摘要
目的探讨基于多模式麻醉方式的加速康复外科(ERAS)理念在腹腔镜膀胱癌根治术中的价值。方法收集2015年1月至2017年12月我院行腹腔镜下膀胱癌根治术和/或回肠代膀胱术的患者围术期相关信息,应用基于多模式麻醉方式的ERAS理念进行围术期处理的为ERAS组(9例),应用常规围术期处理方案的为常规治疗组(27例)。比较两组患者的住院时间、术后疼痛等差异。结果 ERAS组患者较常规治疗组总住院时间及术后住院时间均明显减少(20 d vs 33 d,P=0.002;9 d vs 18 d,P=0.002),术中补液量明显降低[5.5(ml/kg/h) vs 8.1(ml/kg/h),P=0.003],术后按时予镇痛药的患者比例更高(P=0.001),临时需要再次追加镇痛药的比例更低(P=0.046),术后首次排便时间更快(P=0.035)。而在住院总花费、麻醉费用和术后并发症方面,两组差异无统计学意义。结论在腹腔镜膀胱癌根治术应用多模式麻醉方式联合ERAS理念,可以加快患者的康复速度,减少术后对追加镇痛药的需要,对术后并发症无影响。
Objective To explored the values of enhanced recovery after surgery （ERAS） based on multimodal anesthesia in laparoscopic radical cystectomy. Methods The data of patients undergoing laparoscopic radical cystectomy with or without ilealneobladder during perioperative period were collected from January 2015 to December 2017 in our hospital, 9 patients in Group ERAS who were managed with ERAS protocols based on multimodal anesthesia preoperatively, and 27 in Group control who were managed with routine protocols preoperatively. Length of hospital stay, pain after surgery and other parameters were compared between the two groups. Results Compared with Group control, length of stay and postoperative length of stay were signifcantly shorter （20 d vs 33 d, P=0.002; 9 d vs 18 d, P=0.002）, intra-operative fuid volume was significantly less [5.5 （ml/kg/h） vs 8.1 （ml/kg/h）, P=0.003], a higher proportion of patients receiving analgesics on time postoperatively （P=0.001）, a lower proportion of those requiring extra analgesics （P=0.046）, and the frst postoperative defecation was signifcantly faster （P=0.035, in Group ERAS）. There was no significant difference between the two groups in the total cost, anesthesia costs and postoperative complications. Conclusion The use of multimodal anesthesia combined with enhanced recovery inlaparoscopic radical cystectomy can speed up the recovery of patients and reduce the need for extra analgesics, and there was no signifcant difference in postoperative complications.
作者
潘婧儒
龚楚链
黄品婕
高婉菱
黑子清
周少丽
Pan Jingru;Gong Chulian;Huang Pinjie;Gao Wanling;Hei Ziqing;Zhou Shaoli(Department of Anesthesiology,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China)
出处
《中华腔镜泌尿外科杂志（电子版）》
2018年第6期402-406,共5页
Chinese Journal of Endourology(Electronic Edition)
基金
中山大学临床医学研究"5010"计划项目(2015006)
