【作者】 李颖；

【导师】 宋焱峰；

【作者基本信息】 兰州大学 ， 人体解剖与组织胚胎学， 2018， 硕士

【摘要】 目的研究结直肠癌患者围手术期应用快速康复外科理念的临床效果。方法1.病例选择:回顾性选择接受腹腔镜结直肠癌根治术治疗的结直肠癌患者60例,纳入标准:(1)术前确诊为结直肠癌;(2)年龄35~75岁;(3)无心脑血管系统、免疫系统及内分泌系统疾病,无手术禁忌证;(4)符合腹腔镜结直肠癌根治术标准;(5)患者及家属同意参加本研究并签署知情同意书;(6)术前患者戒酒、戒烟14天以上,术前经过良好宣教,无焦虑,依从性好。2.分组:用随机数字表法将60例患者分为研究组和对照组,研究组采用快速康复外科理念管理,对照组采用传统结直肠外科理念管理。3.观察指标:(1)两组患者术中生命体征对比;(2)两组患者术中全麻药物用量及输血输液量比较;(3)两组患者术后麻醉苏醒时间比较;(4)两组患者术后48h镇痛效果比较;(5)两组患者术中误吸及术后并发症比较;(6)两组患者术后住院日、住院费用、再入院及再入院率比较。4.统计学方法:应用Excel 2007软件录入数据,采用SPSS19.0软件进行统计学处理。计量资料以均数±标准差(x±s)表示,两均值比较采用t检验,多样本均数比较采用方差分析。以P<0.05为差异有统计学意义。结果1.研究组和对照组在性别、年龄上差异无显著性(P>0.05)。2.术中生命体征比较:研究组患者术中探查瘤体时及气管插管拔管后1min心率、平均动脉压、中心静脉压,明显低于入手术室即刻、气管插管后1min、切皮时(P﹤0.05);对照组患者术中探查瘤体时及气管插管拔管后1min的心率、平均动脉压、中心静脉压,明显高于入手术室即刻、气管插管后1min、切皮时(P﹤0.05)。研究组探查及拔管后1min心率、平均动脉压、中心静脉压,明显低于对照组(P<0.05)。3.研究组术中全麻药物用量、输血输液量,明显低于对照组(P<0.05)。4.研究组术后自主呼吸恢复时间、拔管时间及达steward4分时间,明显低于对照组(P<0.05)。5.研究组患者术后48h VAS评分0-3分、4-6分、7-10分例数,明显低于对照组(P<0.05)。6.研究组手术中误吸及手术后并发症发生例数、发生率,明显低于对照组(P<0.05)。7.研究组手术后住院日、住院费用、再入院及再入院率,明显低于对照组(P<0.05)。结论在结直肠癌围手术期中应用快速康复外科理念有明显优势,与传统结直肠外科理念相比术中生命体征平稳,药物及输液量少,术毕苏醒快,镇痛完善,术后并发症少,住院时间短,住院费用低,再入院率低,对促进患者术后恢复安全、可行,具有良好的临床效果。更多还原

【Abstract】 ObjectiveTo research the clinical effect of applying enhanced recovery after surgery during the perioperative period of colorectal cancer.Method:1.Case selection: 60 cases of patients with colorectal cancer underwent laparoscopic radical resection of colorectal cancer was retrospective selected.Inclusion criteria:(1)Preoperative diagnosis was colorectal cancer;(2)Age ranges from 35~75;(3)No cardio-cerebrovascular disease,immune system disease and endocrine system diseases,and no surgical contraindications;(4)In accordance with the standard of laparoscopic colorectal cancer radical resection;(5)Patients and their families agreed to participate in this study and signed informed consent;(6)Before the operation,the patients gave up drinking and smoking for more than 14 days,and they were well educated before the operation and freed of anxiety and good in compliance.2.Divide into groups: 60 patients were divided into study group and control group by random number table method.The study group was managed with the concept of enhanced recovery after surgery(ERAS),and the control group was managed by traditional colorectal surgery.3.Observation index:(1)Comparison of intraoperative vital signs between the two groups;(2)Comparison of two groups of patients with the amount of general anesthesia drug and metachysis and transfusion volume;(3)Comparison of postoperative awakening time between two groups of patients;(4)Comparison of analgesic effect of 48 hours after operation between two groups;(5)The incidence of intraoperative aspiration and postoperative complications between the two groups;(6)The postoperative hospitalization days,hospitalization expenses;re-admission and re-admission rate were compared between the two groups.4.Statistical methods: Excel 2007 Software was applied to input data,and SPSS19.0 software was used to conduct the statistical analysis.The measurement data is expressed as mean ± standard deviation,T test was used to compare the mean of value,multiple sample meanings were compared using variance analysis.P <0.05 for the difference was statistically significant.Results:1.There was no significant difference in sex and age between the study group and the control group(P>0.05)2.Comparison of intraoperative vital signs.The heart rate,mean arterial pressure and central venous pressure measured in the study group during surgery when exploring tumors and one minute after trachea cannula was extubated was apparently lower than that into the operating room immediately,one minute after tracheal intubation was introduced into and the time of skin cutting(p < 0.05);the heart rate,mean arterial pressure and central venous pressure in the control group during surgery when exploring tumors and one minute after trachea cannula was extubated was apparently higher than that into the operation room immediately,one minute after tracheal intubation was introduced into,and the time of skin incision(P < 0.05).The heart rate,mean arterial pressure and central venous pressure of the study group during surgery when exploring tumors and one minute after trachea cannula was extubated were significantly lower than those of the control group.3.The amount of general anesthesia drag,metachysis and transfusion volume in the study group were significantly lower than those in the control group.4.Spontaneous breathing recovery time,extubation time and the time of achieved steward4 in the study group were significantly lower than those in the control group.5.The number of cases in the study group that patient’s VAS scored 0-3 points,4-6 points,7-10 points at 48 hours after operation was significantly lower than that in the control group.6.The number of cases and incidence of intraoperative aspiration and postoperative complications in the study group was significantly lower than that in the control group.7.The postoperative hospitalization days,hospitalization expenses and re-admission rate of the study group were significantly lower than those of the control group.Conclusion:There is an obvious advantage in the application of ERAS concept in colorectal cancer operation during the perioperative period.Compared with the traditional concept of colorectal surgery,it has apparently advantage with stable vital signs,less medicine and infusion during intraoperative period,quicker recovery after the operation,perfect analgesia,decrease complications,short hospitalization time,low hospitalization expense and low readmission rate.It is feasible and safe to promote the recovery of postoperative patients,and has good clinical effect.更多还原