【摘要】 目的探讨加速康复外科(enhanced recovery after surgery,ERAS)对腹腔镜胃癌根治术患者预后、负面情绪及心理应激的影响。方法选取2016年1月至2018年5月于铜陵市人民医院拟择期行腹腔镜胃癌根治术的130例患者为研究对象,采用随机数表法将入选患者分为观察组和对照组,每组各65例。对照组患者采用传统围术期干预,观察组患者在围术期给予ERAS综合干预。比较两组患者预后指标及手术前后不同时间点汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、应激反应问卷(stress response questionnaire,SRQ)各维度评分。结果全部患者均顺利完成腹腔镜胃癌根治术,观察组患者首次排气时间、首次进食时间、下床活动时间、胃管拔除时间、术后住院天数均显著短于对照组(P_均<0.05)。观察组患者术前1 h、术后48 h HAMA、HAMD及SRQ各维度评分均显著低于本组入院即刻(P_均<0.05),对照组患者术前1 h SRQ躯体反应评分及术后48 h HAMA、HAMD、SRQ各维度评分均显著低于本组入院即刻(P_均<0.05)。观察组患者术前1 h、术后48 h HAMA、HAMD及SRQ各维度评分均显著低于同期对照组(P_均<0.05)。结论 ERAS能显著促进腹腔镜胃癌根治术患者的胃肠道功能恢复,改善预后,明显缓解患者围术期的焦虑和抑郁情绪,减轻心理应激反应,值得临床推广应用。更多还原

【Abstract】 Objective To investigate the effect of enhanced recovery after surgery（ERAS） on prognosis, negative emotion and psychological stress in patients with undergoing laparoscopic radical resection of gastric carcinoma. Method 130 patients underwent laparoscopic radical resection of gastric carcinoma in Tongling People’s Hospital from January 2015 to December 2017 were enrolled for the study and divided into observation group and control group according to random number table method, 65 cases in each group. Patients in control group were given traditional perioperative intervention, patients in observation group were given ERAS comprehensive intervention. The postoperative recovery indexes, scores of Hamilton depression scale（HAMD）, Hamilton anxiety scale（HAMA） and stress response questionnaire（SRQ） were compared between two groups at different time points. Result All patients successfully completed laparoscopic radical resection of gastric carcinoma. The first exhaust time, first eating time, time of beginning get out of bed, stomach tube extubation time, postoperative hospitalization days in observation group were significantly shorter than those in control group(P_all< 0.05). The scores of HAMA, HAMD and all dimensions of SRQ at 1 hour before operation and 48 hours after operation in observation group were significantly lower than those at hospitalization(P_all< 0.05), while somatic reaction score of SRQ at 1 hour before operation, scores of HAMA, HAMD and all dimensions of SRQ at 48 hours after operation in control group were significantly lower than those at hospitalization(P_all< 0.05). The scores of HAMA, HAMD and all dimensions of SRQ at 1 hour before operation and 48 hours after operation in observation group were significantly lower than those in control group at the same time(P_all< 0.05). Conclusion ERAS can significantly promote the recovery of gastrointestinal function and improve prognosis in patients with gastric cancer undergoing laparoscopic radical resection of gastric carcinoma, and it also can significantly alleviate perioperative anxiety, depression and psychological stress reaction, whose effect is satisfactory and worthy of clinical application.更多还原