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。

Application value of Fast recovery measures in weight loss and metabolic surgery.

ObjectiveTo summarize the application value of rapid rehabilitation surgical measures in the surgery of weight loss and metabolic diseases by implementing various enhanced recovery after surgery (ERAS) measures in the perioperative period of weight loss metabolic surgery. Methodsthe clinical data of 91 patients with obesity or type 2 diabetes treated in the Department of weight loss and Metabolic Diseases, Xiaolan Hospital affiliated to Southern Medical University from January 2015 to January 2018 were retrospectively analyzed. According to the principle of random grouping, patients who received rapid rehabilitation measures during perioperative period were included in the rapid rehabilitation surgery group (ERAS group), while patients who only used traditional perioperative measures in gastrointestinal surgery were included in the control group. The differences of postoperative pain score, anal exhaust time, complications, average hospitalization time,total hospitalization cost, weight loss effect, rehospitalization rate and reoperation rate between the two groups were compared, and the application value of ERAS in weight loss metabolic surgery was analyzed and discussed. ResultsThe NRS score of postoperative pain in the ERAS group was lower than that in the control group (3.81.2) vs. (6.41.5), P<0.05). The postoperative anal exhaust time was shortened (1.0 ±0.3) d vs. (1.9 ±0.7) d, P<0.05). There were no serious complications, the postoperative hospital stay was shorter (6.4 ±1.3) d vs. (13.7 ±1.5) d, P<0.05), and the hospitalization cost was reduced (46813 ±3070) ￥ vs. (66973 ±4520)￥, P<0.05. The average rate of excess weight loss 1 year after operation in both groups was more than 80%. ConclusionsIn the perioperative period of weight loss and metabolic surgery, the implementation of rapid rehabilitation measures is superior to the traditional mode, which can significantly shorten the time of hospitalization, reduce postoperative complications, rapid recovery and save cost, and has outstanding application value.