婴幼儿法洛四联症一期根治术后ICU滞留的危险因素

目的 探讨婴幼儿法洛四联症(tetralogy of Fallot, TOF)一期根治术后重症监护室(ICU)滞留的危险因素。方法 回顾性分析武汉亚洲心脏病医院2015年1月至2019年12月收治的215例法洛四联症行一期根治术患儿的临床资料,根据术后ICU时间分为滞留组46例(ICU时间≥7d)和对照组169例(ICU时间＜7d),比较两组患儿围术期相关资料。多因素logistic回归分析TOF一期根治术后ICU滞留的危险因素。结果 单因素分析显示,两组患儿在年龄（P=0.003）、体重（P=0.002）、左心室舒张末期容积指数(LVEDVI,P=0.001)、McGoon比值（P<0.001）、Nakata指数（P=0.042）、升主动脉与主肺动脉直径比值（AO/PA,P=0.012）、跨瓣环补片（P=0.022）、体外循环时间（P<0.001）、主动脉阻断时间（P<0.001）、机械通气时间（P<0.001）及术后并发症（P<0.001）方面均存在统计学差异,logistic回归分析结果提示,体外循环时间大于120 min[P<0.05,OR=3.445（1.241~9.561）]、体重低于8kg[P<0.05,OR=2.802（1.103~7.120）]及术后并发症[p<0.01,OR=7.660（3.464~16.941）]是TOF患儿一期根治术后ICU滞留的危险因素。结论 体外循环时间延长、低体重及术后出现并发症是TOF患儿一期根治术后ICU滞留的危险因素。     

超快通道麻醉对小儿心脏手术后C反应蛋白和降钙素原的影响

目的:比较超快通道麻醉方法和传统麻醉方法对于小儿心脏手术后血清高敏C反应蛋白(hs-CRP)、C反应蛋白(CRP)和降钙素原(PCT)含量的影响。方法:回顾分析了2013-09至2014-05由同一位麻醉医师实施的心脏手术101例患儿麻醉资料,根据术后是否在手术室内拔管,术后手术室内拔管的40例为超快通道麻醉组,余44例患儿为传统麻醉组,比较术前(T0)、术后第1天(T1)、术后第2天(T2)三个时间点两组患儿血清hs-CRP、CRP和PCT含量的变化。结果:hs-CRP含量:两组T1、T2时间点较T0时间点升高,差异均有统计学意义(P0.05);两组间比较,在T1时间点,超快通道麻醉组显著低于传统麻醉组,差异有统计学意义(P0.05)。CRP含量:在超快通道麻醉组不同时间点差异没有统计学意义,而在传统麻醉组T2时间点较T1时间点增加,差异有统计学意义(P0.05);两组间比较,在T2时间点,传统麻醉组显著高于超快通道麻醉组,差异有统计学意义(P0.05)。PCT含量:组内各时点比较均无明显变化;两组间比较,在T1时间点,超快通道麻醉组显著低于传统麻醉组,差异有统计学意义(P0.05)。结论:与传统麻醉方法比较,超快通道麻醉管理可以减少术后hs-CRP、CRP和PCT含量的升高,有可能减少心脏手术后的呼吸机相关肺炎的发生。     

围术期快速康复外科理念在老年心脏外科手术患者中的应用

目的 探讨围术期快速康复外科理念在老年心脏大手术患者中的应用。方法 选取老年心脏外科手术患者78例,采用简单随机抽样分为对照组和试验组各39例。对照组接受心外科手术患者常规围术期管理,试验组接受快速康复外科理念管理。比较两组下床活动时间、首次排气时间、住院时间、满意度及术后并发症发生率,术后6个月随访患者体力状态及生活质量。结果 试验组下床活动时间、首次排气时间、住院时间明显短于对照组(P<0.01);术后并发症发生率显著低于对照组(P<0.05);6 min步行距离(6MWD)、Barthel指数、健康调查简表(SF)-36评分及满意度显著高于对照组(P<0.001)。结论 快速康复外科理念可有效缩短老年心脏外科手术患者术后恢复时间,减少术后并发症且改善患者远期预后,提高患者满意度。     

