加速康复外科对腹腔镜肾部分切除术患者术后康复及生命质量的影响
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1.南京医科大学公共卫生学院;2.南京医科大学第一附属医院;3.南京医科大学第二附属医院

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国家自然科学基金面上项目(81570676);江苏省泌尿外科医学重点学科;江苏省“333工程”培养资金资助项目(BRA2015478)


Effect of enhanced recovery after surgery on postoperative recovery and quality of life in patients undergoing laparoscopic partial nephrectomyYU Aimei <sub>1,2</sub>, MIAO Chenkui <sub>2</sub>, QIN Chao<sub>2</sub>, WANG Zengjun <sub>2</sub>, GU Min <sub>1,</sub><sub>2, </sub><sub>3,*</sub>
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1.School of Public Health, Nanjing Medical University;2.The First Affiliated Hospital of Nanjing Medical University;3.The second affiliated hospital of nanjing medical university

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    摘要:

    目的:探讨加速康复外科(enhanced recovery after surgery,ERAS)对腹腔镜肾部分切除术患者术后康复有效性及术后生命质量的影响。方法:选取2016年7月-2017年12月收住南京医科大学第一附属医院行腹腔镜肾部分切除术的213例患者,将患者随机分成两组,一组为ERAS实施组(110例),另一组采用传统处理方式为对照组(103例)。对比两组患者临床指标、术前与术后焦虑程度、抑郁程度,术后生活质量等指标。结果:两组患者均完成手术并顺利出院。两组患者在年龄、性别、体重、肿瘤类型及大小等基本资料无统计学意义。ERAS组手术时间、术中出血量与对照组无统计学差异。记录所有患者肠道恢复时间、首次排便时间,导尿管、引流管拔除时间,术后住院天数、住院费用及术后并发症情况,结果显示ERAS组皆明显优于对照组(P<0.01),两组患者术后首次排气时间无统计学差异。两组患者术前焦虑程度、抑郁程度无统计学差异(P>0.05),术后均较术前有所降低。ERAS组相较于对照组术后焦虑程度、抑郁程度显著降低,住院期间满意度也明显提高(P<0.01)。术后3个月后,ERAS组的躯体功能、角色功能、情感功能及综合功能等评分明显高于对照组(P<0.01),而在认知功能和社会功能方面无统计学差异。ERAS组在肾癌相关症状评分明显比对照组低,说明ERAS组肾癌相关症状方面明显好转。结论:对于腹腔镜肾部分切除患者围术期采用ERAS方案可以有效改善预后,并具有经济优势。同时能够有效降低患者住院期间的焦虑和抑郁程度,提高住院满意度和术后生命质量。

    Abstract:

    Objective: To investigate the effect of enhanced recovery after surgery (ERAS) on postoperative recovery and postoperative quality of life in patients undergoing laparoscopic partial nephrectomy. Methods: A total of 213 patients who underwent laparoscopic partial nephrectomy from the First Affiliated Hospital of Nanjing Medical University from July 2016 to December 2017 were randomly divided into two groups. One group was implemented by ERAS (110 cases), the other group used the traditional treatment as the control group (103 cases). The clinical indicators, preoperative and postoperative anxiety, degree of depression, and postoperative quality of life were compared between the two groups. Results: Both groups completed the operation smoothly. There were no significant differences in the basic data of age, sex, weight, tumor type and size between the two groups. There was no significant difference in the operation time and intraoperative blood loss between the ERAS group and the control group. Intestinal recovery time, first defecation time, catheterization time, drainage time, postoperative hospital stay, hospitalization cost and postoperative complication rate were significantly lower in the ERAS group than in the control group (P<0.01). There was no significant difference in the first exhaust time between the two groups. There was no significant difference in preoperative anxiety degree and degree of depression between the two groups (P>0.05), and the postoperative period was lower than that before surgery. Compared with the control group, the degree of anxiety and depression in the ERAS group were significantly lower, and the satisfaction during hospitalization was also significantly increased (P<0.01). After 3 months, the scores of physical function, role function, emotional function and comprehensive function of the ERAS group were significantly higher than those of the control group (P<0.01), but there was no statistical difference in cognitive function and social function. The scores of renal cancer-related symptoms in the ERAS group were significantly lower than those in the control group, indicating that the symptoms associated with renal cancer in the ERAS group were significantly improved. Conclusion: The application of ERAS in the perioperative period of patients undergoing laparoscopic partial nephrectomy can significantly shorten the length of hospital stay, reduce hospitalization costs, and reduce the incidence of complications. At the same time, it can effectively reduce the degree of anxiety and depression during hospitalization, improve hospitalization satisfaction and postoperative quality of life.

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  • 收稿日期:2018-08-01
  • 最后修改日期:2018-11-06
  • 录用日期:2019-01-11
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