加速康復(fù)外科策略對復(fù)發(fā)性膽道結(jié)石患者腹腔鏡手術(shù)后應(yīng)激狀態(tài)的影響

鄧曉春

摘 要 目的：評價(jià)加速康復(fù)外科策略（enhanced recovery after surgery，ERAS）對復(fù)發(fā)性膽道結(jié)石患者腹腔鏡手術(shù)后應(yīng)激狀態(tài)的影響。方法：選擇2018年6月至2020年7月于江西省撫州市南城縣人民醫(yī)院接受腹腔鏡手術(shù)的復(fù)發(fā)性膽道結(jié)石患者96例，按照隨機(jī)數(shù)表法分成兩組各48例。常規(guī)組接受常規(guī)圍術(shù)期干預(yù)，ERAS組在圍術(shù)期實(shí)施ERAS干預(yù)。采用視覺模擬評估量表（VAS）評估疼痛程度，應(yīng)激反應(yīng)問卷（SRQ）評估心理應(yīng)激反應(yīng)情況，比較兩組圍術(shù)期指標(biāo)、心理應(yīng)激、生理應(yīng)激指標(biāo)及術(shù)后并發(fā)癥。結(jié)果：ERAS組引流管拔除時(shí)間、術(shù)后進(jìn)食時(shí)間、排氣時(shí)間及術(shù)后住院時(shí)間均比常規(guī)組短（P<0.05）。ERAS組術(shù)后48 h SRQ量表各維度評分、VAS評分、血清血管緊張素-2（ANG-2）、腎素（PRA）、醛固酮（ALD）水平均比常規(guī)組低（均P<0.05）。ERAS組術(shù)后并發(fā)癥發(fā)生率為6.25%，與常規(guī)組的12.50%相比差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論：ERAS理念用于復(fù)發(fā)性膽道結(jié)石患者腹腔鏡手術(shù)可加快術(shù)后康復(fù)進(jìn)程，降低圍術(shù)期心理、生理應(yīng)激。

關(guān)鍵詞 復(fù)發(fā)性膽道結(jié)石；腹腔鏡手術(shù)；加速康復(fù)外科策略；應(yīng)激狀態(tài)

中圖分類號：R657.4 文獻(xiàn)標(biāo)志碼：A 文章編號：1006-1533（2021）20-0020-04

Effect of accelerated rehabilitation surgery strategy on the stress state of patients with recurrent biliary calculi after laparoscopic surgery

DENG Xiaochun（The Second Department of Surgery of Nancheng County Peoples Hospital， Fuzhou City， Jiangxi Province 244700， China）

ABSTRACT Objective： To evaluate the effect of accelerated rehabilitation surgery strategy on stress state of patients with recurrent biliary calculi after laparoscopic surgery. Methods： Ninety-six patients with recurrent biliary calculi who underwent laparoscopic surgery in Nancheng County Peoples Hospital， Fuzhou City， Jiangxi Province from June 2018 to July 2020 were selected， and according to the random number table method， divided into two groups with 48 cases each. The routine group received routine perioperative intervention， and the accelerated rehabilitation surgery strategy group received accelerated rehabilitation surgery strategy intervention during perioperative period. The visual analogue assessment scale（VAS） was used to assess the degree of pain， the stress response questionnaire（SRQ） was used to assess the psychological stress response， and the perioperative indicators， psychological stress， physiological stress indicators and postoperative complications were compared between the two groups. Results： The drainage tube extraction time， postoperative eating time， exhaust time and postoperative hospital stay in the accelerated rehabilitation surgery strategy group were shorter than those in routine group（P<0.05）； the SRQ scale scores， VAS scores， serum angiotensin-2（ANG-2）， renin and aldosterone（ALD） levels in the accelerated rehabilitation surgery strategy group were lower than those in the routine group at 48 h after surgery（all P<0.05） . The postoperative complication rate in the accelerated rehabilitation surgery strategy group was 6.25%， which was not statistically different from 12.50% in the routine group（P>0.05）. Conclusion： The concept of accelerated rehabilitation surgery strategy for laparoscopic surgery in patients with recurrent biliary calculi can speed up the postoperative recovery process and reduce perioperative psychological and physical stress.