摘要
目的:探讨腹腔镜胃袖状切除术围手术期安全、可行的加速康复干预措施及临床路径。方法:回顾分析2020年8月至2022年8月为61例患者行腹腔镜胃袖状切除术的临床资料,按照围手术期干预措施分为对照组(n=30,执行常规管理模式)与试验组(n=31,执行加速康复干预措施与临床路径管理)。对比分析两组手术相关指标、术后48 h实验室指标及手术并发症情况(Ⅰ~Ⅱ级:发热、切口感染、严重呕吐、上腹疼痛、肺部感染、胸腔积液、肺不张;Ⅲ~Ⅳ级:消化道瘘、腹腔出血、腹腔感染、深静脉血栓;Ⅴ级:死亡)。结果:两组手术时间、手术出血量差异无统计学意义(P>0.05);试验组术后首次下床时间、术后胃管留置时间、术后首次排气时间、术后首次进食时间、住院时间、术后住院时间、住院费用均少于对照组,差异有统计学意义(P<0.05);两组术后48 h白细胞计数、乳酸、血氧饱和度、血清钠、血清钾、白蛋白、甘油三酯、尿酸水平差异无统计学意义(P>0.05);试验组降钙素原水平高于对照组(P<0.05);Ⅰ~Ⅱ级手术并发症试验组少于对照组(P<0.05);两组均未发生Ⅲ~Ⅴ级手术并发症。结论:腹腔镜胃袖状切除术围手术期采用加速康复干预措施及临床路径具有可行性。
Objective:To explore the safe and feasible enhanced recovery interventions and clinical pathways during the peri-operative period of laparoscopic sleeve gastrectomy.Methods:The clinical data of 61 patients undergoing laparoscopic sleeve gastrectomy from Aug.2020 to Aug.2022 were retrospectively analyzed.The patients were divided into 2 groups:the control group(n=30,implementing the conventional management model)and the experimental group(n=31,implementing the enhanced recovery interventions and clinical pathway management).The operation-related indexes,postoperative 48 h laboratory indexes and the surgical complications during hospitalization(GradeⅠ-Ⅱ:fever,incisional infection,severe vomiting,epigastric pain,pulmonary infection,pleural effusion,a telectasis;GradeⅢ-Ⅳ:gastrointestinal fistula,abdominal bleeding,abdominal infection,deep vein thrombosis;GradeⅤ:death)in the two groups were compared and analyzed.Results:There was no statistically significant difference between the two groups in terms of o perative time and surgical blood loss(P>0.05);the time to first ambulation after surgery,time of postoperative gastric tube indwelling,time to first postoperative venting,time to first postoperative feeding,hospital stay,postoperative hospital stay and hospitalization cost were less in the experimental group than those in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the levels of white blood cell count,lactate,oxygen saturation,serum sodium,serum potassium,albumin,triglyceride and uric acid at 48 h postoperatively between the two groups(P>0.05).The level of procalcitonin in the experimental group was higher than that in the control group(P<0.05).The gradeⅠtoⅡsurgical complications were fewer in the experimental group than those in the control group(P<0.05).No gradeⅢtoⅤsurgical complications occurred in both groups.Conclusions:The enhanced recovery interventions and associated clinical pathways during the perioperati
作者
朱江
曾维兴
何荣东
吴警
庄云峰
黄海军
蒋铁民
ZHU Jiang;ZENG Wei-xing;HE Rong-dong(Department of Hepatobiliary&Hydatid Diseases,Digestive&Vascular Surgery Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Abdominal Surgery,the Third People's Hospital of Xinjiang Uygur Autonomous Region;Department of General Surgery,Zepu County People's Hospital of Kashgar Region)
出处
《腹腔镜外科杂志》
2023年第6期401-406,共6页
Journal of Laparoscopic Surgery
基金
新疆维吾尔自治区自然科学基金面上项目(2020D01A113)
新疆维吾尔自治区第三人民医院科研基金(2019ZYBYK01)。
关键词
袖状胃切除术
腹腔镜检查
围手术期
加速康复
临床路径
Sleeve gastrectomy
Laparoscopy
Perioperative period
Enhanced recovery
Critical pathways
