快速康复外科在活体肝移植供者中的应用

目的 探讨快速康复外科(FTS)在活体肝移植供者择期手术中的临床价值.方法 回顾性分析2006年1月至2011年11月上海交通大学附属仁济医院收治的214例肝移植供者的临床资料,根据手术处理方法分为传统组和快速组.传统组:73例,2006年1月至2009年5月采用传统围手术期处理方案;快速组:141例,2009年5月至2011年11月采用FTS方案.观察比较两组供者术后康复情况,计数资料比较采用x2检验,计量资料比较采用t检验.结果 快速组供者手术时间、下床活动时间、肛门排气时间、排便时间、术后住院时间、住院费用分别为(178±37) min、(1.6±1.0)d、(2.9±1.6)d、(3.1±1.5)d、(5.9±1.9)d、(1.8±0.6)万元,传统组供者相应指标分别为(167±33) min、(3.6±1.4)d、(4.6±2.3)d、(4.5±1.4)d、(7.6±1.5)d、(2.2±0.4)万元,两组比较,差异有统计学意义(t =2.115,77.138,6.504,6.913,6.970,73.038,P＜0.05);而快速组和传统组术中出血量分别为(130±47)ml和(138±46) ml,两组比较,差异无统计学意义(t=1.251,P＞0.05).快速组和传统组供者满意率分别为98.6％(139/141)和89.2％(74/83),两组比较,差异有统计学意义(x2=9.94,P＜0.05).结论 FTS在活体肝移植供者中应用安全、经济,能够减少手术应激反应,促进供者早日康复,降低住院费用,具有较高的临床应用价值.     

快速康复外科理念在髋膝关节置换术中的初步应用

[目的]探讨快速康复外科理念在髋膝关节置换围手术期应用的效果。[方法]回顾分析2014年1月~2015年5月期间186例行髋膝关节置换术的患者资料。将行快速康复理念治疗的91例患者作为快速康复组,常规方式治疗的95例患者作为常规康复组。比较两组患者术后疼痛(VAS),术后并发症,术后是否输血,住院时间,住院费用,以及患者满意度。[结果]与常规康复组相比,快速康复组术后早期疼痛减轻(P0.05),术后恶心、呕吐发生率低(P0.05),输血率减少(P0.05),住院时间缩短(P0.05),住院费用减少(P0.01),患者满意度明显提高(P0.05)。[结论]快速康复外科理念在关节置换围手术期的应用,能明显缩短住院时间、减少住院费用,提高患者满意度,促进患者的快速康复。     

加速康复外科在肝移植围手术期的应用

加速康复外科（ERAS）是指采用一系列围手术期的优化措施,以阻断或减轻机体的炎症应激反应,促进患者术后快速康复,缩短住院时间,降低术后并发症发生率、再入院率和病死率。肝移植作为终末期肝病的唯一有效治疗手段,具有手术难度大、手术时间长、术中大量输血、术后管理复杂等特点,术后恢复面临着巨大的挑战。本文主要介绍ERAS在肝移植围手术期应用进展以及肝移植围手术期ERAS实施方案建议。     

快速康复外科及其应用

快速康复外科或者称为加速康复外科是一种理念,最近受到越来越多临床医生和学者的重视,并且广泛应用于外科领域许多手术之中,使得许多疾病的临床治疗模式发生了很大变化,极大改善了患者术后康复速度及预后,提高了患者生活质量及治疗效果.本文就快速康复外科及其应用进行综述.     

快速康复外科理念在食管癌治疗中的应用

目的探讨快速康复外科理念在食管癌患者围手术期的应用及对患者的临床结局的影响。方法收集2011年1-6月间南京医科大学附属淮安第一医院胸外科接受食管癌根治术的食管鳞癌患者117例,其中4-6月63例（研究组）,围手术期采用快速康复外科理念进行处理：1～3月接受手术54例（对照组）,围手术期按常规处理。结果研究组术后排气时间、术后拔除胸腔引流管时间、术后住院时间及住院总费用均显著低于对照组（P〈O．05）：手术时间两组差异无统计学意义（P〉0．05）。研究组和对照组总并发症的发生率分别为7．9％（5／63）和24．1％（13／54）,差异有统计学意义（P〈0．05）。结论食管癌患者围手术期应用快速康复外科理念,可促进术后肠功能恢复．减少术后并发症发生率．从而改善患者的临床结局．     

