快速康复外科理念在开胸肺切除手术患者中的运用

目的探讨快速康复外科（fast track surgery，FTS）理念在开胸肺部手术中应用的可行性及效果。方法选取1130例同期住院拟行开胸肺部手术治疗的患者，随机分为两组，分别采用快速康复方案（FTS组）及传统方法治疗（对照组）。比较两组患者手术时间、术中出血量、术后胸管置留时间、术后第3天白细胞计数、总并发症发生率及住院总时间。结果FTS组：手术时间（109．5±42．4）min，术中出血量（147．4±86．8）ml，胸管置留时间（2．9±1．2）d，术后第三天白细胞计数（10．5±2．1）×10^9／L，住院总时间（8．8±1．6）d，总并发症发生率11．1％（5／45）。对照组：手术时间（114．2±50．5）min，术中出血量（153．7±93．5）ml，胸管置留时间（3．5±1．1）d，术后第3天白细胞计数（11．7±2．0）×10^9／L，住院总时间（10．1±1．7）d，总并发症发生率28．0％（14／50）。两组手术时间及术中出血量相比差异无统计学意义（P〉0．05）；胸管拔除时间、术后第三天白细胞计数、住院总时间、总并发症发生率比较，差异均有统计学意义（P〈0．05）。结论将FTS方案应用于开胸肺切除术患者可以有效地减少术后并发症的发生，促进患者的术后康复，缩短住院时间。

Application of fast track surgery program in patients after pneumonectomy

Objective To investigate the feasibility and effect of fast track surgery （FTS） program in patients after pulmonary neoplasms. Methods A total of 100 patients who would underwent pneumonectomy were divided into two groups at random：FTS group,in which the patients were treated according to the FTS program; conventional group, in which the patients were given conventional treatments. The operation time, intraoperative blood loss, duration for chest tube drainage, the leukocyte count 3 days after operation, postoperative morbidity and the median hospital stay were compared between the two groups. Results In the FTS group, the operation time was （ 109.5 ± 42.4） min, the intraoperative blood loss （ 147.4 ±86.8） ml, the duration for chest tube drainage （2.9 ±1.2）d, the leukocyte count（ 10.8 ±2.1 ） × 10^9/L, the median hospital stay（8.8 ±1.6）d and the rate of overall complications 11.1% （5/45）. In the control group, the values of the indice mentioned above were （ 114.2 ± 50.5 ） min, （ 153.7 ± 93.5 ） ml, （3.5 ±1.1 ） d, （ 11.7 ±2.0） × 10^9/L, （9.9 ±1.3 ） d and 28.0% （ 14/50 ） , respectively. There were significant differences in the duration of chest tube drainage, the leukocyte count, the postoperative morbidity and the median hospital stay between the two groups （ P 〈 0. 05 ）. Conclusion The new FTS program apparently reduces the rate of overall complications, shortens the hospital stay and accelerates the recovery after pneumonectomy.