加速康复外科理念在急性胆囊炎围手术期的应用价值

摘要/Abstract

摘要： 目的探讨加速康复外科理念治疗急性胆囊炎的临床疗效,并分析术后胃肠道功能恢复、术后疼痛情况及机体应激状态。方法选择2018年6月~2021年6月北京大学首钢医院收治的100例急性胆囊炎患者为研究对象,采用随机数表法平均分为观察组与对照组,每组50例。对照组围手术期给予常规外科管理,观察组给予加速康复外科理念管理。比较两组术后胃肠道功能恢复情况及并发症发生情况,于术后6 h、12 h、24 h采用疼痛视觉模拟评分评价患者疼痛状态,并采用酶联免疫吸附法检测血清白细胞介素-1β（IL-1β）、肿瘤坏死因子（TNF-α）水平。结果观察组术后肠鸣音恢复时间、排便时间、肛门排气时间、下地活动时间、住院时间均较对照组短,差异有统计学意义（P<0.05）。术后观察组并发症发生率明显低于对照组,差异有统计学意义（P<0.05）。随着时间延长,两组疼痛视觉模拟评分均逐渐降低;术后6 h、12 h及24 h观察组疼痛视觉模拟评分均低于对照组,差异有统计学意义（P<0.05）。术后24 h两组IL-1β及TNF-α水平均较术后6 h降低;术后6 h两组IL-1β及TNF-α水平比较,差异无统计学意义（P>0.05）;术后24 h观察组IL-1β及TNF-α水平均低于对照组,差异有统计学意义（P<0.05）。结论加速康复外科理念可以促进急性胆囊炎患者术后胃肠道功能恢复,降低术后疼痛程度及缩短持续时间,降低并发症发生风险及机体应激反应程度,值得临床应用。

关键词: 加速康复外科理念, 急性胆囊炎, 围手术期, 并发症

Abstract: Objective To explore the clinical efficacy of the concept of enhanced recovery after surgery in the treatment of acute cholecystitis, and to analyze the effects of postoperative gastrointestinal function recovery, postoperative pain and the body's stress state. Methods A total of 100 patients with acute cholecystitis from June 2018 to June 2021 admitted to Peking University Shougang Hospital were selected for study, and were randomly divided into the observation group and the control group, with 50 cases in each group. The control group was given routine surgical management during the perioperative period, and the observation group was given enhanced recovery surgery concept management. The postoperative gastrointestinal function recovery and complications were compared. The pain visual analogue scale was used to evaluate the pain status of patients after 6 h, 12 h and 24 h operation, and levels of IL-1β and tumor necrosis factor were detected by enzyme-linked immunosorbent assay after 6 h and 24 h operation. Results The postoperative bowel sounds recovery time, defecation time, anal exhaust time, ground activity time and hospital stay in the observation group were significant shorter than those in the control group (P<; 0.05). The incidence of postoperative complications in the observation group was significant lower than that in the control group (P<; 0.05). With the prolongation of time, the pain visual analog scores in the two groups gradually decreased, and the pain visual analog scores in the observation group were lower than those in the control group after 6 h, 12 h and 24 h operation, respectively. The levels of interleukin-1β and tumor necrosis factor in the two groups after 24 h operation were lower than those after 6 h. There was no significant difference in the levels of interleukin-1β and tumor necrosis factor between the two groups after 6 h operation. Moreover, the levels of interleukin-1β and tumor necrosis factor in the observation group were lower than those in the control group after 24 h operation. Conclusion The concept of enhanced recovery after surgery could promote the earlier recovery of postoperative gastrointestinal function in patients with acute cholecystitis, and reduce the degree and duration of postoperative pain, the risk of complications and the degree of stress response of the body, which is worthy of clinical application.;

Key words: enhanced recovery after surgery concept, acute cholecystitis, perioperative period, complications

中图分类号:

R711.7

钟波, 王海, 荣万水, 赵晓丽, 祝振忠. 加速康复外科理念在急性胆囊炎围手术期的应用价值[J]. 中华养生保健, 2022, 40(8): 1-4.

ZHONG Bo, WANG Hai, RONG Wan-shui, ZHAO Xiao-li, ZHU Zhen-zhong. The Application Value of the Concept of Enhanced Recovery after Surgery in the Perioperative Period of Acute Cholecystitis[J]. ZHONGHUA YANGSHENG BAOJIAN, 2022, 40(8): 1-4.

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