加速康复外科理念下肝癌患者围术期全程胃肠道管理
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摘要
目的探讨加速康复外科(ERAS)理念下肝癌患者围术期全程胃肠道管理的效果。方法将78例肝癌手术患者按时间顺序分为对照组40例和干预组38例。对照组给予常规围术期胃肠道管理;干预组在ERAS理念下实施全程胃肠道管理,即入院后进行营养不良筛查及干预,术前加服碳水化合物,术后早期进食及营养支持,指导早期活动,嚼口香糖、足三里穴位按摩及小茴香热敷腹部等促进胃肠道功能恢复。结果干预组口渴、饥饿发生率显著低于对照组,首次下床时间及肠功能恢复时间显著提前,白蛋白及前白蛋白水平显著优于对照组,腹水及感染发生率显著低于对照组(P<0.05,P<0.01)。结论肝癌患者围术期实施ERAS全程胃肠道管理措施,安全有效,可加速患者术后康复。
Objective To implement measures for maintaining gastrointestinal function during enhanced recovery after surgery(ERAS) program on patients undergoing resection of hepatocellular carcinoma(HCC) and to evaluate the application effects. Methods Seventy-eight patients with HCC undergoing liver resection were assigned into two groups chronologically. The control group of 40 patients received routine perioperative care, while the intervention group of 38 patients were subjected to an ERAS program, in which whole-course measures regarding gastrointestinal function were implemented, including nutritional screening and intervention after admission, intake of carbohydrates before surgery, oral dietary intake and nutritional support after surgery as early as possible, early mobilization, gum chewing, massage of the Zusanli acupuncture point, and fomentation with fennel on the abdomen. Results The intervention group had lower incidence rates of thirst and hungry, earlier out-of-bed mobilization and recovery of gastrointestinal function, higher albumin and pre-albumin levels, and less ascites and infection compared with the control group(P<0.05, P<0.01). Conclusion The above measures implemented in ERAS program were safe and effective for patients undergoing liver resection for HCC, because it allowed maintaining of gastrointestinal function and promoted faster postoperative recovery.
Objective To implement measures for maintaining gastrointestinal function during enhanced recovery after surgery(ERAS) program on patients undergoing resection of hepatocellular carcinoma(HCC) and to evaluate the application effects. Methods Seventy-eight patients with HCC undergoing liver resection were assigned into two groups chronologically. The control group of 40 patients received routine perioperative care, while the intervention group of 38 patients were subjected to an ERAS program, in which whole-course measures regarding gastrointestinal function were implemented, including nutritional screening and intervention after admission, intake of carbohydrates before surgery, oral dietary intake and nutritional support after surgery as early as possible, early mobilization, gum chewing, massage of the Zusanli acupuncture point, and fomentation with fennel on the abdomen. Results The intervention group had lower incidence rates of thirst and hungry, earlier out-of-bed mobilization and recovery of gastrointestinal function, higher albumin and pre-albumin levels, and less ascites and infection compared with the control group(P<0.05, P<0.01). Conclusion The above measures implemented in ERAS program were safe and effective for patients undergoing liver resection for HCC, because it allowed maintaining of gastrointestinal function and promoted faster postoperative recovery.
引文
[1] 宋伟,邹书兵.加速康复外科在肝脏手术围手术期应用的Meta分析[J].中国普通外科杂志,2016,25(1):115-125.
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[8] 王乐,唐宏英,刘怡素.快速康复肠道管理措施在肝叶切除术患者中的应用[J].齐鲁护理杂志,2016,22(22):70-71.
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[10] 杨尹默.加速康复外科临床实践中应重视的几个问题[J].中国实用外科杂志,2018,38(1):34-36.
[11] 郑惊雷,王在国,陈刘镇,等.肝癌手术患者应用快速康复外科措施的效果分析[J].中华临床医师杂志(电子版),2016,10(1):16-19.
[12] 施姬,李雷雪,林巧,等.快速康复外科理念对胃肠道手术患者护理的意义[J].中国医学创新,2013,10(30):72-74.
[13] 首志雄,郑达武,罗永香,等.快速康复外科理念在肝癌肝切除术围手术期管理中的临床价值[J].中华消化外科杂志,2014,13(6):456-460.
[14] 严锦,王瑞兰,王继涛,等.基于快速康复外科理念的肝癌患者围术期护理流程应用[J].护理学杂志,2014,29(16):32-34.
[15] 许柳琴,陈瑜,郭秋兰,等.快速康复外科护理与传统护理在腹腔镜胆囊切除术围手术期的应用研究[J].护士进修杂志,2016,31(11):1008-1010.
[16] 姜梅.快速康复护理对肠道手术患者胃肠功能恢复的影响[J].中华现代护理杂志,2013,19(6):658-660.
