古桂芳?李志珍?李秀玲?古红珍?张冬青?钟丽清

【摘要】目的 探讨个性化的改良加速康复外科（ERAS）方案在二级医院腹部微创手术患者围术期的实施方法与效果。方法 选择在二级医院行腹部微创手术的102例患者，分为观察组51例和对照组49例，对照组患者围术期采用传统的ERAS处理方案，观察组患者围术期采用个性化的改良ERAS处理方案，比较2组患者临床指标及术后并发症发生情况。结果 与对照组相比，观察组术后排气时间较早、术后24 h 疼痛视觉模拟评分较低、住院时间较短（P均< 0.05）。观察组恶心、呕吐、腹胀、肠梗阻及术后低体温等并发症的发生率均低于对照组（P均< 0.05）。结论 在二级医院运用个性化的改良ERAS方案，可减少腹部微创手术患者术后并发症的发生，促进患者早期康复，缩短住院时间。

【关键词】改良;加速康复外科;微创手术;围术期;并发症

Perioperative implementation and effect evaluation of enhanced recovery after surgery for patients undergoing minimally invasive abdominal surgery in secondary hospitals Gu Guifang， Li Zhizhen， Li Xiuling， Gu Hongzhen， Zhang Dongqing， Zhong Liqing. Wuhua County Peoples Hospital， Meizhou 514400， China

Corresponding author， Zhong Liqing， E-mail： whxhlb@ 126. com

【Abstract】Objective To evaluate the implementation method and effect of enhanced recovery after surgery （ERAS） for patients undergoing minimally invasive abdominal surgery in secondary hospitals. Methods A total of 102 patients undergoing minimally invasive abdominal surgery were divided into the observation group （n = 51） and control group （n = 49）. Patients in the control group were treated with conventional ERAS during the perioperative period， and those in the observation group received modified ERAS. Clinical parameters and the incidence of postoperative complications were statistically compared between two groups. Results Compared with the control group， postoperative exhaust time was significantly earlier， VAS score at postoperative 24 h was remarkably lower and the length of hospital stay was considerably shorter in the observation group （all P < 0.05）. The incidence of vomiting， abdominal distension， intestinal obstruction， postoperative hypothermia and other complications in the observation group was significantly lower than that in the control group （all P < 0.05）. Conclusion Application of modified and individualized ERAS in secondary hospitals can reduce the incidence of postoperative complications， accelerate early recovery and shorten the length of hospital stay of patients treated with minimally invasive abdominal surgery.

【Key words】Modified;Enhanced recovery after surgery;Minimally invasive surgery;

Perioperative period;Complication

微創手术是腹部外科疾病的革命性创新治疗方法，目前腹部微创手术日趋成熟，因其具有创伤小、手术时间短等特点在临床广泛使用[1]。但是，腹部微创手术面临呕吐、肠梗阻、感染等并发症的风险。加速康复外科（ERAS）基于循证，通过多学科协作方式，尽量降低患者的应激反应、并发症，提高手术安全性和患者生存质量[2]。ERAS在我国不断推广应用，但由于多种因素影响，其可行性及有效性不一，加之二级医院普遍存在各专科医务人员人力不足，会诊流程欠完善等，多学科合作模式受限。本研究在传统ERAS基础上，针对二级医院有限的医疗资源，实施个性化的改良ERAS方案，现将实施过程及结果报告如下。

对象与方法

一、研究对象

选择从2018年1月至2020年12月在我院行腹部微创手术的102例患者。病例纳入标准：具有微创手术适应证;患者及家属同意参与研究。……