摘要
目的评估加速康复外科(ERAS)策略在行胰十二指肠切除术患者围手术期中的安全性和有效性。方法选取2012年8月-2016年7月于吉林大学第一医院实施胰十二指肠切除术100例患者的临床资料。将患者按照不同的围手术期管理模式分为ERAS组(n=50)和对照组(n=50),其中对照组进行常规管理,ERAS组应用ERAS策略。比较两组患者病死率、并发症发生率、手术时间、进食情况、肠道功能、术后住院时间、住院费用、二次手术干预情况以及再次入院率等。计量资料两组比较采用t检验;计数资料2组比较采用χ~2检验或Fisher精确概率法。结果 3例患者术后死亡,其中对照组2例,ERAS组1例。两组患者病死率、再手术率及再入院率方面差异均无统计学意义(P值均> 0. 05)。ERAS组术后并发症发生率明显低于对照组(31. 0%vs 56. 3%,χ~2=5. 84,P=0. 016); ERAS组排气时间、进食时间、下地活动时间及拔除引流管时间均明显早于对照组(P值均<0. 001);两组总住院时间[(14. 3±1. 2) d vs (18. 5±1. 8) d,t=13. 73,P <0. 001]、总住院费用[(10. 7±1. 4)万元vs (13. 2±4. 1)万元,t=4. 08,P <0.001]比较,差异均有统计学意义。结论 ERAS策略能够在胰十二指肠切除术患者围手术期安全有效地实施,可明显降低患者住院费用、缩短住院时间,使患者围手术期管理统一化,减少临床变异,从而最终实现患者快速康复,值得推广。
Objective To investigate the clinical effect and safety of the enhanced recovery after surgery (ERAS) strategy in the perioperative period of pancreaticoduodenectomy (PD). Methods A retrospective analysis was performed for the clinical data of 100 patients who underwent PD in The First Hospital of Jilin University from August 2012 to July 2016. The patients were divided into ERAS group and control group according to the management mode during the perioperative period,with 50 patients in each group. The patients in the control group were given routine management,and those in the ERAS group were given ERAS management. The two groups were compared in terms of mortality rate,incidence rate of complications,time of operation,diet,intestinal function,length of postoperative hospital stay,hospital costs,secondary surgical intervention,and readmission rate. The t -test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. Results Two patients in the control group and one in the ERAS group died after surgery. There were no significant differences in mortality,reoperation,and readmission rates between the two groups (all P >0.05). Compared with the control group,the ERAS group had a significantly lower incidence rate of complications (31.0% vs 56.3%,χ^2=5.84,P =0.016) and significantly shorter time to first flatus,time to diet,time to ambulation,and time to removal of drainage tube and other tubes (all P <0.001). There were significant differences between the ERAS group and the control group in length of hospital stay (14.3±1.2 d vs 18.5±1.8 d,t=13.73,P <0.001) and total hospital costs [10.7±1.4 ten thousand yuan vs 13.2±4.1 ten thousand yuan,t=4.08,P <0.001]. Conclusion The ERAS strategy is safe and effective in the perioperative period of PD and can significantly reduce hospital costs,shorten the length of hospital stay,standardize perioperative management,diminish clinical variability,and thus help patients to achieve enhanced recovery. Therefore,it holds promise for clinical application.
作者
纪柏
刘松阳
张威
王英超
刘亚辉
JI Bai;LIU Songyang;ZHANG Wei(Second Department of Hepatopancreatobiliary Surgery,The First Hospital of Jilin University,Changchun 130021,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2019年第5期1032-1036,共5页
Journal of Clinical Hepatology
基金
国家自然科学基金项目(81802805)
关键词
胰十二指肠切除术
加速康复外科
围手术期医护
pancreaticoduodenectomy
enhanced recovery after surgery
perioperative care
