da Costa Haracelli Christina Barbosa Alves Leite, Santos Rogério Leite, de Aguilar-Nascimento José Eduardo
Postgraduation in Health Sciences Faculty of Medicine, Federal University of Mato Grosso-UFMT, Mato Grosso State, MT, Brazil.
Rev Col Bras Cir. 2013 May-Jun;40(3):174-9. doi: 10.1590/s0100-69912013000300002.
To compare the postoperative clinical outcomes of patients undergoing cancer surgery in the Mato Grosso Cancer Hospital before and after implementation of the ACERTO protocol.
We prospectively observed 271 patients during two periods: the first between April and May 2010 (n = 101) comprised patients undergoing conventional conducts (Phase 1) and the second from September to October 2010 (n = 171) formed by patients undergoing a new protocol of perioperative established by ACERTO (Phase 2). The variables examined were length of preoperative fasting, reintroduction of diet in the postoperative period, hydration volume and length of stay.
When comparing the two periods, in Phase 2 there was a decrease of approximately 50% in the time of preoperative fasting (14.7 [4-48] hours vs 7.2 [1-48] hours, p <0.001 ), a reduction of approximately 35% of the volume of intravenous fluids in the immediate postoperative period (p <0.001), 47% in the first postoperative day (p <0.001) and 28% at second PO (p = 0.04), with an overall reduction of 23% (p <0.001). There was no difference in length of postoperative hospital stay between the two phases (3.9 [0-51] vs. 3.2 [0-15] days, p = 0,52). However, in patients whose time of preoperative fasting was up to 5 hours, hospitalization time decreased by one day (3.8 [0-51] vs 2.5 [0-15] days, p = 0.03).
The adoption of ACERTO measures is feasible and safe in cancer patients. After implementation of the ACERTO protocol, there was reduction of intravenous fluids volume and, when the preoperative fasting was reduced, hospitalization time was shorter.
比较马托格罗索癌症医院实施ACERTO方案前后癌症手术患者的术后临床结局。
我们前瞻性地观察了271例患者的两个阶段：第一阶段为2010年4月至5月（n = 101），包括接受传统治疗的患者（第1阶段）；第二阶段为2010年9月至10月（n = 171），由接受ACERTO制定的新围手术期方案的患者组成（第2阶段）。所检查的变量包括术前禁食时间、术后饮食恢复、补液量和住院时间。
比较两个阶段时，在第2阶段，术前禁食时间减少了约50%（14.7[4 - 48]小时对7.2[1 - 48]小时，p <0.001），术后即刻静脉补液量减少了约35%（p <0.001），术后第一天减少了47%（p <0.001），术后第二天减少了28%（p = 0.04），总体减少了23%（p <0.001）。两个阶段的术后住院时间无差异（3.9[0 - 51]天对3.2[0 - 15]天，p = 0.52）。然而，术前禁食时间长达5小时的患者，住院时间缩短了一天（3.8[0 - 51]天对2.5[0 - 15]天，p = 0.03）。
在癌症患者中采用ACERTO措施是可行且安全的。实施ACERTO方案后，静脉补液量减少，且术前禁食时间缩短时，住院时间更短。