快速康复外科理念在老年腹腔镜胰体尾切除术中的应用价值

目的探讨快速康复外科理念对老年腹腔镜胰体尾切除术围术期恢复的影响。方法选取120例老年腹腔镜胰体尾切除术(LDP)患者,并随机分为常规组和快速康复外科组各60例,比较两者术后围术期并发症发生率、术后住院时间、腹腔引流管拔出时间、经济花销等围术期临床资料。结果快速康复外科组围术期总体并发症发生率低于常规组,术后住院时间、腹腔引流管拔出时间及下地活动时间等均少于常规组并具有统计学意义(P<0.05)。结论快速康复外科理念对老年LDP患者,不但可以降低术后总体并发症的发生率,而且可以减少术后住院日,促进患者术后快速康复。     

快速康复外科对胃肠道手术患者围术期的作用

目的分析探讨快速康复外科对胃肠道手术患者围术期的作用。方法将入选的接受胃肠道择期手术治疗患者120例,随机分为对照组(应用传统围术期处理方法)及观察组(采用快速康复外科的新型围术期处理方法),比较两组肛门恢复排气时间、进食时间、住院时间、切口愈合时间、住院治疗费用及术后并发症发生情况。结果观察组术后进食时间、肛门恢复排气时间、切口愈合时间较对照组明显提前,住院时间显著缩短,治疗总费用减少(P<0.05);术后咽喉疼痛、恶心呕吐并发症发生率显著降低(P<0.05),腹胀、切口感染及肺部感染等发生率并未明显增加(P>0.05)。结论快速康复外科方案应用于胃肠道手术安全、有效,可促进病人早日康复,具有很好的应用前景。     

基于发生风险模型干预对食管癌患者围手术期营养不良的预防研究

目的 探讨基于发生风险模型干预对食管癌患者围手术期营养不良的预防效果。方法 选取2022年1月至2022年12月安阳市肿瘤医院胸外科收治的食管癌手术患者进行单中心的前瞻性研究。采用随机抽样法,将120例患者分为常规组和干预组,每组60例。常规组予以常规围术期护理,干预组在常规围术期护理基础上予以基于发生风险模型干预。在干预后,比较常规组患者和干预组患者营养不良的发生情况、术后并发症发生率、胃肠道功能及护理满意度。结果 干预后,与常规组相比较,干预组患者围术期营养不良和并发症的发生率明显降低(分别为χ²=8.547,P=0.000;χ²=10.385,P=0.001)患者术后肠鸣音恢复时间(t=3.867,P=0.000)、首次排气时间(t=8.151,P=0.000)、进食时间(t=8.712,P=0.000)、胃管留置时间(t=14.233,P=0.000)和住院时间(t=10.554,P=0.000)明显缩短,护理满意度也明显提高(Z=-4.088,P<0.001)。结论 基于发生风险模型干预可有效预防食管癌患者的围术期营养不良和术...     

加速康复措施在减重代谢外科中的应用价值

目的通过在减重代谢外科围手术期实施各种加速康复外科（ERAS）措施，总结出加速康复外科措施在减重与代谢病外科中的应用价值。 方法回顾性分析2015年1月至2018年1月南方医科大学附属小榄医院减重与代谢病外科收治的91例肥胖症或2型糖尿病患者的临床病例资料，将患者在围手术期实施快速康复措施的纳入加速康复外科组（ERAS组）；而仅采用传统胃肠外科围手术期措施的患者纳入对照组。对比两组患者在术后疼痛评分、肛门排气时间、并发症、平均住院时间、住院总费用、减重效果、再住院率、再手术率等方面的差异，分析ERAS实施在减重代谢外科中的应用价值。 结果ERAS组术后疼痛NRS评分低于对照组(3.8±1.2) vs. (6.4±1.5)，P<0.05；术后肛门排气时间缩短(1.0±0.3)d vs.(1.9±0.7)d，P<0.05；无严重并发症；术后住院时间短(6.4±1.3)d vs.(13.7±1.5)d ，P<0.05，住院费用降低（46813±3070）元vs. (66973±4520)元，P<0.05；两组的平均术后1年多余体重减除率均>80%。 结论在减重与代谢手术中，实施围手术期快速康复措施，可明显缩短住院时间，减少术后并发症，快速康复，节省费用，具有突出的应用价值。     