快速康复外科理念在踝关节骨折治疗中的应用

目的:了解快速康复外科(FTS)理念在踝关节骨折治疗中的应用效果。方法:选取踝关节骨折患者62例,随机分为对照组(32例)、观察组(30例)。对照组采用常规方法治疗,观察组治疗中融入FTS理念,由专职医师用踝关节Baird-Jackson评分系统、WHO疼痛程度分级评分系统、症状自评量表(SCL-90)、Olerud-Molander评分系统进行症状评估,同时比较两组患者平均住院的时间、并发症发生率。数据采用SPSS 19.0进行分析处理。结果:术前踝关节骨折患者SCL-90的躯体化、强迫、抑郁、焦虑、敌对、恐怖、偏执、精神病性等各项因子评分均高于常模(正常人评分,n=1388);拆线后观察组Baird-Jackson评分(84.5±5.3)、Olerud-Molander评分(88.7±6.3)高于对照组(分别为75.3±6.1、81.4±5.7),差异均有统计学意义(P0.05);观察组住院天数(12.2±2.3)、疼痛评分(1.3±0.3)、并发症数(1)低于对照组(分别为19.3±2.8、2.2±0.4、8),其差异均有统计学意义(P0.05);观察组SCL-90的抑郁、焦虑、精神病性、敌对、恐怖评分低于对照组,差异有统计学意义(P0.05)。结论:FTS用于踝关节骨折的围术期,有助于改善患者踝关节功能、心理状况,缩短住院时间,减少术后并发症,提高其生活质量。     

快速康复外科在食管癌治疗中的应用

过去的10年间,快速康复外科治疗在很多外科领域都得到了应用。快速康复外科的应用可以使患者更快地恢复从而缩短住院时间,在增加患者满意度的同时减少了治疗费用。本文通过相关文献复习并结合我们的临床实践,探讨食管癌快速康复外科的具体措施及其临床应用价值。     

快速康复外科在结直肠癌手术中的应用

目的研究快速康复外科(fast-track surger,FTS)在结直肠手术中应用的安全性及有效性。方法将43例结直肠择期手术患者随机分为快速康复组和对照组,对比患者术后恢复指标。结果快速康复组:术后首次排气时间1.0～2.6 d,中位数1.8d;首次排便时间1.5～3.3 d,中位数2.7 d;恶心、呕吐发生率分别为13.6%和4.5%;总并发症发生率5.5%;住院总费用(0.96±0.32)万元(1.07～1.83万元)。对照组:术后首次排气时间1.8～4.2 d,中位数3.1 d;排便时间2.5～6.0 d,中位数3.4 d;恶心、呕吐的发生率分别19.0%和9.5%;总并发症发生率14.3%;住院总费用(1.26±0.43)万元(1.54～2.34万元)。2组首次排气和排便时间、并发症发生率、住院总费用比较,差别均有统计学意义。结论 FTS可明显加速患者术后康复进程,减少并发症的发生率,节省住院总费用。在结直肠手术中的应用是安全的。     

快速康复外科和腹腔镜在结直肠癌治疗中的应用

目的 了解近年来快速康复外科及腹腔镜技术应用于结直肠癌治疗的进展,探索两者联合应用于结直肠癌治疗的可能性.方法 收集国内、外有关结直肠外科领域快速康复外科和腹腔镜治疗的临床和基础研究的相关文献并作综述.结果 同传统的治疗方式相比,两者应用于结直肠癌的治疗均可以获得良好的临床疗效.结论 快速康复外科和腹腔镜技术应用于结直肠癌的治疗是可行的,但两者联合应用的效果还需要随机对照试验研究的证实.     

Further reduction of hospital stay for laparoscopic colon resection by modifications of the fast-track care plan

Background

Fast-track surgery has been described as a plan to facilitate early recovery. We present one surgeon's modifications to fast-track surgery for laparoscopic colectomy patients.

Methods

We performed a retrospective review of 48 consecutive patients undergoing elective laparoscopic colectomy treated by a modified fast-track plan between 2004 and 2008. Elements included preoperative education, pre-anesthesia dexamethasone, immediate postoperative general diet, no urinary catheter, no epidural anesthesia, and no flatus or bowel movement as a discharge requirement. Data collected included the following: age, sex, body mass index, resection indications, surgical time, blood loss, pain score, time to ambulation, time to bowel function, length of stay, complications, and mortality.

Results

The mean length of stay was 37 hours (1.5 d), with 29 of 48 patients discharged without passage of flatus or stool. Only 1 patient required readmission.

Conclusions

Our modified fast-track plan achieved significant improvement in length of stay for laparoscopic colectomy compared with previous results.     

高风险结直肠癌患者快速流程模式的临床应用

目的：探讨快速流程应用于高风险结直肠癌患者的可行性和安全性。方法：回顾性研究2007年11月—2008年12月264例结直肠癌患者的临床资料,分析不同管理模式下患者早期恢复情况及快速流程模式的完成情况。结果：术后早期康复方面,快速流程（FT）组首次下床时间和首次经口进食时间短于传统组且差异有统计学意义（P〈0.05）;术后管道管理方面,首次拔除尿管时间FT组早于传统组,差异有统计学意义（P〈0.05）;术后住院时间方面,FT组也明显短于传统组,差异有统计学意义（P〈0.05）。对于术后并发症发生情况,2组术后并发症发生率的差异无统计学意义（P〉0.05）。结论：在高风险结直肠癌患者中快速流程是安全可行的,可以促进患者早期康复,缩短住院时间,对提高高风险结直肠肿瘤患者围手术期管理质量有着重要的推动作用。     

