加速康复外科在老年人腹腔镜胆囊切除术围手术期的应用分析

张勇; 陈延山

doi:10.3969/j.issn.1001-5256.2014.12.015

加速康复外科在老年人腹腔镜胆囊切除术围手术期的应用分析

DOI: 10.3969/j.issn.1001-5256.2014.12.015

张勇,
陈延山

嘉峪关市第二人民医院普通外科

详细信息

中图分类号: R657.4
计量
- 文章访问数: 1848
- HTML全文浏览量: 11
- PDF下载量: 489
- 被引次数: 0
出版历程
- 收稿日期: 2014-06-19
- 出版日期: 2014-12-20

Application of fast track surgery in elderly patients during perioperative period of laparoscopic cholecystectomy

Department of General Surgery, The Second People 's Hospital of Jiayuguan City

摘要

摘要:
目的探讨老年人腹腔镜胆囊切除术（LC）应用加速康复外科（FTS）措施的安全性和优越性。方法收集嘉峪关市第二人民医院普外科2010年1月-2014年3月进行LC的124例老年人的临床资料。其中62例为FTS组,62例为传统方法组,对比研究两组术后患者肛门通气时间、进食和下床活动、住院时间等恢复情况,并对手术结果、不良反应等给予记录。计量资料组间比较采用独立样本的t检验,计数资料采用χ2检验。结果 FTS组术后患者较传统方法组患者术后肛门排气时间短[（8.5±1.5）h vs（16.3±2.4）h]、术后进食时间短[（5.5±1.5）h vs（19.5±2.5）h]、术后下床活动时间早[（7.5±1.5）h vs（12.8±3.5）h]、住院天数少[（5.88±1.56）d vs（8.96±1.24）d]、术后心脑并发症发生率低（4.83%vs 16.13%）,差异均有统计学意义（P值均<0.05）。结论 LC应用FTS措施对老年患者术后早期恢复更加积极有效。
- 加速康复外科 /
- 胆囊切除术,腹腔镜 /
- 围手术期护理 /
- 老年人
Abstract:
Objective To investigate the safety and superiority of fast track surgery (FTS) in elderly patients during the perioperative period of laparoscopic cholecystectomy (LC) . Methods The clinical data of 124 elderly patients who underwent LC at the Department of General Surgery in our institution between January 2010 and March 2014 were assessed, with 62 cases assigned to FTS group and 62 cases to conventional method group. Anal exhaust time, feeding time, off-bed activity time, and length of hospital stay were compared between the two groups, and postoperative results and adverse reactions were recorded. Continuous data were analyzed using the independent-samples t test, and categorical data were compared using the chi-square test. Results Compared with the control method group, patients in the FTS group showed earlier postoperative anal exhaust, feeding, and off-bed activity, a shorter length of hospital stay, and a lower incidence of postoperative cardiovascular and cerebrovascular complications (P < 0. 05) . Conclusion FTS is an effective approach to accelerate rehabilitation in elderly patients after LC.
- fast track surgery /
- cholecystectomy, laparoscopic /
- perioperative nursing /
- aged

HTML全文

参考文献(16)

[1]HUANG ZQ.Present status of biliary surgery in the era of minimally invasive surgery[J].Chin J Pract Surg, 2011, 31 (1) :1-3. (in Chinese) 黄志强.微创外科时代的胆道外科-胆囊切除术尚非平安无事[J].中国实用外科杂志, 2011, 31 (1) :1-3.

[2]KEHLET H, WILMORE DW.Muhimodal strategies to improve surgical outcome[J].Am J Surg, 2002, 186 (6) :630-641.

[3]SUN W, CHEN AS, CAO XK, et al.Influence of early oral feeding after laparoscopic surgery in functional status and gastrointestinal living quality of patients with colorectal cancer[J].J Jilin Univ:Med Edit, 2014, 40 (4) :855-860. (in Chinese) 孙威, 陈爱山, 曹献馗, 等.腹腔镜术后早期经口进食对结直肠癌患者功能状态和胃肠生存质量的影响[J].吉林大学学报:医学版, 2014, 40 (4) :855-860.

