Application of enhanced recovery after surgery in laparoscopic cholecystectomy of elderly patients
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摘要:
目的 探讨加速康复外科理念在老年患者腹腔镜胆囊切除中的优势及安全性。 方法 随机选择2013年6月~2016年6月在解放军总院海南分院肝胆外科住院接受腹腔镜胆囊切除的老年患者80例，分为ERAS组及对照组，每组40例。ERAS组采用加速康复围术期干预措施，对照组采用传统的围术期方法。分析比较两组患者术后住院时间、住院费用及术后并发症等。 结果 加速康复组与传统方法组比较，可更好地缩短住院时间（P<0.05）、降低住院费用（P<0.05），减轻患者术后并发症的发生（P<0.05）。 结论 加速康复外科治疗措施在老年患者腹腔镜胆囊切除术中应用是安全、有效、经济的围手术期处理方案。 Abstract:Objective To evaluate the prognosis of enhanced recovery after surgery (ERAS) on senile patient after laparoscopic cholecystectomy. Methods Eighty senile patients underwent laparoscopic cholecystectomy from June 2013 to June 2016 in our department were included and divided into conventional care group (n=40) and ERAS group (n=40). Statistics, including postoperative hospital stay, hospitalization expenses and postoperative complication were recorded and comparatively analyzed.. Results Compared with conventional care group, the ERAS group spent significantly shorter postoperative hospital stay (P<0.05), less medical cost (P<0.05) and underwent fewer postoperative complications (P<0.05). Conclusion The enhanced recovery measure is a safe, effective and economical treatment scheme for senile patients during the perioperative period of laparoscopic cholecystectomy. -
表 1 两组围手术期处理方案
方案 ERAS组 对照组 术前策略 术前宣教 详细介绍康复计划 常规谈话，告知手术风险 树立信心、缓解焦虑 禁食水 禁食6 h，禁水2 h， 禁食12 h，禁水6 h 术前2 h口服5%葡萄糖250 mL 肠道准备 无常规肠道准备 清洁肠道 胃管及尿管不常规留置 常规留置 术中策略 术中操作 三孔法、操作规范、细致 无严格要求 术中输液 限制性输液， 无严格要求 术后第1天停止输液 术中体温 避免低体温 同前 腹腔引流管 常规不留置 视术中情况是否留置 抗生素术使用 术前30 min预防使用 同前 术后策略 镇痛 个体化、多模式镇痛（NSAIDs药物） 静脉自控镇痛泵 进食水 术后6 h进水，术后1天 排气后方可进食水 进流食、逐步过渡普食 活动 术后6 h床上活动 无具体要求 术后1天鼓励患者下床活动 
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表 2 两组术后康复情况比较（n=40，Mean±SD）
组别 首次进食时间（h） 排气时间（h） 首次下床活动时间（h） 术后住院时间（d） 住院总费用（元） ERAS组 6.0±1.2 28.0±12.4 5.8±1.4 1.6±0.4 11318.4±2018.3 对照组 24±5.6 42.2±15.6 12.6±2.4 3.5±1.2 14328.6±1823.7 P <0.05 <0.05 <0.05 <0.05 <0.05
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表 3 两组术后并发症比较（n=40，Mean±SD）
切口疼痛 恶心、呕吐 肺部感染 腹腔出血、胆漏 ALT（U/L） WBC（×109/L） ERAS组 4 2 1 0 45±10 7.6±1.2 对照组 36 28 10 0 56±11 9.4±1.8 P <0.01 <0.01 <0.05 >0.05 >0.05 >0.05
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