喉罩复合超快通道麻醉技术在先天性心脏病患儿介入治疗中的应用效果

目的观察喉罩复合超快通道麻醉技术(UFTA)在先天性心脏病患儿介入治疗中的应用效果。 方法选取2017年1月至2018年2月尉氏县人民医院行介入治疗的86例CHD患儿纳入研究,按随机数表法将其分为A、B两组,各43例。A组接受气管插管复合UFTA,B组接受喉罩复合UFTA。记录两组患儿麻醉清醒时间、开始进食时间及住院时间;记录两组患儿不同时间点MAP和HR水平;统计两组患儿躁动、咽痛、喉痉挛发生率。 结果B组患儿麻醉清醒时间、开始进食时间和住院时间均短于A组,差异有统计学意义(P<0.05)。B组患者T₁、T₂、T₃、T₄时的MAP和HR水平均低于A组,差异有统计学意义(P<0.05)。B组患儿术后躁动、咽痛、喉痉挛等不良反应发生率均低于A组,差异有统计学意义(P<0.05)。 结论CHD患儿介入治疗过程中使用喉罩复合UFTA麻醉临床效果较好,术中生命体征较平稳,术后清醒较早,术后不良反应少。     

快速康复理论对高血压患者术后麻醉苏醒时间及并发症发生率的影响

目的 探究快速康复（FTS）理论对高血压手术患者术后麻醉苏醒时间及并发症发生率的影响。方法 纳入2019年1月至2020年12月于本院行手术治疗的96例高血压患者进行研究,根据随机排列法分为参照组48例,施行常规围术期护理;研究组48例,施行围术期FTS护理,比较两组术后麻醉苏醒时间、并发症发生率、护理前（入院24h内）、护理后（出院时）血压水平的差异。结果 研究组术后苏醒时间、进食时间、下床活动时间、住院时间均短于参照组,差异有统计学意义（P<0.05）;并发症比较,研究组高血压、肺部感染、静脉血栓、苏醒延迟总发生率为4.17%,低于参照组18.75%,差异有统计学意义（P<0.05）;血压水平比较,护理后,研究组收缩压（SBP）、舒张压（DBP）均较护理前降低,且低于同时期的参照组,差异有统计学意义（P<0.05）。结论 FTS护理可促进患者的术后苏醒及快速康复,并减少并发症的发生,有效控制其血压水平,应用于高血压围术期效果显著。     

高功率短时程消融在老年心房颤动患者中的可行性及应用优势分析

目的 探讨在老年心房颤动(房颤)患者中应用高功率短时程消融的可行性及优势。方法 选取2021年9月至2022年4月解放军总医院第六医学中心心血管病医学部接受高功率短时程导管射频消融的老年房颤患者40例(高功率组),同期接受常规功率消融的老年房颤患者40例(传统消融组),比较2组消融指标、单圈隔离率、术中耐受程度及围术期并发症发生率。结果 高功率组消融时间、消融点、盐水灌注量较传统消融组明显减少[(29.0±6.5)min vs(68.6±12.0)min,P<0.01;(70.5±8.0)个vs(94.1±18.3)个,P<0.01;(294.7±34.4)ml vs(545.9±106.4)ml,P<0.01]。高功率组术中芬太尼使用量和因疼痛终止消融次数明显减少[(59.4±14.6)μg vs(79.4±16.9)μg,P<0.01;(0.5±0.2)次vs(1.5±1.4)次,P<0.01]。结论 在老年房颤消融术中,高功率短时程消融明显缩短手术时间,患者耐受程度好,手术效果与常规功率消融相仿,且不增加围术期并发症发生率,有较为明显的优势。     

