摘要
目的回顾性分析实施快速通道外科程序前后胃癌患者的临床疗效和恢复情况。方法130例接受择期开放性胃癌手术且无并发症发生的胃癌患者纳入本研究，根据快速通道外科实施与否分为传统处理组（n=65）和快速通道外科组（n=65）。对两组患者术后饮食、液体输入、恢复活动、术后住院时间和出院后康复情况进行回顾性分析。结果快速通道外科组术后开始活动、进流食和固体食物时间和停止静脉输液时间均优于传统处理组[0．3（0～1）d vs 3．3（2～4）d，0．2（0—1）d vs 83．5（3～4）d，3．3（3—4）d vs 5．6（5～6）d，3．4（3～4）d vs 5．2（5～6）d；均P=0．000]，前者术后住院时间也明显缩短[6．6（6—8）d vs 8．6（8—9）d，P=0．000]。两组工具性日常生活活动于术后14d均有所减少，但传统处理组术前活动水平更高，其减幅更大[5．0（3—6） vs 3．0（3～5），4．0（3～6） vs 3．0（3—5）；均P=0．000]。两组术前疲劳强度相似，出院后14d传统处理组明显增高，但在30d时恢复到正常水平[2．0（1～5）vs 3．0（1—5），2．0（1～5） vs 2．0（1～6）；P=0．005，P=0．065]。传统处理组术后14d时总睡眠时间明显长于术前[9．0（6—11）h vs 8．0（5～10）h，P=0．000]，而快速通道外科组则无明显变化[8．0（5～11）h／）88．0（6—10）h，P=0．327]。结论快速通道外科程序能减少术后应激并加速择期及无手术并发症发生的胃癌患者的康复过程。
Objective To investigate the clinical outcome before and immediately after implementation of fast track surgery protocol on patients with gastric cancer. Methods One hundred and thirty patients with gastric cancer in our hospital underwent an elective, uncomplicated, open gastric surgery before （Traditional care group, n = 65） and immediately after implementing fast track surgery （ Fast track surgery group, n = 65 ）. Postoperative food and fluid intake, mobilization, length of hospital stay, and clinical outcome were recorded and analysed, and a in- terview-based assessment was performed on days 14 and 30 postoperatively. Results Patients implemented fast track surgery were associated with a significantly earlier resumption of mobilization and oral fluids and normal diet, shorter duration of intravenous infusion compared with traditional care patients 0. 3 （0 - 1 ） d vs 3.3 （2 - 4） d, 0. 2 （0-1） dvs3.5（3-4） d, 3.3（3-4） dvs5.6（5-6） d, 3.4（3-4） dvs5.2（5-6） d; P=0. 000, respec- tively. Postoperative hospital stay was also shorter in fast track surgery group 6.6 （6 - 8 ） d vs 8.6 （ 8 - 9） d ; P = 0. 000. Instrumental activities of daily living decreased in both groups on day 14, but significantly more in the tradi- tional care group, despite having a higher preoperative instrumental activities of daily living level eompared with the fast track surgery group 5.0 （ 3 - 6 ） vs 3.0 （ 3 - 5 ）, 4.0 （ 3 - 6 ） vs 3.0 （ 3 - 5 ） ; P = 0. 000, respectively. Preoperative fatigue score was not different between two groups, but the fatigue score was significantly increased on day 14, and returned to normal value on day 30 in the traditional care group 2.0 （ 1 - 5 ） vs 3.0 （ 1 - 5 ）, 2.0 （ 1 - 5 ） vs 2.0（ 1 -6） ; P =0. 005, P =0.065. Total length of sleep on day 14 was increased significantly in the traditional eare group, but not changed in the fast track surgery group compared with preoperative value 9.0 （ 6 - 11 ） vs 8.0 （5 -10） h, 8.0（5 -11） vs 8.0（6 -10） h; P=0.000, P=0.327. Conclusions A fast track surgery protocol can lessen postoperative stress reactions and enhance recovery for patients with gastric cancer undergoing an elective, uncomplicated, open resection.
出处
《国际外科学杂志》
2012年第11期737-741,共5页
International Journal of Surgery
关键词
胃肿瘤
外科手术
康复
快速通道外科
Stomach neoplasms
Surgical procedures, operative
Rehabilitation
Fast track surgery