Future perspectives and research initiatives in fast-track surgery

Background and aims Major surgery is still followed by a risk of morbidity, a need for hospitalisation and convalescence. Fast-track surgery has been introduced as a coordinated effort to combine unimodal evidence-based principles of care into a multi-modal effort to enhance recovery. The aim of this article was to update recent data on fast-track abdominal surgery and outline future strategies for research.Results The data from fast-track colonic resection support the validity of the concept because pain, ileus, cardiopulmonary function and muscle function were all improved, compared with traditional treatment and with reduced post-operative fatigue and convalescence. Although less data is available, similar positive results may be achieved in other types of major surgery. Current research initiatives include improved multi-modal non-opioid analgesia, rational principles for perioperative fluid management, pharmacological reduction of surgical stress responses and the role of laparoscopic procedures within the fast-track concept.Conclusions Fast-track surgery has evolved as a valid concept to improve post-operative outcome. Further progress may be expected based upon intensified research within perioperative pathophysiology and a multi-disciplinary collaboration between surgeons, anaesthesiologists and surgical nurses.     

快速康复外科联合精准肝切除对非选择性肝切除患者的应用价值

目的探讨快速康复外科技术及精准肝切除的引入在非选择性肝切除患者中的应用价值。 方法选取2009年1月至2014年1月武汉黄陂区人民医院收治的345例肝切除的手术患者,随机分为传统组及快速康复组,传统组155例,按照常规开腹手术方法以及通气后进饮食等传统围手术期治疗方案进行治疗;快速康复组190例,应用快速康复外科技术联合精准肝切除技术。对比分析两组患者术后C反应蛋白(CRP)、血皮质醇、血糖等变化以及术后离床时间、进食时间、肛门排气时间、住院天数、住院费用等指标,并观察记录不良反应及并发症。 结果快速康复组手术前后皮质醇、血糖水平变化小于传统组(P<0.05),离床时间、进食时间、肛门排气时间明显提前(P<0.05),住院天数、住院费用少于传统组,且并未增加并发症及再入院率。 结论快速康复外科技术联合精细肝切除的引入对于非选择性肝切除患者是成功且较安全的。     

快通道麻醉在肝移植手术中应用的研究进展

快通道麻醉是实施肝移植加速康复外科（enhanced recovery after surgery, ERAS）的一个关键环节。肝移植手术快通道麻醉的适应证及围手术期管理要点是近年来的关注热点。文章主要阐述快通道麻醉在肝移植围手术期应用的可行性与安全性、适应证与禁忌证及围手术期管理,以达到更合理进行麻醉管理、加速肝移植...     

Potential benefits of fast-track concepts in paediatric colorectal surgery

Background

Structured care pathways optimising peri-operative care have been shown to significantly enhance post-operative recovery. We aim to determine if enhanced recovery after surgery (ERAS) principles could provide benefit for paediatric patients undergoing major colorectal resection for inflammatory bowel disease (IBD).

Methods

Children undergoing elective bowel resection for IBD at a regional paediatric unit using standard methods of peri-operative care were matched to adult cases from an associated tertiary referral university hospital already using an ERAS program. Cases were matched for disease type, gender, operative procedure, and ASA grade.

Results

Forty-four children undergoing fifty procedures were identified. Thirty-four were matched to adult cases. Total length of stay in the paediatric group was significantly longer than in the adult group (6 vs. 9 days; P = 0.001). Paediatric patients were slower to start solid diet (1 vs. 4 days; P < 0.0001) and were slower to mobilize post-operatively (1 vs. 4 days; P < 0.0001). No difference was seen in time to restoration of bowel function (2 vs. 3 days; P = 0.49). Thirty day readmissions and total in-hospital morbidity were not significantly different between the groups.

Conclusion

Potentially, application of ERAS in paediatric surgery could accelerate recovery and reduce length of post-operative stay thereby improving quality and efficiency of care.     

加速康复外科技术对肝肿瘤患者术后恢复的影响

Objective To investigate the effects of fast-track surgery on postoperative rehabilitation of patients with liver cancer. Methods Forty-one patients with liver cancer who had been admitted to Zhongshan Hospital of Fudan University from 9 to 30 in July 2008 were randomly divided into fast-track surgery group (n =20) and routine treatment group (n =21) according to the random number table. Patients in fast-track surgery group were preoperatively educated in order to lessen their anxiety. Bowel preparation was not applied before operation, and they were orally administered with 1000 ml of enteral nutrition emulsion (1300 kcal), then they were fasted for 4 hours before operation. Urethral catheter and gastric tube were removed after operation. They were orally administered with 1000 ml of enteral nutrition emulsion on postoperative day 2, and were encouraged to partake in off-bed activity shortly after the operation. The off-bed time, anus exhaust time, postoperative complica-tions, hospitalization time, expense, nutritional and metabolic indexes on postoperative day 1, 3 and 5, hepatic and renal function, immune and stress indexes between the 2 groups were compared by t test and chi-square test. Results There were significant differences in off-bed time, anus exhaust time, patients' weight, expense, total bilirubin level on postoperative day 1, 3 and 5, and level of serum TNF-α on postoperative day 3 between the 2 groups (t =7.065, 5.483, 3.754, 2.291,2.289, 3.218, 3.192, 2.434, 2.089, P <0.05). Conclusions Fast-track surgery can accelerate the postoperative rehabilitation of patients with liver cancer.