King P M, Blazeby J M, Ewings P, Longman R J, Kipling R M, Franks P J, Sheffield J P, Evans L B, Soulsby M, Bulley S H, Kennedy R H
Department of Surgery, Yeovil District Hospital, Yeovil, Somerset, UK.
Colorectal Dis. 2006 Jul;8(6):506-13. doi: 10.1111/j.1463-1318.2006.00963.x.
Optimizing peri-operative care using an enhanced recovery programme improves short-term outcomes following colonic resection. This study compared a prospective group of patients undergoing resection of colorectal cancer within an enhanced recovery programme, with a prospectively studied historic cohort receiving conventional care.
Sixty patients underwent elective resection within an enhanced recovery programme (ERP). This incorporated pre-operative counselling, epidural analgesia, early feeding and mobilization. Clinical outcomes were compared with 86 prospectively studied historic control patients receiving conventional care (CC). All patients completed EORTC QLQ-C30, QLQ-CR38 and health economics questionnaires up to three months after surgery.
Baseline clinical data were similar in both groups. Postoperative hospital stay was significantly reduced in the ERP, with patients staying 49% as long as those in the CC group including convalescent hospital stay (95% CI 39% to 61%P < 0.001). There were no differences in the number of complications, readmissions or re-operations. There were no significant differences in quality of life or health economic outcomes.
Patients undergoing colorectal resection within an ERP stay in hospital half as long as those receiving conventional care, with no increased morbidity, deterioration in quality of life or increased cost.
采用强化康复方案优化围手术期护理可改善结肠切除术后的短期预后。本研究将在强化康复方案下接受结直肠癌切除的一组前瞻性患者与接受传统护理的前瞻性历史队列患者进行了比较。
60例患者在强化康复方案（ERP）下接受了择期切除术。该方案包括术前咨询、硬膜外镇痛、早期进食和活动。将临床结局与86例接受传统护理（CC）的前瞻性历史对照患者进行比较。所有患者在术后三个月内完成了欧洲癌症研究与治疗组织（EORTC）QLQ-C30、QLQ-CR38和健康经济学问卷。
两组的基线临床数据相似。ERP组的术后住院时间显著缩短，包括康复期住院时间在内，患者的住院时间仅为CC组患者的49%（95%可信区间为39%至61%，P<0.001）。并发症、再入院或再次手术的数量没有差异。生活质量或健康经济结局没有显著差异。
在ERP下接受结肠切除术的患者住院时间仅为接受传统护理患者的一半，且发病率没有增加，生活质量没有恶化，成本也没有增加。