腹腔镜盆底和韧带整体修复治疗直肠内脱垂的围手术期加速康复护理的对比研究

目的探讨在盆底整体理论指导下腹腔镜盆底和韧带整体修复手术治疗直肠内脱垂的早期疗效以及加速康复外科围手术期护理方法有效性的对比研究。 方法研究对比2017年3月至2019年11月间行手术治疗82例直肠内脱垂患者的临床资料,40例采用传统围手术期护理（对照组）,42例采用加速康复外科围手术期护理（观察组）。比较两组患者首次排气时间、住院时间、手术出血量、住院费用以及术后并发症的发生率;并且比较两组患者术前和术后3个月直肠脱垂程度（DIRP）、Wexner便秘评分（WCS）、胃肠生活质量指数（GIQLI）及Wexner肛门失禁评分（WIS）。 结果观察组在首次排气时间、住院时间和住院费用明显优于对照组（t=4.991,9.651,10.494;P<0.001）。比较两组术前与术后3个月患者的DIRP、WCS、GIQLI、WIS,结果显示各项指标均得到明显改善（t_对照组=44.826、16.794、9.459、-5.477,t_观察组=44.077、18.504、17.405、-19.730;P<0.001）。观察组术后3个月WCS、GIQLI、WIS与对照组比较均明显改善（t=2.734,11.005,-3.916;P<0.001）,两组术后Clavien-Dindo Ⅰ~Ⅲ级并发症比较差异无统计学意义。 结论在盆底整体理论指导下腹腔镜盆底和韧带整体修复手术治疗直肠内脱垂,创伤小、并发症少、临床效果好。采用加速康复外科围手术期护理措施和方法能够明显加快术后康复速度,早期恢复肠道功能,缩短住院时间,减少住院费用,提高患者生活质量。     

加速康复外科治疗手术切除肝癌患者的价值探讨

目的比较加速康复外科与传统围手术期处理肝癌切除术患者的安全性及有效性。方法采用加速康复外科治疗23例原发性肝癌切除术病人,采用传统方法进行围手术期处理30例原发性肝癌病人,比较两组病人术后住院时间、肠道恢复排气时间、肝脏功能变化和住院费用情况。结果两组患者术后肛门开始排气时间、首次排便时间比较,差异有显著意义(P0.05);加速康复外科治疗患者较传统治疗住院时间缩短、住院费用降低(P0.05);两组病人术后第3天和第5天谷丙转氨酶、总胆红素、血清白蛋白和前白蛋白水平有显著性差异(P0.05)。结论行加速康复外科治疗肝癌切除术患者是安全、有效的方法,既有利病人术后器官功能的康复,又可以减少住院时间与治疗费用。     

Effect of preoperative use of propranolol on postoperative outcome in patients with tetralogy of Fallot

The aim of this study was to determine if preoperative propranolol therapy has a deleterious effect on postoperative variables in patients with tetralogy of Fallot. Data from 97 patients who underwent complete repair of tetralogy of Fallot were reviewed. The patients were divided into 2 groups: those receiving preoperative propranolol therapy (n = 32) and those not receiving therapy (n = 65). Preoperative and intraoperative variables did not differ between groups. There were no differences in postoperative inotrope scores on arrival to the intensive care unit and through the first 12 hours postoperatively. There was a trend toward increased inotrope scores at 24 hours (median 8 vs 5, p = 0.05) and 48 hours (median 8 vs 3, p = 0.05) postoperatively in the patients treated with propranolol. Temporary pacing in the early postoperative period occurred more often in the propranolol group (16% vs 3%, p = 0.04). There was no difference between groups in length of mechanical ventilation, intensive care unit stay, or total hospital postoperative stay. In conclusion, propranolol therapy can be used in patients with tetralogy of Fallot until the time of surgery, without important effects on their postoperative courses. Any blunting of inotropic or chronotropic activity in propranolol-treated patients appears to be easily overcome with increased inotropic medications or temporary pacing, without increased morbidity or mortality.     

