加速康复外科理念的围术期管理在腹腔镜阑尾切除术患者中的应用

目的探讨手术室应用加速康复外科(enhanced recovery after surgery,ERAS)理念的围术期管理在腹腔镜阑尾切除术患者中的临床效果。方法选取东莞市万江医院2019年1月至2020年8月收治的100例行腹腔镜阑尾切除术患者为研究对象。采用随机数字法将其分为对照组50例(常规围术期管理)和观察组50例(基于ERAS理念的围术期管理),比较两组患者术后排气时间、首次进食时间、首次活动时间、总住院时间,术后6h、12h、24h疼痛数字评分法(numerical rating scale,NRS)评分,手术前及术后第3天日常生活活动能力(activity of daily living,ADL)评分及术后并发症发生率。结果观察组术后排气时间、首次进食时间、首次活动时间及总住院时间均短于对照组(P<0.01);术后6h、12h观察组NRS评分均低于对照组(P<0.01),术后24h两组患者评分比较差异无显著性(P>0.05);术前两组患者ADL评分比较差异无显著性(P>0.05),术后第3天观察组ADL评分高于对照组(P<0.01);观察组出现切口感染、出血、恶心呕吐及腹泻等并发症发生率明显低于对照组(χ~2=8.31,P<0.01)。结论手术室采用基于ERAS理念的围术期管理能有效减少患者围术期应激反应,降低并发症发生率,促进术后康复,缩短住院时间。

Research application of perioperative management of stands for enhanced recovery after surgery in patients undergoing laparoscopic appendectomy

Objective To explore the clinical effect of stands for enhanced recovery after surgery(ERAS)in the operating room in patients with laparoscopic appendectomy.Methods We selected 100 patients with laparoscopic appendectomy in John Wan Hospital from January 2019 to August 2020 as the research objects.Using random number method,they were divided into 50 cases in the control group(conventional perioperative management)and 50 cases in the observation group(perioperative management based on the concept of ERAS).The postoperative exhaust time,first meal time,first activity time and total hospital stay,the numerical rating scale(NRS)scores at 6 h,12 h and 24 h after operation,activity of daily living(ADL)scores before and 3 days after operation and the incidence of postoperative complications were compared between the two groups.Results The postoperative exhaust time,first meal time,first activity time and total hospital stay in the observation group were significantly lower than those in the control group(P<0.01);The NRS of the observation group at 6 h and 12 h after operation were significantly lower than those of the control group(P<0.01),and there was no significant difference in the scores of the two groups at 24 h after operation(P>0.05);There was no significant difference in ADL scores between the two groups before surgery(P>0.05),and the ADL scores of the observation group were higher than those of the control group on the 3 rd day after surgery(P<0.01);The incidence of complications such as wound infection,bleeding,nausea and vomiting and diarrhea in the observation group was significantly lower than that in the control group(χ~2=8.31,P<0.01).Conclusion Based on the perioperative management of ERAS,it can effectively reduce the patient’s perioperative stress response,reduce the incidence of complications,promote postoperative recovery,and shorten the length of hospitalization.