ERAS理念下日间手术管理模式在妇科腹腔镜手术患者中的安全性及可行性研究

刘华英; 李玲; 史元湘; 荣欣; 梁小龙; 王延洲; 吴治敏

doi:10.16016/j.2097-0927.202401004

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ERAS理念下日间手术管理模式在妇科腹腔镜手术患者中的安全性及可行性研究

临床医学 | 更新时间：2026-01-09

- ERAS理念下日间手术管理模式在妇科腹腔镜手术患者中的安全性及可行性研究
- Safety and feasibility of day surgery management model under ERAS concept for gynecologic laparoscopic surgery
- 陆军军医大学学报 2024年46卷第14期页码：1658-1665
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院妇产科
- 作者简介：
  
  [吴治敏，E-mail: wzm_xnyy@126.comWU Zhimin, E-mail: wzm_xnyy@126.com
- 基金信息：
  
  重庆市技术创新与应用发展专项重点项目(CSTB2022TIAD-KPX0154)
- DOI：10.16016/j.2097-0927.202401004
  中图分类号： R473.71;R572;R713
- 收稿：2024-01-02，
  
  修回：2024-02-25，
  
  纸质出版：2024-07-30
- 稿件说明：
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刘华英, 李玲, 史元湘, 等. ERAS理念下日间手术管理模式在妇科腹腔镜手术患者中的安全性及可行性研究[J]. 陆军军医大学学报, 2024,46(14):1658-1665.

Huaying LIU, Ling LI, Yuanxiang SHI, et al. Safety and feasibility of day surgery management model under ERAS concept for gynecologic laparoscopic surgery[J]. Journal of Army Medical University, 2024, 46(14): 1658-1665.
刘华英, 李玲, 史元湘, 等. ERAS理念下日间手术管理模式在妇科腹腔镜手术患者中的安全性及可行性研究[J]. 陆军军医大学学报, 2024,46(14):1658-1665. DOI： 10.16016/j.2097-0927.202401004.

Huaying LIU, Ling LI, Yuanxiang SHI, et al. Safety and feasibility of day surgery management model under ERAS concept for gynecologic laparoscopic surgery[J]. Journal of Army Medical University, 2024, 46(14): 1658-1665. DOI： 10.16016/j.2097-0927.202401004.

摘要

目的

探讨快速康复外科(enhanced recovery after surgery，ERAS)理念下日间手术管理模式在妇科腹腔镜手术患者中应用的安全性及可行性。

方法

采用非随机对照研究设计方案。选取2021年1-8月在妇科行腹腔镜手术的患者，双日入院的96例日间腹腔镜手术患者收在妇科A区病房为干预组，同期单日入院的92例住院腹腔镜手术患者收在妇科B区病房为对照组。对照组患者入院后完善相关检查，住院期间实施普通住院手术方案；干预组实施基于快速康复外科理念下的日间手术管理模式，组建日间手术团队，优化患者围手术期管理措施，包括院前预康复、术前缩短禁食水时间、多模式镇痛、预防性止吐、术中保暖、深静脉血栓预防、术后即刻进食、即刻活动，出院后随访等。比较2组患者术后主观舒适度、肠道功能恢复情况、社会经济效益、术后并发症及炎性指标的差异。

结果

干预组患者术后0~6、7~12、13~24 h口渴、饥饿、恶心、疼痛、腹胀、咽部不适评分均低于对照组(

＜0.01)；住院时间缩短、肠鸣音恢复及首次肛门排气时间明显早于对照组(

＜0.01)，差异有统计学意义。2组患者均未发生跌倒、非计划性二次手术、伤口感染等术后并发症。2组患者术后24 h、术后3、7 d检测降钙素原测定(procalcitonin

PCT)、中性粒细胞百分比(neutrophil percentage

Neu%)及白细胞计数(white blood cell count

WBC)等炎性指标均在正常范围。2组患者术后首次下床活动、住院时间、住院费用及患者满意度等差异有统计学意义(

＜0.01)。

结论

基于ERAS理念的妇科腹腔镜日间手术，住院时间更短、医疗费用更低，患者术后康复更快、舒适度及满意率更高。

Abstract

Objective

To explore the safety and feasibility of the application of day surgery management model under enhanced recovery after surgery (ERAS) concept in patients undergoing gynecologic laparoscopic surgery.

Methods

A non-randomized concurrent control trial was conducted on the patients who underwent laparoscopic surgery in our department from January to August 2021. A total of 92 patients admitted on odd date were assigned into Ward B of our department and served as the control group

and another 96 patients hospitalized on even date were subjected into Ward A and served as the observation group. The control group was given the routine treatment schedule

including the relevant examinations after admission and general operation procedure during hospitalization. The observation group was under a day surgery management model based on the concept of ERAS

with aid of a day surgery team and optimized perioperative management measures

including pre-hospital rehabilitation

shortening water fasting before surgery

multi-mode analgesia

preventive antiemesis

intraoperative warmth

prevention of deep vein thrombosis

immediate postoperative eating and activity

and follow-up after discharge. Postoperative subjective comfort

intestinal function recovery

social and economic benefits

postoperative complications and inflammatory indicators were compared between the 2 groups.

Results

In 0~6

7~12 and 13~24 h after operation

the scores of thirst

hunger

nausea

pain

abdominal distension and pharyngeal discomfort were significantly lower in the observation group than the control group (

0.01). The observation group had obviously shorter length of hospital stay and ealier bowel sound recovery and first anal exhaust than the control group (

0.01). No postoperative complication

such as fall

unplanned secondary operation or wound infection was observed in both groups. The postoperative inflammatory indicators

including procalcitonin (PCT)

neutrophil percentage (Neu%) and white blood cell count (WBC) were all in the normal ranges in the 2 groups at 24 h and 3 and 7 d after surgery. Statistical differences were found in firstly postoperative mobilization

length of hospital stay

hospitalization cost and patient satisfaction between the 2 groups (

0.01).

Conclusion

ERAS-based day surgery management model has the advantages of shortening hospital stay

reducing medical costs

promoting postoperative rehabilitation

and improving the comfort and satisfaction in patients undergoing gynecologic laparoscopic surgery.

关键词

Keywords

references

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