加速康复外科策略对腹腔镜结直肠癌手术患者术后恢复的影响

目的探讨围术期实施加速康复外科(enhanced recovery after surgery,ERAS)策略对腹腔镜结直肠癌根治术患者术后恢复的影响。方法选择2015年3月至2016年6月择期行腹腔镜结直肠癌根治术患者84例,男55例,女29例,年龄36~78岁,ASAⅠ或Ⅱ级,随机分为两组,每组42例。E组采用硬膜外阻滞联合全麻,加强术前宣教,术中保温,限制性补液,术中、术后完善镇痛等一系列ERAS策略进行围术期管理,C组采用常规围术期处理。记录补液量、术毕鼻咽温度、术后首次肠鸣音时间、首次排气时间、首次进流体食物时间、首次下床活动时间及导尿管拔出时间;记录术后PACU停留时间、总住院时间及总住院费用等。结果 E组补液量(1 328±64)ml vs.(2 463±135)ml]明显少于C组(P0.05),术毕鼻咽温度(36.2±0.2)℃vs.(35.1±0.5)℃]明显高于C组(P0.05),术后首次肠鸣音时间(33.4±12.5)h vs.(42.8±14.3)h]、首次排气时间(43.6±13.9)h vs.(60.7±15.4)h]、首次进流体食物时间(26.8±4.1)h vs.(67.4±13.5)h]、首次下床活动时间(7.4±1.6)h vs.(26.5±3.8)h]、导尿管拔出时间(29.2±6.1)h vs.(51.8±7.6)h]、术后PACU停留时间(26.4±8.5)min vs.(37.2±11.6)min]和总住院时间(7.5±0.9)d vs.(9.7±1.2)d]明显短于C组(P0.05),总住院费用(2.1±0.6)万元vs.(2.6±0.8)万元]明显少于C组(P0.05),术后恶心呕吐(2.4%vs.21.4%)、躁动(4.8%vs.26.2%)、皮肤瘙痒(7.1%vs.23.8%)及寒战(0%vs.19.0%)的发生率明显低于C组(P0.05)。结论加速康复外科策略应用于腹腔镜结直肠癌患者围术期管理,可减少术中舒芬太尼用量,防止术后低体温的发生,胃肠功能恢复更快,明显缩短住院时间和降低医疗费用。

Impact of enhanced recovery after surgery program on postoperative recovery in patients undergoing lapa-roscopic colorectal resection

Objective To investigate the impact of enhanced recovery after surgery (ERAS) program on postoperative recovery in patients undergoing laparoscopic colorectal resection. Methods Eighty-four patients undergoing laparoscopic colorectal resection from March 201 5 to June 201 6 (55 males,29 females,aged 36-78 years,ASA physical status Ⅰ or Ⅱ),were randomly divid-ed into two groups (n = 38 each).Patients in group E were received epidural block combined with general anesthesia,and a series of perfect ERAS strategies,such as strengthen preoperative educa-tion, maintaining perioperative normothermia, perioperative goal-directed fluid therapy, intraoperative and postoperative analgesia.While the patients in group C received routine anesthetic management.The volume of fluid,the nasopharyngeal temperature,the time of recovery of bouel sound,first anal exhaust,eating fluid food,ambulation and remove of the catheter were recorded in two groups.Furthermore,time of PACU after surgery,the total days of hospitalization and total hos-pital costs were recorded.Results The volume of fluid (1 328 ± 64)ml vs.(2 463 ± 135 )ml]in group E were significantly lower than group C (P <0.05),the nasopharyngeal temperature (36.2± 0.2)℃ vs.(35.1±0.5)℃]was significantly higher in group E (P <0.05).Compared with group C,the time of recovery of bowel sound (33.4 ± 12.5 )h vs.(42.8 ± 14.3 )h],first anal exhaust (43.6±13.9)h vs.(60.7±1 5.4)h],eating fluid food (26.8±4.1)h vs.(67.4±13.5)h],first ambulation (7.4±1.6)h vs.(26.5±3.8)h]and remove of the catheter (29.2±6.1)h vs.(5 1.8 ±7.6) h ], time of PACU (26.4 ± 8.5 ) min vs.(37.2 ± 1 1.6 ) min ], the total days of hospitalization (7.5±0.9)d vs.(9.7±1.2)d]were significantly shorter (P <0.05),and hospital costs (2.1±0.6)ten thousand yuan vs.(2.6±0.8)ten thousand yuan]were significantly decreased (P <0.05).The incidence of adverse reactions such as nausea and vomiting (2.4% vs.21.4%),pru-ritus (7.1% vs.23.8%),agitation (4.8% vs.26.2%)and chills (0% vs.1 9.0%)were significantly lower in group E (P <0.05).Conclusion ERAS program applied to patients undergoing laparoscopic colorectal resection can reduce the intraoperative sufentanil consumption,avoid the occurrence of postoperative hypothermia, accelerate recovery of gastrointestinal function, which can obviously reduce the hospitalization costs and shorten the hospitalization time.