结肠手术的加速康复治疗或传统护理。

Colonic surgery with accelerated rehabilitation or conventional care.

作者信息

Basse Linda, Thorbøl Jens Erik, Løssl Kristine, Kehlet Henrik

机构信息

Department of Surgical Gastroenterology 435, Hvidovre University Hospital, University of Copenhagen, Hvidovre, Denmark.

出版信息

Dis Colon Rectum. 2004 Mar;47(3):271-7; discussion 277-8. doi: 10.1007/s10350-003-0055-0.

DOI:10.1007/s10350-003-0055-0

PMID:14991487

Abstract

BACKGROUND

For patients undergoing colonic surgery, the postoperative hospital stay is usually 6 to 10 days, and the morbidity rate is 15 to 20 percent. Fast-track rehabilitation programs have reduced the hospital stay to 2 to 3 days. The aim of this study was to evaluate the postoperative outcome after colonic resection with conventional care compared with fast-track multimodal rehabilitation.

METHODS

One hundred thirty consecutive patients receiving conventional care (group 1) in one hospital were compared with 130 consecutive patients receiving multimodal, fast-track rehabilitation (group 2) in another hospital. Outcomes were time to first defecation after surgery, postoperative hospital stay, and morbidity during the first postoperative month.

RESULTS

Median age was 74 years (group 1) and 72 years (group 2). American Society of Anesthesiologists (ASA) score was significantly higher in group 2 ( P < 0.05). Defecation occurred on day 4.5 in group 1 and day 2 in group 2 ( P < 0.05). Median hospital stay was 8 days in group 1 and 2 days in group 2 ( P < 0.05). The use of a nasogastric tube was longer in group 1 ( P < 0.05). The overall complication rate (35 patients) was lower in group 2 ( P < 0.05), especially cardiopulmonary complications (5 patients; P < 0.01). Readmission was necessary in 12 percent of cases for group 1 and 20 percent in group 2 ( P > 0.05).

CONCLUSIONS

Time to first defecation, hospital stay, and morbidity may be reduced after colonic resection with fast-track multimodal rehabilitation.

摘要

背景

对于接受结肠手术的患者，术后住院时间通常为6至10天，发病率为15%至20%。快速康复计划已将住院时间缩短至2至3天。本研究的目的是评估与快速多模式康复相比，传统护理下结肠切除术后的结果。

方法

将一家医院连续接受传统护理的130例患者（第1组）与另一家医院连续接受多模式快速康复的130例患者（第2组）进行比较。观察指标为术后首次排便时间、术后住院时间以及术后第一个月的发病率。

结果

第1组患者的中位年龄为74岁，第2组为72岁。第2组美国麻醉医师协会（ASA）评分显著更高（P<0.05）。第1组在术后第4.5天排便，第2组在术后第2天排便（P<0.05）。第1组的中位住院时间为8天，第2组为2天（P<0.05）。第1组使用鼻胃管的时间更长（P<0.05）。第2组的总体并发症发生率（35例患者）更低（P<0.05），尤其是心肺并发症（5例患者；P<0.01）。第1组12%的病例需要再次入院，第2组为20%（P>0.05）。