加速康复外科在腹腔镜袖状胃切除术围手术期的应用

目的探讨术后加速康复外科(enhanced recovery after surgery，ERAS)、疼痛管理在腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy，LSG)围手术期的临床应用效果。 方法回顾性分析2013年1月至2018年1月在首都医科大学附属北京世纪坛医院行LSG的300例患者资料，分别采用ERAS、疼痛管理，注重术前宣教和呼吸功能训练，术中行切割线浆肌层包埋，术中腹壁切口部位行局部浸润麻醉，术后不留置胃管、尿管及腹腔引流管，术后合理镇痛，早期进食和活动。统计患者在平均住院时间、术后疼痛(数字疼痛评分表，numerical rating scale，NRS)评分、术后进食时间及术后下床活动时间的差异，分析讨论目前实施ERAS的优点和存在问题。 结果ERAS组术后平均住院时间短(1.5±0.8)d vs (2.7±0.8)d，P<0.05]；无严重并发症发生；术后疼痛NRS评分低于传统组(P<0.05)；术后下床活动时间早。 结论在减重与代谢手术的围手术期措施中，实施ERAS可显著缩短住院时间，患者术后疼痛明显减轻，患者恢复迅速，值得临床推广。

Application of enhanced recovery after surgery in perioperative period of laparoscopic sleeve gastrectomy

ObjectiveTo explore the clinical effect of ERAS and pain management in perioperative period of laparoscopic sleeve gastrectomy. MethodsA retrospective analysis was made of 300 patients who underwent laparoscopic sleeve gastrectomy in Beijing Shijitan Hospital Affiliated to Capital Medical University from Jan. 2013 to Jan. 2018. The concept of enhanced recovery after surgery(ERAS) plus pain management was adopted. Preoperative education and respiratory function training were emphasized. The incision site of gastric wall was covered by serosal muscular layer during the operation. Local infiltration anesthesia was performed at the incision site of abdominal wall during the operation. No gastric tube, urinary tube and abdomen cavity drainage tube, reasonable analgesia after operation, early feeding and activity. The differences of average hospitalization time, post-operative pain score, post-operative food intake and activity time were counted, and the advantages and problems of ERAS implementation were analyzed and discussed. ResultsThe average hospitalization time of ERAS group was shorter(1.5±0.8)d vs (2.7±0.8)d, P<0.05]; there were no serious complications; the NRS score of pain after ERAS group was lower than that of control group (P< 0.05); the time of activity after ERAS group was earlier and the time of bed rest was shorter. ConclusionsIn the perioperative measures of weight loss and metabolic surgery, ERAS can significantly shorten the hospitalization time, relieve the pain of patients after operation, and recover quickly, which is worthy of clinical promotion.