快速康复与常规护理在老年腹腔镜结直肠切除术中的效果比较：一项随机试验。

Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial.

机构信息

Department of Gastric and Colorectal Surgery, Jilin University First Hospital, Changchun, China.

出版信息

Colorectal Dis. 2012 Aug;14(8):1009-13. doi: 10.1111/j.1463-1318.2011.02855.x.

DOI:10.1111/j.1463-1318.2011.02855.x

PMID:21985126

Abstract

AIM

The aim of the study was to evaluate the efficacy and safety of fast-track rehabilitation in elderly patients over 65 years of age, following laparoscopic surgery to remove colorectal cancer.

METHOD

A total of 78 elderly patients with colorectal cancer who underwent laparoscopic colorectal resection were randomly assigned to receive either the fast-track care programme (n = 40) or the conventional perioperative care protocol (control group, n = 38). Medical personnel conducting the study were blinded to patients' clinical outcomes prior to statistical analysis. The fast-track protocol included no preoperative mechanical bowel irrigation, immediate oral alimentation and earlier postoperative ambulation exercise. The length of postoperative hospital stay, the length of time to regain bowel function and the rate of postoperative complications were compared between the two groups.

RESULTS

The length of time to regain bowel function, including the passage of flatus[31 (26-40) h vs 38 (32-51) h, P = 0.001], to the first bowel movement [55 (48-63) h vs 64 (48-71) h, P = 0.009] and to start a liquid diet (12 [11-16] h vs 47 [35-50] h, P = 0.000) were significantly shorter in patients receiving the fast-track care protocol compared with those receiving the conventional care protocol. A shorter duration of postoperative hospital stay was recorded in patients receiving the fast-track program than in those receiving conventional care (P = 0.0001). A reduced percentage of patients who developed general complications was also observed in the fast-track group (5.0%vs 21.1%, P = 0.045).

CONCLUSION

This randomized controlled trial has shown that in the elderly undergoing laparoscopic colorectal surgery, the fast-track recovery programme resulted in a more rapid postoperative recovery, earlier discharge from hospital and fewer general complications compared with a conventional postoperative protocol.

摘要

目的

本研究旨在评估快速康复方案在 65 岁以上接受腹腔镜结直肠癌切除术的老年患者中的疗效和安全性。

方法

将 78 例接受腹腔镜结直肠切除术的老年结直肠癌患者随机分为快速康复组（n=40）和常规围手术期护理组（对照组，n=38）。在进行统计分析之前，进行研究的医务人员对患者的临床结果不知情。快速康复方案包括术前不进行机械性肠道灌洗、术后立即口服饮食和更早地进行术后活动。比较两组患者的术后住院时间、恢复肠道功能的时间和术后并发症发生率。

结果

快速康复组患者恢复肠道功能的时间（排气时间[31（26-40）h 比 38（32-51）h，P=0.001]、首次排便时间[55（48-63）h 比 64（48-71）h，P=0.009]和开始进流食时间[12（11-16）h 比 47（35-50）h，P=0.000]明显短于常规护理组。快速康复组患者的术后住院时间也明显短于常规护理组（P=0.0001）。快速康复组患者发生一般并发症的比例也低于常规护理组（5.0%比 21.1%，P=0.045）。