接受急诊小肠手术的患者中采用适应性快速康复外科路径与标准护理的随机对照试验。
Adapted ERAS Pathway Versus Standard Care in Patients Undergoing Emergency Small Bowel Surgery: a Randomized Controlled Trial.
机构信息
Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India.
Department of Preventive Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006, India.
出版信息
J Gastrointest Surg. 2020 Sep;24(9):2077-2087. doi: 10.1007/s11605-020-04684-6. Epub 2020 Jul 6.
BACKGROUND
Emergency laparotomy for small bowel pathologies comprises a significant number of all emergency surgeries. Application of evidence-based adapted enhanced recovery after surgery (ERAS) protocol can potentially improve the perioperative outcome in these procedures.
AIMS
To determine the feasibility, safety, and efficacy of adapted ERAS pathway in emergency small bowel surgery.
METHODOLOGY
This was a single-center, prospective, open-labeled, superiority, randomized controlled trial. Patients suspected to have small bowel pathology by the emergency surgical team were randomized preoperatively into standard care and adapted ERAS group. Patients with American Society of Anesthesiologist class ≥ 3, polytrauma patients with associated other intra-abdominal organ injuries, duodenal ulcer perforations, patients presenting with refractory shock, and pregnant patients were excluded. Primary outcome parameter was the length of hospitalization (LOH). Morbidity and other functional recovery parameters were also assessed.
RESULTS
Thirty-five patients were included in the adapted ERAS and standard care group. The laboratory and demographic variables were comparable. Patients in the ERAS group had significantly earlier recovery (days) in terms of first fluid diet (1.48 ± 0.18, p < 0.001), solid diet (2.11 ± 0.17, p < 0.001), time to first flatus (1.25 ± 0.24, p < 0.001), and first stool (1.8 ± 0.27, p < 0.001). Postoperative nausea, vomiting (RR 0.69, p = 0.19), pulmonary complications (RR 0.38, p = 0.16), superficial (RR 0.79, p = 0.33), and deep surgical site infections (RR 0.65, p = 0.39) were similar. Compared with the standard care group, ERAS group had significantly shorter LOH (8 ± 0.38 vs. 10.83 ± 0.42; Mean difference, 2.83 ± 0.56; p < 0.001).
CONCLUSION
Adapted ERAS pathways are feasible, safe, and significantly reduces the LOH in select patients undergoing emergency small bowel surgery.
背景
小肠病变的急诊剖腹手术占所有急诊手术的很大比例。应用循证的适应性术后加速康复（ERAS）方案有可能改善这些手术的围手术期结果。
目的
确定适应性 ERAS 途径在急诊小肠手术中的可行性、安全性和疗效。
方法
这是一项单中心、前瞻性、开放性、优效性、随机对照试验。由急诊外科团队怀疑存在小肠病变的患者，术前随机分为标准治疗和适应性 ERAS 组。排除美国麻醉医师学会分级≥3 级、多发伤合并其他腹腔内器官损伤、十二指肠溃疡穿孔、出现难治性休克的患者和孕妇。主要观察指标为住院时间（LOH）。还评估了发病率和其他功能恢复参数。
结果
35 例患者被纳入适应性 ERAS 和标准治疗组。实验室和人口统计学变量具有可比性。ERAS 组患者在恢复方面（天）具有显著更早的恢复，具体表现为首次液体饮食（1.48±0.18，p<0.001）、固体饮食（2.11±0.17，p<0.001）、首次排气（1.25±0.24，p<0.001）和首次排便（1.8±0.27，p<0.001）。术后恶心、呕吐（RR 0.69，p=0.19）、肺部并发症（RR 0.38，p=0.16）、浅表（RR 0.79，p=0.33）和深部手术部位感染（RR 0.65，p=0.39）发生率相似。与标准治疗组相比，ERAS 组的 LOH 明显更短（8±0.38 与 10.83±0.42；平均差异，2.83±0.56；p<0.001）。
结论
适应性 ERAS 途径在选择性接受急诊小肠手术的患者中是可行的、安全的，并显著缩短了 LOH。
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