[4]SOOP M, NYGREN J, MYRENFORS P, et al.Preoperative oral carbohydrate treatment attenuates immediate postoperative insulin resistance[J].Am J Physiol Endocrinol Metab, 2001, 280 (4) :e576-e583.

[5]MANNING BJ, WINTER DC, MCGREAL G, et al.Nasogastric intubation causes gastroesophageal reflux in patients undergoing elective lapamtomy[J].Surgery, 2001, 130 (5) :788-791.

[6] LIU J, XU JG.Analgesic effects of lornoxicam for upper abdominal surgery[J].Chin J New Drugs, 2004, 13 (Suppl) :16-19. (in Chinese) 刘建, 徐建国.氯诺昔康用于上腹部手术术后镇痛的临床研究[J].中国新药杂志, 2004, 13 (Suppl) :16-19.

[7]FU ZQ, LYU GY, DENG NF.Research on clinical pharmacodynamics of flurbiprofen axetil for postoperative analgesia in patients undergoing laparoscopic operation[J].J China-Japan Friendship Hosp, 2008, 22 (5) :279-281. (in Chinese) 付志强, 吕国义, 邓迺封.氟比洛芬酯用于腹腔镜术后镇痛临床药效学研究[J].中日友好医院学报, 2008, 22 (5) :279-281.

[8]ALEXANDER JW, FISCHER JE, BOYAJIAN M, et al.The influence of hair-removal methods on wound infections[J].Arch Surg, 1983, 118 (3) :347-352.

[9]ZHENG MH.Progress and developing tendency of microtraumatic surgery[J].Chin J Pract Surg, 2002, 22 (1) :16-17. (in Chinese) 郑民华.微创外科的进展和发展趋势[J].中国实用外科杂志, 2002, 22 (1) :16-17.

[10]ZHU WM, LI N, LI JS.Fast track surgery[J].Chin J Pract Surg, 2007, 27 (1) :24-27. (in Chinese) 朱维铭, 李宁, 黎介寿.加速康复外科治疗[J].中国实用外科杂志, 2007, 27 (1) :24-27.

[11]SIDO B, GRENACHER L, FRIESS H, et al.Abdominal trauma[J].Orthopade, 2005, 34 (9) :880-888.

[12]BRANDSTRUP B.Fluid therpy for the surgical patient[J].Best Pract Res Clin Anaesthesiol, 2006, 20 (2) :265-283.

[13]HOLTE K, FOSS NB, ANDERSEN J, et al.Liberal or restrictive fluidadministration in fast-track colonic surgery:a randomized, doubleblind study[J].Br J Anaesth, 2007, 99 (4) :500-508.

[14]PETROWSKY H, DEMARTINES N, ROUSSON V, et al.Evidence-based value of prophylactic drainage in gastrointestinal surgery:a systematic review and meta-analyses[J].Ann Surg, 2004, 240 (6) :1074-1084.

[15]HE YN, LI GH, WNAG DY.Application of accelerated rehabilitation surgery in perioperative period of elderly laparoscopic rectal cancer[J].J Jinggangshan Univ:Natural Science, 2012, 33 (3) :86-88. (in Chinese) 贺咏宁, 李观华, 王冬芽.加速康复外科在老年腹腔镜结直肠癌围手术期中的应用[J].井冈山大学学报:自然科学版, 2012, 33 (3) :86-88.

[16]LIU HJ, WANG ZM, JIA YT, et al.Significance of fast track surgery for preventing postoperative delirium in elderly patients with colorectal cancer[J].Hebei Med J, 2011, 33 (4) :560-561. (in Chinese) 刘洪杰, 王志敏, 贾漪涛, 等.加速康复外科对预防老年结直肠癌患者手术后谵妄的意义[J].河北医药, 2011, 33 (4) :560-561.

施引文献

资源附件(0)

访问统计