issn.1671-7554.0.2018.757

摘要/Abstract

摘要： 目的观察加速康复外科(ERAS)缩短胃癌患者术后重症监护病房(ICU)住院时间的安全性与有效性。方法回顾性分析2017年1月至6月在南京大学医学院附属金陵医院行胃癌D2根治术患者80例。根据围手术期是否采用加速康复外科理念分为ERAS组和传统组,两组各40例。比较两组患者在术后ICU病房停留时间、术后住院天数(ICU住院天数加上普通病房住院天数)、术后首次通气时间、术后首次下床时间、术后第1天视觉模拟评分(VAS)以及术后并发症发生率。结果 ERAS组胃癌患者术后重症监护病房住院时间明显短于传统组［(0.65±0.53)d vs(1.93±1.59)d, Z=4.938, P<0.001］;ERAS组术后住院时间也明显短于传统组［(6.23±4.67)d vs(8.55±4.51)d, Z=4.529, P<0.001］;ERAS组术后首次通气时间、术后首次下床时间短于传统组［(38.73±6.81)h vs(59.90±12.71)h, t=8.848, P<0.001］、［(14.63±3.98)h vs(23.68±4.51 )h, t=9.519, P<0.001］;另外ERAS组术后第1天VAS评分低于传统组［(2.33±0.73)vs(4.33±0.76), t=11.970, P<0.001］,两组术后并发症发生率差异并无统计学意义,分别为12.5% vs 22.5%(χ2=1.385, P=0.378)。结论加速康复外科缩短了胃癌术后重症监护病房住院时间,减少了手术应激,并没有增加术后并发症发生率,节省了医疗资源。

关键词: 加速康复外科, 重症监护病房, 胃癌, 住院时间

Abstract: Objective To observe the safety and effectiveness of enhanced recovery after surgery(ERAS)to shorten the time of stay in the intensive care unit(ICU)for patients with gastric cancer. Methods In the retrospective study, 80 cases of gastric cancer undergoing D2 radical resection in our hospital during Jan. and Jun. 2017, were divided into the ERAS group and traditional group, 40 cases in each group. The duration of stay in the ICU, hospitalization days(ICU plus general ward hospitalization days), time of bowel function recovery and early mobilization, VAS score of the first day after surgery, and the incidence of postoperative complications were compared between the two groups. Results Compared with the traditional group, the ERAS group needed shorter duration of stay in the ICU［(0.65±0.53)d vs(1.93±1.59)d, Z=4.938, P<0.001］, shorter length of postoperative hospital stay［(6.23±4.67)d vs(8.55±4.51)d, Z=4.529, P<0.001］; shorter time of bowel function recovery and early mobilization［(38.73±6.81)h vs(59.90±12.71)h, t=8.848, P<0.001］,［(14.63±3.981)h vs(23.68±4.51)h, t= 9.519, P<0.001 ］, and had lower VAS score on the 1st day after operation［(2.33±0.73)vs(4.33±0.76), t=11.970, P<0.001 ］. However, 山东大学学报 (医学版)57卷9期 -房鹏,等.加速康复外科减少胃癌患者术后重症监护病房住院时间的临床观察 \=-there was no difference in the incidence of postoperative complications(12.5% vs 22.5%, χ2 =1.385, P=0.378). Conclusion Enhanced recovery after surgery shortens the time of stay in the intensive care unit, reduces surgical stress in patients, and saves medical resources. Meanwhile, it does not increase postoperative complication rate.

Key words: Enhanced recovery after surgey, Intensive care unit, Gastric cancer, Hospitlization days

中图分类号:

R619

房鹏,王刚,赵健,刘江,王海锋,周嘉晖,江志伟. 加速康复外科减少胃癌患者术后重症监护病房住院时间的临床观察[J]. 山东大学学报 (医学版), 2019, 57(9): 28-32.

FANG Peng, WANG Gang, ZHAO Jian, LIU Jiang, WANG Haifeng, ZHOU Jiahui, JIANG Zhiwei. Clinical observation of enhanced recovery after surgery to reduce the time of stay in the intensive care unit for patients with gastric cancer[J]. Journal of Shandong University (Health Sciences), 2019, 57(9): 28-32.

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