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术后加速康复在妇科良性疾病腹腔镜手术患者围手术期管理中的应用

Application of enhanced recovery after surgery in perioperative management of patients undergoing laparoscopic surgery for benign gynecological conditions.

作者信息

Nuermanguli Rouzi, Jing Deng, JiangYing Yan, Yu Hou

机构信息

Department of Gynecology, Guangyuan Central Hospital, Guangyuan, China.

出版信息

Medicine (Baltimore). 2025 Jul 18;104(29):e43161. doi: 10.1097/MD.0000000000043161.

Abstract

This study evaluates the effectiveness of enhanced recovery after surgery (ERAS) protocol in laparoscopic gynecological surgery and its impact on perioperative management. A retrospective analysis was conducted on 187 patients who underwent elective laparoscopic gynecological surgery at Guangyuan Central Hospital between November 2022 and December 2023. Of these, 92 patients were enrolled in the ERAS group, and 95 were assigned to the conventional care group. The ERAS protocol included evidence-based interventions such as shortened fasting duration, carbohydrate loading, avoidance of mechanical bowel preparation, and early postoperative mobilization. Primary endpoints included stress response markers (serum cortisol, homeostatic model assessment of insulin resistance), nutritional parameters (prealbumin, albumin, blood urea nitrogen), and clinical outcomes (time to gastrointestinal recovery, length of hospital stay). Secondary endpoints comprised postoperative complications, healthcare costs, and patient satisfaction. The ERAS group showed significantly faster gastrointestinal recovery (first flatus: 15.54 ± 1.73 vs 21.24 ± 3.53 hours, P < .001), shorter hospitalization (4.91 ± 0.90 vs 6.29 ± 1.25 days, P < .001), and lower healthcare costs (13,960 ± 1967 vs 15,270 ± 2856 yuan, P < .001). Postoperative stress response was reduced (cortisol, P = .012), and nutritional parameters were better preserved (P < .001). Patient satisfaction was higher in the ERAS group (100% vs 96.8%, P = .042). The ERAS protocol significantly optimizes perioperative management for patients undergoing laparoscopic gynecological surgery, reducing hospital stay, lowering complication rates, and enhancing patient satisfaction, thus providing robust evidence for clinical implementation. However, further research is needed to explore its long-term effects.

摘要

本研究评估了加速康复外科(ERAS)方案在腹腔镜妇科手术中的有效性及其对围手术期管理的影响。对2022年11月至2023年12月期间在广元市中心医院接受择期腹腔镜妇科手术的187例患者进行了回顾性分析。其中,92例患者纳入ERAS组,95例被分配到传统护理组。ERAS方案包括基于证据的干预措施,如缩短禁食时间、碳水化合物负荷、避免机械肠道准备和术后早期活动。主要终点包括应激反应标志物(血清皮质醇、胰岛素抵抗稳态模型评估)、营养参数(前白蛋白、白蛋白、血尿素氮)和临床结局(胃肠道恢复时间、住院时间)。次要终点包括术后并发症、医疗费用和患者满意度。ERAS组胃肠道恢复明显更快(首次排气:15.54±1.73 vs 21.24±3.53小时,P<.001),住院时间更短(4.91±0.90 vs 6.29±1.25天,P<.001),医疗费用更低(13960±1967 vs 15270±2856元,P<.001)。术后应激反应降低(皮质醇,P=.012),营养参数得到更好的维持(P<.001)。ERAS组患者满意度更高(100% vs 96.8%,P=.042)。ERAS方案显著优化了腹腔镜妇科手术患者的围手术期管理,缩短了住院时间,降低了并发症发生率,提高了患者满意度,从而为临床实施提供了有力证据。然而,需要进一步研究以探索其长期影响。

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