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中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 444 -446. doi: 10.3877/cma.j.issn.1674-3946.2021.04.025

论著

ERAS对胆囊结石合并胆总管结石患者术后康复及应激因子的影响
张娟1, 张艳芳2, 马静1, 杨雷1, 吴华彰3, 李灵艳2, 叶枫林4,()   
  1. 1. 233000 蚌埠市第一人民医院普外科
    2. 233004 蚌埠医学院第一附属医院肝胆外科
    3. 233030 蚌埠医学院生命科学院
    4. 233004 蚌埠医学院第一附属医院外科
  • 收稿日期:2021-05-02 出版日期:2021-08-17
  • 通信作者: 叶枫林

Effect of ERAS on postoperative rehabilitation and stress factors in patients with cholecystolithiasis and choledocholithiasis

Juan Zhang1, Yanfang Zhang2, Jing Ma1, Lei Yang1, Huazhang Wu3, Lingyan Li2, Fenglin Ye4,()   

  1. 1. 233000 Department of General Surgery, First People's Hospital of Bengbu City
    2. Department of Hepatobiliary Surgery of the First Affiliated Hospital of Bengbu Medical College
    3. 233030 College of Life Sciences, Bengbu Medical College
    4. 233004 Department of Surgery of the First Affiliated Hospital of Bengbu Medical College
  • Received:2021-05-02 Published:2021-08-17
  • Corresponding author: Fenglin Ye
  • Supported by:
    The Natural Science Foundation of Anhui Province in 2019(1908085MH257)
引用本文:

张娟, 张艳芳, 马静, 杨雷, 吴华彰, 李灵艳, 叶枫林. ERAS对胆囊结石合并胆总管结石患者术后康复及应激因子的影响[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(04): 444-446.

Juan Zhang, Yanfang Zhang, Jing Ma, Lei Yang, Huazhang Wu, Lingyan Li, Fenglin Ye. Effect of ERAS on postoperative rehabilitation and stress factors in patients with cholecystolithiasis and choledocholithiasis[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(04): 444-446.

目的

探究加速康复外科(ERAS)对胆囊结石合并胆总管结石患者术后康复及应激因子的影响。

方法

选取71例胆囊结石合并胆总管结石患者,分别纳入ERAS组(n=35)、常规组(n=36),常规组接受围术期常规康复干预,ERAS组接受ERAS理念的围术期干预,两组患者均接受腹腔镜胆囊切除+胆总管切开+胆道镜探查取石+胆总管Ⅰ期缝合或T管引流治疗,手术均由同组医师完成。使用SPSS 22.0软件分析数据,围术期各项指标、肝功能和炎症因子指标以(±s)表示,独立t检验;并发症发生率采用χ2检验,P<0.05差异有统计学意义。

结果

ERAS组术后排气时间、术后排便时间、术后补液总量、术后住院时间、住院费用和术后并发症发生率均低于常规组(P<0.05)。两组患者术后3 d谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TBIL)均较术前下降,ERAS组下降更为明显;两组患者术后3 d白细胞介素-6 (IL-6)、肿瘤坏死因子-α(TNF-α)、肾素(PRA)、血管紧张素-2(Ang-2)、醛固酮(ALD)均较术前上升,IL-10均较术前下降,常规组变化更为明显(P<0.05)。

结论

基于ERAS理念开展围术期管理,能促进胆囊结石合并胆总管结石患者腹腔镜术后早期康复,减轻炎症反应与应激反应,并提高手术安全性。

Objective

To analyze the effect of enhanced recovery after surgery (ERAS) on postoperative rehabilitation and stress factors of patients with cholecystolithiasis complicated with choledocholithiasis.

Methods

Seventy-one patients with cholecystolithiasis complicated with choledocholithiasis were divided into ERAS group (n=35) and routine group (n=36). The routine group received routine perioperative rehabilitation intervention, while ERAS group received perioperative intervention based on ERAS concept. Both groups received laparoscopic cholecystectomy+ choledocholithotomy+ choledochoscope exploration+ primary suture of common bile duct or T\\tube drainage, and all the operations were performed by doctors in the same group. SPSS 22.0 software was used to analyze the data. The indexes of intraoperative and postoperative liver function and inflammatory factors were expressed as (±s), and independent t test was performed. The incidence of complications was tested by χ2 tests. The difference was statistically significant (P<0.05).

Results

The postoperative exhaust time, postoperative defecation time, postoperative rehydration amount, postoperative hospitalization time, hospitalization expenses and postoperative complication rate in ERAS group were lower than those in routine group (P<0.05). AST, ALT and TBIL decreased 3 days after operation, On the 3rd day after operation, IL-6 and TNF-α increased and IL-10 decreased in both groups, especially in the routine group (P<0.05). The PRA, Ang-2, ALD in the two groups increased 3 days after operation, especially in the routine group (P<0.05).

Conclusion

Perioperative management based on ERAS concept can promote early rehabilitation of patients with cholecystolithiasis complicated with choledocholithiasis after laparoscopic surgery, reduce inflammatory reaction and stress reaction, and improve surgical safety.

表1 71例胆囊结石合并胆总管结石患者不同围术期处理两组基线资料比较(±s)
表2 71例胆囊结石合并胆总管结石患者不同围术期处理两组患者术后各项指标比较(±s)
表3 71例胆囊结石合并胆总管结石患者不同围术期处理两组患者术后并发症发生率比较(例)
表4 71例胆囊结石合并胆总管结石患者不同围术期处理两组患者肝功能变化比较(±s)
表5 71例胆囊结石合并胆总管结石患者不同围术期处理两组患者炎症因子水平变化比较[(±s), pg/ml]
表6 71例胆囊结石合并胆总管结石患者不同围术期处理两组患者应激指标变化比较(±s)
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