[17] 王静,张丽霞,程瑜琳.表格式床旁护理日志的应用对胃癌术后康复的影响[J].肿瘤预防与治疗,2017,30(5):368-372.
[18] Short V,Herbert G,Perry R,et al.Chewing gum for postoperative recovery of gastrointestinal function[J].Cochrane Database Syst Rev,2015(2):CD006506.
[19] 罗敏,曾丽文,程茂华.腹部非胃肠道手术后患者肠道功能恢复判定方式的改进[J].护理学杂志,2015,30(4):9-11.
[20] Roskams T,Kojiro M.Pathology of early hepatocellular carcinoma:conventional and molecular diagnosis[J].Semin Liver Dis,2010,30(1):17-25.
[21] 袁玉萍,尹罗庚,贡国娟,等.术前置胃管时间对全麻胃肠道手术患者皮质醇的影响[J].护理学杂志,2012,27(6):4-5.
[22] 易佳盛,张吉翔,王静.肝癌患者营养不良的原因及其营养治疗[J].肿瘤代谢与营养电子杂志,2015,2(3):73-76.
[2] 黄兴华,胡还章,江艺.快速康复外科在肝癌患者围手术期的应用[J].国际外科学杂志,2016,43(4):228-230.
[3] 郑惊雷,王在国,游志坚,等.快速康复外科在肝癌围手术期的应用研究[J].中国肿瘤外科杂志,2015,7(5):273-277.
[4] 邓国荣,陈博艺,张玉胜,等.加速康复外科理念在原发性肝癌患者肝切除围术期中的应用与安全性评价[J].消化肿瘤杂志(电子版),2016,8(4):243-248.
[5] 中华医学会外科学分会,中华医学会麻醉学分会.加速康复外科中国专家共识及路径管理指南(2018版)[J].中国实用外科杂志,2018,38(1):1-20.
[6] Bauer J,Capra S,Ferguson M.Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer[J].Eur J Clin Nutr,2002,56(8):779-785.
[7] 王锡山.腹部手术后不容忽视的问题——消化道功能障碍[J].中华胃肠外科杂志,2015,18(5):501-511.
[8] 王乐,唐宏英,刘怡素.快速康复肠道管理措施在肝叶切除术患者中的应用[J].齐鲁护理杂志,2016,22(22):70-71.
[9] 李乐之,路潜.外科护理学[M].5版.北京:人民卫生出版社,2012:93-94.
[10] 杨尹默.加速康复外科临床实践中应重视的几个问题[J].中国实用外科杂志,2018,38(1):34-36.
[11] 郑惊雷,王在国,陈刘镇,等.肝癌手术患者应用快速康复外科措施的效果分析[J].中华临床医师杂志(电子版),2016,10(1):16-19.
[12] 施姬,李雷雪,林巧,等.快速康复外科理念对胃肠道手术患者护理的意义[J].中国医学创新,2013,10(30):72-74.
[13] 首志雄,郑达武,罗永香,等.快速康复外科理念在肝癌肝切除术围手术期管理中的临床价值[J].中华消化外科杂志,2014,13(6):456-460.
[14] 严锦,王瑞兰,王继涛,等.基于快速康复外科理念的肝癌患者围术期护理流程应用[J].护理学杂志,2014,29(16):32-34.
[15] 许柳琴,陈瑜,郭秋兰,等.快速康复外科护理与传统护理在腹腔镜胆囊切除术围手术期的应用研究[J].护士进修杂志,2016,31(11):1008-1010.
[16] 姜梅.快速康复护理对肠道手术患者胃肠功能恢复的影响[J].中华现代护理杂志,2013,19(6):658-660.
[17] 王静,张丽霞,程瑜琳.表格式床旁护理日志的应用对胃癌术后康复的影响[J].肿瘤预防与治疗,2017,30(5):368-372.
[18] Short V,Herbert G,Perry R,et al.Chewing gum for postoperative recovery of gastrointestinal function[J].Cochrane Database Syst Rev,2015(2):CD006506.
[19] 罗敏,曾丽文,程茂华.腹部非胃肠道手术后患者肠道功能恢复判定方式的改进[J].护理学杂志,2015,30(4):9-11.
[20] Roskams T,Kojiro M.Pathology of early hepatocellular carcinoma:conventional and molecular diagnosis[J].Semin Liver Dis,2010,30(1):17-25.
[21] 袁玉萍,尹罗庚,贡国娟,等.术前置胃管时间对全麻胃肠道手术患者皮质醇的影响[J].护理学杂志,2012,27(6):4-5.
[22] 易佳盛,张吉翔,王静.肝癌患者营养不良的原因及其营养治疗[J].肿瘤代谢与营养电子杂志,2015,2(3):73-76.
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