Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Medicine (Baltimore). 2021 Feb 26;100(8):e24730. doi: 10.1097/MD.0000000000024730.
This study aims to investigate the effect of applying enhanced recovery after surgery methods (ERAS) in perioperative nursing of choledocholithiasis following endoscopic retrograde cholangiopancreatography (ERCP) for treatment of biliary calculus.Clinical data from 161 patients who underwent ERCP surgery in Wuhan Union Hospital from January 2017 to December 2019 were retrospectively analyzed. A total of 78 patients received perioperative nursing using the ERAS concept (experimental group) and 83 patients received conventional perioperative nursing (control group). Group differences were compared for the time to first postoperative ambulation, exhausting time, time to first defecation and eating, intraoperative blood loss, postoperative complication incidence (pancreatitis, cholangitis, hemorrhage), white blood cell (WBC), and serum amylase (AMS) values at 24 hours, duration of nasobiliary duct indwelling, length of hospital stay, and hospitalization expenses.No significant between-group differences were noted for demographic characteristics (age, sex, BMI, ASA score, and comorbidity) (P > .05). Time to first ambulation, exhausting time, time to defecation and eating, and nasobiliary drainage time were shorter in the experimental group than the control group, and the differences were statistically significant (P < .05). There was no significant between-group difference in postoperative WBC values at 24 hours (P > .05), but the experimental group's AMS values at 24 hours postoperation were significantly lower than those of the controls (154.93 ± 190.01 vs 241.97 ± 482.64, P = .031). Postoperative complications incidence was 9.1% in the experimental group, which was significantly lower than the 20.4% in the control group, and this difference was statistically significant (P = .039). Compared with the control group, nasobiliary drainage time (26.53 ± 7.43 hours vs 37.56 ± 9.91 hours, P < .001), hospital stay (8.32 ± 1.55 days vs 4.56 ± 1.38 days, P < .001), and hospitalization expenses (36800 ± 11900 Yuan vs 28900 ± 6500 Yuan, P = .016) were significantly lower in the experimental group.ERAS is a safe and effective perioperative nursing application in ERCP for treating choledocholithiasis. It can effectively accelerate patients' recovery and reduce the incidence of complications; therefore, it is worthy of being applied and promoted in clinical nursing.
本研究旨在探讨在经内镜逆行胰胆管造影术（ERCP）治疗胆道结石后，对围手术期护理应用加速康复外科（ERAS）方法对胆总管结石患者的影响。回顾性分析 2017 年 1 月至 2019 年 12 月期间在武汉协和医院接受 ERCP 手术的 161 例患者的临床资料。共有 78 例患者接受了 ERAS 理念围手术期护理（实验组），83 例患者接受了常规围手术期护理（对照组）。比较两组患者术后首次下床活动时间、排气时间、首次排便和进食时间、术中出血量、术后并发症发生率（胰腺炎、胆管炎、出血）、白细胞（WBC）和术后 24 小时血清淀粉酶（AMS）值、鼻胆管留置时间、住院时间和住院费用。两组患者的人口统计学特征（年龄、性别、BMI、ASA 评分和合并症）差异无统计学意义（P>.05）。实验组患者术后首次下床活动时间、排气时间、排便和进食时间、鼻胆管引流时间均短于对照组，差异有统计学意义（P<.05）。两组患者术后 24 小时 WBC 值差异无统计学意义（P>.05），但实验组患者术后 24 小时 AMS 值明显低于对照组（154.93±190.01 vs 241.97±482.64，P=.031）。实验组术后并发症发生率为 9.1%，明显低于对照组的 20.4%，差异有统计学意义（P=.039）。与对照组相比，实验组患者的鼻胆管引流时间（26.53±7.43 小时 vs 37.56±9.91 小时，P<.001）、住院时间（8.32±1.55 天 vs 4.56±1.38 天，P<.001）和住院费用（36800±11900 元 vs 28900±6500 元，P=.016）明显降低。ERAS 是一种安全有效的 ERCP 治疗胆总管结石的围手术期护理应用方法，能有效加快患者康复速度，降低并发症发生率，值得在临床护理中推广应用。