快速康复外科技术在老年结直肠癌患者围手术期应用效果的临床研究

目的探讨快速康复外科护理措施在结直肠癌患者围术期的应用效果。 方法将68例结直肠癌手术患者按住院号随机分为快速康复治疗组和传统治疗组,分别采用快速康复外科(FTS)技术及传统方法进行围手术期处理。 结果相比传统组,采用FTS组的术后首次排气时间、首次排便时间缩短;恶心、呕吐发生率、手术并发症的发生率降低;术前、术后营养状态良好、住院时间缩短、住院总费用降低。 结论采用FTS技术对老年结直肠癌患者进行围手术期处理可促进患者康复、减少费用。     

Echocardiographic and morphological correlations in tetralogy of Fallot.

AIMS: Our aim was to clarify the location and structure of the outlet septum relative to the free-standing subpulmonary infundibulum in the setting of tetralogy of Fallot and to examine its relationship to the other components of the subpulmonary outflow tract, determining their potential influence on clinical outcome. METHODS AND RESULTS: We studied prospectively 41 patients with tetralogy of Fallot (mean age 14 +/- 10.9 months) prior to surgical repair, and compared them with 15 patients undergoing closure of a ventricular septal defect associated with malalignment of the outlet septum but no subpulmonary infundibular stenosis (Eisenmenger ventricular septal defect), and 20 healthy controls. We also examined available autopsied hearts from cases with uncorrected tetralogy of Fallot (8) and Eisenmenger ventricular septal defect (13). Data were indexed for body surface area, and diameter of the tricuspid valve, respectively. The overall length of the subpulmonary infundibulum, including the extent of the muscular outlet septum, was significantly greater for patients with tetralogy of Fallot compared to normals (2.34 +/- 0.6 vs 1.46 +/- 0.34 cm/BSA0.5, P<0.001), whereas the difference between those with tetralogy of Fallot and an Eisenmenger ventricular septal defect was confined to the degree of narrowing of the subpulmonary outlet (0.43 +/- 0.22 vs 2.17 +/- 0.64 cm/BSA0.5, P<0.001). Within the tetralogy of Fallot group, there were linear relationships between deviation of the outlet septum (r= -0.61, P<0.005) and the diameter of the pulmonary valvar orifice (r=0.75, P<0.001), suggesting that growth of the pulmonary arteries may be related to this feature. When patients requiring a transannular patch as part of their surgical repair were compared with those not needing this procedure, differences were found in the diameter of the pulmonary valvar orifice and the pulmonary trunk, but not in the dimensions of the outlet septum. CONCLUSION: The position of the outlet septum in relationship to the remainder of the muscular subpulmonary infundibulum represents a hallmark of tetralogy of Fallot, permitting its differentiation from Eisenmenger ventricular septal defects and normal hearts.     

Impact of centralization of pancreaticoduodenec-tomy coupled with fast track recovery protocol:a comparative study from India

BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to evaluate the effect of fast track strategy on patients subjected to pancreaticoduodenectomy(PD) from an individual unit during transit from low to a high volume center.METHODS: A total of 142 PD patients who had been subjected to fast track strategy between June 2008 and September 2012 were compared with 46 patients who had received conventional surgery between January 2006 and May 2008. Comparative analysis was made of postoperative complications, postoperative recovery, length of hospital stay and patient readmission requirement.RESULTS: The patients subjected to fast track strategy had a faster recovery and a shorter hospital stay than those who were treated conventionally(7.8 vs 12.1 days). The intraoperative events like operative blood loss(417.9±83.8 vs 997.4 ±151.8 mL, P0.001), blood transfused(a median of 0 vs 1 unit, P0.001) and operative time taken(125 vs 245 minutes, P0.001) were significantly lower in the fast track group. The frequency of pancreatic fistula(4.9% vs 13.0%) and delayed gastric emptying(7.0% vs 17.4%) was also significantly reduced with fast track treatment. Nevertheless, the readmission rate(11.3% vs 6.5%) was found relatively higher within the fast track group. However, increased readmission rates in this study seem to be independent of fast track protocol.CONCLUSIONS: This preliminary analysis suggests that the fast track approach might be beneficial to the well-being of the patients after PD, for it accelerates the immediate clinical recovery of patients and significantly shortens their length of hospital stay.     

