实用肝脏病杂志 ›› 2018, Vol. 21 ›› Issue (3): 368-371.doi: 10.3969/j.issn.1672-5069.2018.03.013

• 肝硬化 • 上一篇    下一篇

加速康复外科在脾切除贲门周围血管离断术治疗门脉高压症患者临床应用研究*

李亮亮, 马金良, 荚卫东, 张传海, 韩梅, 李国芹   

  1. 230001 合肥市 安徽医科大学附属省立医院普外科
  • 收稿日期:2017-11-01 出版日期:2018-05-10 发布日期:2018-05-25
  • 通讯作者: 马金良,E-mail:majlwq@163.com
  • 作者简介:李亮亮, 男,28岁,硕士研究生。E-mail:li6466789@
  • 基金资助:
    *安徽省自然科学基金资助项目(编号:1608085MH)

Clinical application of enhanced recovery after surgery program in patients with portal hypertention underwent pericardial devascularization with splenectomy

Li Liangliang, Ma Jinliang, Jia Weidong, et al   

  1. Department of General Surgery,Provincial Hospital,Affiliated to Anhui Medical University,Hefei 230001,Anhui Province,China
  • Received:2017-11-01 Online:2018-05-10 Published:2018-05-25

摘要: 目的 探讨加速康复外科理念(ERAS)在门脉高压症患者围手术期的临床应用价值。方法 随机将80例门脉高压症患者分成两组,40例在围手术期采用ERAS理念管理,另40例在围手术期采用传统处理方案处理。结果 ERAS组患者术后24 h和48 h疼痛评分分别为(2.1±0.6)分和(2.2±0.6)分,显著低于对照组[(3.7±0.8)和(3.0±0.6),P<0.01];ERAS组术后肛门排气时间、术后拔管时间和术后住院时间分别为(2.4±0.5) d、(5.2±0.8) d和(8.5±2.2) d,显著短于对照组[(3.5±0.7) d、(7.6±3.0) d和(11.6±5.3) d,P<0.01];术后第5 d,ERAS组血清谷丙转氨酶、总胆红素和白蛋白水平分别为(27.6±11.3) U/L、(18.3±6.2) μmol/L和(41.8±5.4) g/L,与对照组的[(48.6±44.3) U/L、(23.3±11.5) μmol/L和(37.1±5.1) g/L比,差异显著(P<0.01);ERAS组术后19例(47.5%)出现并发症,显著低于对照组的29例(72.5%)(P<0.05)。结论 应用ERAS在门脉高压症患者围手术期管理中安全有效,可加快患者术后康复。

关键词: 门脉高压症, 加速康复外科, 脾切除术, 贲门周围血管离断术, 康复

Abstract: Objective To investigate the clinical application of enhanced recovery after surgery (ERAS) program in patients with portal hypertention underwent pericardial devascularization with splenectomy. Methods Eighty patients with portal hypertension were recruited in our hospital in recent two years,and they were randomly divided into two groups. Forty patients underwent ERAS management during the perioperative period,and another forty patients underwent conventional perioperative treatment as control groups. Results The pain score 24 h and 48 h postoperation in the ERAS group were (2.1±0.6) and (2.2±0.6),much lower than (3.7±0.8) and (3.0±0.6) in the control(P<0.01);the postoperative anal exhaust time,extubation time and hospital stay in the ERAS group were (2.4±0.5) d,(5.2±0.8) d and (8.5±2.2) d,much shorter than (3.5±0.7) d,(7.6±3.0) d and (11.6±5.3) d in the control(P<0.01);serum alanine transaminase,total bilirubin and albumin levels 5 day after surgery were(27.6±11.3) U/L,(18.3±6.2) μmol/L and (41.8±5.4) g/L,while they were [(48.6±44.3) U/L,(23.3±11.5) μmol/l and (37.1±5.1) g/L,respectively,significantly different between the two groups(P<0.01);there were 19 cases (47.5%) having complications after operation in the ERAS group,much lower than 29 cases(72.5%) in the control group(P<0.05). Conclusion ERAS in the perioperative management of patients with portal hypertension is effective and safe,which might accelerate the recovery of patients.

Key words: Portal hypertension, Enhanced recovery after surgery, Splenectomy, Pericardial devascularization, Recovery