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肝移植术后加速康复外科的应用。

Application of enhanced recovery after surgery following liver transplantation.

机构信息

Department of Intensive Care Unit, Beijing Youan Hospital, Capital Medical University, No. 8 Yoanmenwai Xitoutiao, Beijing, 100069, China.

出版信息

World J Surg Oncol. 2023 Aug 17;21(1):248. doi: 10.1186/s12957-023-03139-x.

Abstract

OBJECTIVE

To investigate the effect of an enhanced recovery after surgery (ERAS) programme following liver transplantation and to further clarify the safety and clinical application value of an ERAS programme.

METHODS

A retrospective analysis of 250 patients who underwent liver transplant at Beijing You'an Hospital affiliated to Capital Medical University between March 2019 and December 2021 was conducted. According to different perioperative management methods, patients were divided into a control group (120 cases) and an ERAS group (130 cases). Postoperative safety indicators, efficacy indicators and economic indicators were compared between the two groups.

RESULTS

There was no significant difference in the safety indicators between the two groups. The ERAS group showed significantly lower results compared with the control group in terms of ventilator-associated pneumonia, urinary tract infection, pressure injury of oral and nasal mucosa, postoperative pain score 5 days after surgery and the incidence of delirium, whereas the Barthel score 10 days after surgery was significantly higher. There was no significant difference between the two groups in skin pressure injury or the Subjective Global Assessment grade 10 days after surgery. The length of intensive care unit stay, the total length of stay after surgery and the 10-day medical expenses after surgery were significantly lower in the ERAS group than in the control group.

CONCLUSION

The application of an ERAS programme after liver transplantation can effectively promote the postoperative recovery of patients and reduce medical costs. Studies have shown that the ERAS programme has important application value in improving the postoperative quality of life and reducing the economic burden of patients after liver transplantation. This programme provides a new concept for related clinical improvement and application.

摘要

目的

探讨肝移植术后加速康复外科(ERAS)方案的效果,进一步明确 ERAS 方案的安全性及临床应用价值。

方法

回顾性分析 2019 年 3 月至 2021 年 12 月首都医科大学附属北京佑安医院行肝移植的 250 例患者的临床资料,根据围术期管理方法的不同分为对照组(120 例)和 ERAS 组(130 例)。比较两组患者术后安全性指标、疗效指标及经济性指标。

结果

两组患者安全性指标比较,差异无统计学意义。ERAS 组呼吸机相关性肺炎、尿路感染、口腔及鼻腔黏膜压力性损伤、术后 5 天疼痛评分及谵妄发生率均低于对照组,术后 10 天 Barthel 评分高于对照组,差异均有统计学意义(P<0.05)。两组术后 10 天皮肤压力性损伤、主观整体评估 1 级发生率比较,差异无统计学意义(P>0.05)。ERAS 组患者重症监护病房停留时间、术后总住院时间及术后 10 天医疗费用均低于对照组,差异均有统计学意义(P<0.05)。

结论

肝移植术后应用 ERAS 方案能有效促进患者术后康复,降低医疗费用。研究表明,ERAS 方案在提高肝移植患者术后生活质量、减轻患者经济负担方面具有重要应用价值,为相关临床改进及应用提供了新的思路。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b2c4/10433670/a476d326e787/12957_2023_3139_Fig1_HTML.jpg

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