Clinical Outcomes and Cost Analysis of a “Fast Track” Postoperative Care Pathway for Ileal Pouch-Anal Anastomosis. A Case Control Study

Purpose Traditional length of hospital stay after ileal pouch-anal anastomosis is 8 to 15 days. Fast track rehabilitation programs reduce stay, but there are concerns that readmission and complication rates may be increased. This study evaluated a fast track pathway after ileoanal pouch surgery. Methods One hundred three consecutive patients underwent ileal pouch-anal anastomosis on two colorectal services using a fast track protocol with early ambulation, diet, and defined discharge criteria. Direct hospital costs and 30-day and long-term complication data were collected. Patients were matched to controls managed with traditional care pathways by other colorectal staff. Results Matching was established for 97 patients. Fast track patients had shorter hospital stay than controls (median 4 vs. 5 days; mean 5.0 vs. 5.9, P = 0.012). Readmission and recurrent operation rates were similar (24 vs. 20 percent, P = 0.49, and 9 vs. 10 percent, P = 0.8, fast track vs. control, respectively). Median direct costs per patient (US$) within 30 days were lower with fast track (5692 vs. 6672, P = 0.001), primarily because of reductions in postoperative management expenses. Complication rates, including pouch failure, bowel obstruction, pouchitis, and anastomotic stricture were comparable. Early discharge (≤ 5 days from surgery) occurred in 79 (77 percent) fast track patients. Failure with early discharge was associated with male gender, reoperations, and anastomotic complications. Conclusions Fast track protocol after ileoanal pouch surgery reduces length of stay and hospital costs without increasing complication rates. Successful early discharge usually signals a benign postoperative course. Presented at the meeting of The American Society of Colon and Rectal Surgeons, Philadelphia, Pennsylvania, April 30 to May 5, 2005.     

Effects of multimodal fast-track surgery on liver transplantation outcomes

BACKGROUND: Fast-track surgery and enhanced recovery after surgery have been applied to many surgical procedures;however, data on fast-track surgery and enhanced recovery after surgery following liver transplantation is limited. This study aimed to conduct a prospective study to determine the effects of fast-track surgery on prognosis after liver transplan-tation. METHODS: This was a prospective, single-blinded, random-ized study. One hundred twenty-eight patients undergoing liver transplantation were selected for the fast-track (FT group, n=54) or conventional process (NFT group, n=74). The prima-ry endpoints were intensive care unit (ICU) stay and hospital stay. The secondary endpoints were as follows: operative time, anhepatic phase time, intraoperative blood loss, intraopera-tive blood transfusion volume, postoperative complications, readmission rate, and postoperative mortality. RESULTS: There was no significant difference in preoperative demographics between the two groups. The median ICU stay was 2 days (range 1-7 days) in the FT group and 5 days (range 3-12 days) in the NFT group (P<0.01). Furthermore, the hospital stay was also significantly reduced in the FT group (P<0.01). The operative time, anhepatic phase time, intraop-erative blood loss, and intraoperative blood transfusion vol-ume were decreased in the FT group compared with the NFT group (P<0.05). Based on Spearman correlation analysis, the ICU stay and hospital stay may be positively correlated with operative time, anhepatic phase time and intraoperative blood loss. There were no differences in the incidence of postopera-tive complications, readmissions, and postoperative mortality between the two groups. CONCLUSION: Fast-track procedures effectively reduce the ICU stay and hospital stay without adversely affecting progno-sis. This study demonstrated that fast-track protocols are safe and feasible in liver transplantation.     

