Kehlet H, Mogensen T
Department of Surgical Gastroenterology and Anaesthesiology, Hvidovre University Hospital, Denmark.
Br J Surg. 1999 Feb;86(2):227-30. doi: 10.1046/j.1365-2168.1999.01023.x.
Hospital stay after colonic surgery is usually between 5 and 10 days, limiting factors being pain, ileus, organ dysfunction and fatigue. Single-modality intervention to reduce these factors with laparoscopic surgery usually requires a hospital stay of 5 days. This paper reports the results of a multimodal rehabilitation regimen after open sigmoidectomy.
Sixteen unselected patients scheduled for elective sigmoid resection (median age 71 years) underwent operation under combined spinal-epidural anaesthesia. After operation, epidural analgesia was continued for 48 h, with immediate oral nutrition and mobilization, and with planned discharge 2 days after surgery.
The median postoperative hospital stay was 2 (range 2-6) days (48 h), patients being mobilized for a median of 5 h on the second postoperative day (24-48 h) and for 10 h on the third day (48-72 h). Within 48 h of operation 14 patients had an oral intake of 2000 ml or more and 15 had resumed defaecation. Fatigue and pain scores were low during the first 8-9 days after operation, with a median of 13 h of mobilization per day after discharge. There were no medical or surgical complications during 30 days of follow-up, except for two patients who suffered postspinal headache.
Postoperative recovery after open colonic surgery may be accelerated by effective pain relief integrated into an accelerated rehabilitation programme.
结肠手术后的住院时间通常在5至10天之间，限制因素包括疼痛、肠梗阻、器官功能障碍和疲劳。采用腹腔镜手术进行单模式干预以减少这些因素，通常需要住院5天。本文报告了开放性乙状结肠切除术后多模式康复方案的结果。
16例计划进行择期乙状结肠切除术的未筛选患者（中位年龄71岁）在腰麻-硬膜外联合麻醉下接受手术。术后，硬膜外镇痛持续48小时，同时立即给予口服营养并鼓励活动，并计划在术后2天出院。
术后中位住院时间为2天（范围2 - 6天）（48小时），患者在术后第二天（24 - 48小时）的中位活动时间为5小时，第三天（48 - 72小时）为10小时。术后48小时内，14例患者口服摄入量达到2000毫升或更多，15例患者恢复排便。术后前8 - 9天疲劳和疼痛评分较低，出院后每天中位活动时间为13小时。在30天的随访期间，除两名患者出现腰麻后头痛外，无医疗或手术并发症。
将有效的疼痛缓解措施纳入加速康复计划，可加速开放性结肠手术后的术后恢复。
