基于ERAS理念的心肺功能路径化管理在老年人腹腔镜胆囊切除围术期的应用研究OACSTPCD
Application of ERAS Concept-based Cardiopulmonary Function Pathway Management during Perioperative Period of Laparoscopic Cholecystectomy in Elderly Patients
目的 探究基于快速康复外科(ERAS)理念的心肺功能路径化管理在老年人腹腔镜胆囊切除围术期的应用效果.方法 选取2019 年11 月—2022 年11 月收治的150 例老年腹腔镜胆囊切除术患者,按随机数字表法分为观察组和对照组,各75 例,对照组采用常规围术期干预方案,观察组在此基础上实行基于ERAS理念的心肺功能路径化管理.对比2 组术后恢复情况(下床活动时间、首次肛门排气时间、术后住院时间),术前及出院前1d疼痛情况[视觉模拟评分法(VAS)]和日常生活活动能力[日常生活活动能力量表(ADL)]、心肺功能指标[无氧阀(AT)、最大摄氧量(VO2 max)、峰值氧脉搏(O2 Ppeak)、左心室射血分数(LVEF)]及并发症发生情况.结果 观察组下床活动时间、首次肛门排气时间及术后住院时间均短于对照组(P＜0.01);出院前1d观察组VAS评分低于对照组,ADL评分高于对照组(P＜0.05,P＜0.01);出院前1d观察组AT、VO2 max、O2 Ppeak、LVEF均高于对照组(P＜0.05,P＜0.01).观察组围术期肺部感染、胸腔积液、心力衰竭总发生率低于对照组(P＜0.05).结论 基于ERAS理念的心肺功能路径化管理可有效促进老年腹腔镜胆囊切除术患者术后康复,改善心肺功能,减少并发症.
Objective To explore the application effect of cardiopulmonary function pathway management based on the concept of enhanced recovery after surgery(ERAS)during the perioperative period of laparoscopic cholecystectomy in eld-erly patients.Methods A total of 150 elderly patients undergoing laparoscopic cholecystectomy in our hospital from Novem-ber 2019 to November 2022 were selected and divided into observation group(n=75)and control group(n=75)by the ran-dom number table method.The control group was given routine perioperative intervention regimen,while the observation group was given ERAS concept-based cardiopulmonary function pathway management on this basis.The postoperative recovery status(the first time of off-bed activity,the time of first anal exhaust,length of postoperative hospital stay),pain status[Visual An-alogue Scale(VAS)]and activities of daily living[Activities of Daily Living Scale(ADL)],cardiopulmonary function indi-cators[anaerobic threshold(AT),maximum oxygen uptake(VO2 max),peak oxygen pulse(O2 Ppeak),left ventricular ejec-tion fraction(LVEF)]before operation and at 1 d before hospital discharge and complications were compared between groups.Results The first time of off-bed activity,the time of first anal exhaust and the length of postoperative hospital stay in the ob-servation group were shorter than those in the control group(P＜0.01).VAS score of observation group was lower than con-trol group,while ADL score was higher than control group at 1 d before discharge(P＜0.05,P＜0.01).AT,VO2max,O2 Ppeak and LVEF in observation group were higher than those in control group at 1 d before discharge(P＜0.05,P＜0.01).The total incidence of perioperative pulmonary infection,pleural effusion and heart failure in observation group was lower than that in control group(P＜0.05).No serious complications such as biliary fistula and abdominal infection occurred in the two groups.Conclusion ERAS concept-based cardiopulmonary function pathway management can effectively promote the postop-erative rehabilitation of elderly patients undergoing laparoscopic cholecystectomy,improve the cardiopulmonary function and reduce the complications.
马国峰;吴玉
226001 江苏南通,南通市老年康复医院普外一科226001 江苏南通,南通市老年康复医院综合病区
临床医学
快速康复外科心肺功能胆囊切除术,腹腔镜疼痛,手术后生活质量最大摄氧量峰值氧脉搏左心室射血分数
Enhanced recovery after surgeryCardiopulmonary functionCholecystectomy,laparoscopicPain,postoperativeQuality of lifeMaximum oxygen uptakePeak oxygen pulseLeft ventricular ejection fraction
《临床误诊误治》 2024 (007)
43-47 / 5
江苏省老年健康科研项目(LKM2022063)
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