Halawa Ahmed, Rowe Stephen, Roberts Fleur, Nathan Chidambaram, Hassan Ahmed, Kumar Avneesh, Suvakov Branislav, Edwards Ben, Gray Cavin
From the Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
Exp Clin Transplant. 2018 Apr;16(2):127-132. doi: 10.6002/ect.2016.0304. Epub 2017 Aug 24.
Our aim was to apply the principles of enhanced recovery in renal transplant recipients and to assess the changes in the quality of patient care and patient satisfaction.
Our study included 286 consecutive renal transplant patients. Of these, 135 patients went through the enhanced recovery program and 151 patients had traditional recovery. Patient education and discharge planning were commenced on admission. For enhanced recovery, prolonged preoperative fasting was avoided by carbohydrate loading. Goal-directed fluid management was aided by transesophageal Doppler to avoid central line insertion. Intrathecal diamorphine and ultrasonography-guided transversus abdominis plane blocks were used to achieve adequate analgesia. Patients started oral intake a few hours postoperatively. The urinary catheter was removed 2 to 4 days after transplant.
The postoperative patient-controlled analgesia requirement for morphine was significantly reduced in the enhanced recovery versus traditional recovery group (median of 9.5 vs 47 mg; P < 0.001). The length of stay was significantly reduced for living-donor (median 5 vs 7 days; P < .001) and for deceased-donor transplant recipients (median 5 vs 8.5 days; P < 0.001) with enhanced recovery versus recipients who had traditional recovery. Implementing enhanced recovery saves £2160 per living-donor transplant and £3078 per deceased-donor transplant. In the enhanced recovery group, readmission within 10 days after transplant was 5%.
Our service evaluation demonstrated that enhanced recovery benefits both types of renal transplant (living and deceased grafts) procedures, with excellent patient satisfaction and reduction of hospital length of stay.
我们的目标是将加速康复原则应用于肾移植受者，并评估患者护理质量和患者满意度的变化。
我们的研究纳入了286例连续的肾移植患者。其中，135例患者接受了加速康复计划，151例患者采用传统康复方式。入院时即开始患者教育和出院计划。对于加速康复，通过碳水化合物负荷避免长时间术前禁食。经食管多普勒辅助目标导向液体管理以避免中心静脉置管。使用鞘内注射二氢吗啡和超声引导下腹横肌平面阻滞来实现充分镇痛。患者术后数小时开始口服摄入。移植后2至4天拔除导尿管。
与传统康复组相比，加速康复组术后患者自控镇痛吗啡需求量显著降低（中位数分别为9.5 mg和47 mg；P < 0.001）。与接受传统康复的受者相比，加速康复的活体供肾移植受者（中位数分别为5天和7天；P < 0.001）和尸体供肾移植受者（中位数分别为5天和8.5天；P < 0.001）住院时间显著缩短。实施加速康复可为每例活体供肾移植节省2160英镑，为每例尸体供肾移植节省3078英镑。在加速康复组中，移植后10天内再入院率为5%。
我们的服务评估表明，加速康复对两种类型的肾移植（活体和尸体供肾）手术均有益，患者满意度高且住院时间缩短。