Comparison of Acute Kidney Injury After Robot-Assisted Laparoscopic Radical Prostatectomy Versus Retropubic Radical Prostatectomy: A Propensity Score Matching Analysis

Acute kidney injury (AKI) is associated with extended hospital stay, a high risk of progressive chronic kidney diseases, and increased mortality. Patients undergoing radical prostatectomy are at increased risk of AKI because of intraoperative bleeding, obstructive uropathy, older age, and preexisting chronic kidney disease. In particular, robot-assisted laparoscopic radical prostatectomy (RALP), which is in increasing demand as an alternative surgical option for retropubic radical prostatectomy (RRP), is associated with postoperative renal dysfunction because pneumoperitoneum during RALP can decrease cardiac output and renal perfusion. The objective of this study was to compare the incidence of postoperative AKI between RRP and RALP.We included 1340 patients who underwent RRP (n = 370) or RALP (n = 970) between 2013 and 2014. Demographics, cancer-related data, and perioperative laboratory data were evaluated. Postoperative AKI was determined according to the Kidney Disease: Improving Global Outcomes criteria. Operation and anesthesia time, estimated blood loss, amounts of administered fluids and transfused packed red blood cells, and the lengths of the postoperative intensive care unit and hospital stays were evaluated. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences between the RRP and RALP groups.After performing 1:1 propensity score matching, the RRP and RALP groups included 307 patients, respectively. The operation time and anesthesia time in RALP were significantly longer than in the RRP group (both P < 0.001). However, the estimated blood loss and amount of administered fluids in RALP were significantly lower than in RRP (both P < 0.001). Also, RALP demonstrated a significantly lower incidence of transfusion and smaller amount of transfused packed red blood cells than RRP (both P < 0.001). Importantly, the incidence of AKI in RALP was significantly lower than in RRP (5.5% vs 10.4%; P = 0.044). Furthermore, the length of hospital stay in RALP was also significantly shorter (P < 0.001).The incidence of AKI after RALP is significantly lower than after RRP. RALP can therefore be a better surgical option than RRP in terms of decreasing the frequency of postoperative AKI.     

快速康复外科对胃癌手术患者临床指标及术后并发症的影响

目的:探讨快速康复外科(fast track surgery,FTS)对胃癌手术患者的临床指标及术后并发症的影响.方法:回顾性分析2008/02-2011/05广州军区广州总医院普外科收治的168例胃癌手术患者资料,其中2009/12-2011/05连续收治的82例采用快速康复外科治疗(FTS组),2008/02-2009/11连续收治的86例按传统围术期处理(传统组),两组行非随机对照研究.比较两组术后首次排气、排便时间、住院时间、住院费用及术后并发症情况.结果:FTS组同传统组相比,术后首次排气时间(2.6dvs4.6d)、排便时间(3.3dvs5.2d)显著提前,住院时间(4.6dvs8.1d)明显缩短,住院费用显著降低(2.3万元vs2.9万元),且差异均有显著统计学意义(P<0.05).FTS组肺部并发症(5/82,6.1%)显著低于传统组(14/86,16.3%),差异显著(P<0.01);FTS组术后消化系瘘发生率(4/82,4.9%)稍高于传统组(3/86,3.5%),但差异无统计学意义(P>0.05).FTS组4例消化系瘘中2例再手术,其中1例死亡,而传统组中3例均通过非手术治疗治愈.其余单个并发症两组无明显差异.FTS组总体并发症(22/82,26.8%)略低于传统组(28/86,32.6%),但无统计学差异(P>0.05).两组各有1例死亡.FTS组再入院率(4/82,4.9%)稍高于传统组(3/86,3.5%),但无统计学意义(P>0.05).结论:FTS应用于胃癌手术安全有效,可促进术后胃肠功能恢复,缩短住院时间,降低住院费用.FTS并不增加术后并发症率,但可能增加消化系瘘、出血等严重并发症的诊断和治疗难度.