摘要
目的:探讨加速康复外科(enhanced recovery after surgery,ERAS)胃癌患者术后首次通气情况,并分析其影响因素。方法:回顾分析2015年2月至2016年2月105例择期行胃癌根治术患者的临床资料。采用自行设计的一般资料及围手术情况登记表、ERAS术后下床活动登记表、术后肠功能恢复记录表登记相关资料,无线智能手环记录术后活动量,术前采用肿瘤患者功能状态评分表评价患者功能状态、医院焦虑抑郁量表评价患者情绪状况。结果:105例患者中60例为48 h内通气,首次通气时间平均(37.10±10.16)h;48 h后通气45例,首次通气时间平均(57.62±7.00)h;48 h内及48 h后首次通气患者的活动量[(484.23±137.34)步vs.(334.00±97.87)步]差异有统计学意义;对ERAS胃癌患者术后首次通气时间的影响因素进行logistic回归分析,筛选出影响首次通气的主要因素:手术方式(β=0.820,OR=2.271,P<0.05)、患者术后活动量(β=-0.048,OR=0.953,P<0.01)、术前白蛋白及C反应蛋白水平。结论:确保患者术前处于良好的机体条件,可促进术后肠功能恢复;ERAS联合机器人微创手术应用于胃癌患者,可进一步减少手术应激,加速首次通气;术后患者适当增加活动量会促进首次通气,对临床有指导意义。
Objective：To evaluate the factors which influence gastric cancer patients＇ first aerofluxus time in enhanced recov-ery after surgery （ERAS）. Methods：Retrospective analysis was performed on 105 patients who underwent elective radical gastrectomy from Feb. 2015 to Feb. 2016. Patients＇ general and perioperative information was collected by pefioperative registration, ERAS postoper-ative ambulation registration, recovery of intestinal function registration, wireless smart bracelet which recorded postoperative activity, KPS function scale for tumor patients evaluating patients＇ functional status, hospital anxiety depression scale to evaluate the patient＇s e-motional state. Results ：Sixty patients exhausted within 48 h and the first aerofiuxus time was （37.10 ± 10.16） h after surgery. 45 pa-tients exhausted after 48 h and the first aerofluxus time was （57.62 ± 7.00） h after surgery. The comparison of the activity between pa-tients exhausted within 48 h and over 48 h was （484.23 ± 137.34） vs. （334.00 ± 97.87 ）, the difference was statistically significant. Logistic regression analysis was performed on the factors which affected the gastric cancer patients＇ first aerofluxus time in ERAS to find out the main factors ： operation method （ β = 0. 820, OR = 2. 271, P 〈 0.05 ）, postoperative activity （ β = -0. 048, OR = 0. 953, P 〈 0.01 ） ,preoperative albumin and C-reactive protein levels. Conclusions：Good preoperative physical condition can promote the recovery of postoperative intestinal function. ERAS combining with robotic minimally invasive surgery in gastric cancer patients can reduce surgi- cal stress as well as accelerate first aerofluxus. Appropriate increase of the postoperative activity can induce first aerofluxus. The results have instructional significance for clinic.
作者
夏灿灿
王刚
刘江
赵健
蒋传伟
胡加伟
江志伟
XIA Can-can;WANG Gang;LIU Jiang(Department of General Surgery,Nanjing General Hospital of PLA,Nanjing 210000,China)
出处
《腹腔镜外科杂志》
2018年第6期415-421,共7页
Journal of Laparoscopic Surgery
基金
社会发展-重点病种规范化诊疗项目(编号:BE2015687)
关键词
胃肿瘤
加速康复外科
首次通气时间
因素分析
统计学
Stomach neoplasms
Enhanced recovery after surgery
First aerofluxus time
Factor analysis
statistical
