張 勇
(河南省安陽市人民醫(yī)院,河南 安陽 455000)
結(jié)直腸外科快速康復(fù)模式加速直腸癌術(shù)后康復(fù)的臨床研究
張 勇
(河南省安陽市人民醫(yī)院,河南 安陽 455000)
目的 對結(jié)直腸外科快速康復(fù)模式對加速直腸癌手術(shù)患者術(shù)后康復(fù)的作用進(jìn)行評價(jià)。方法 將 2009 年 2 月至 2011 年 3 月來自我院的 80 例直腸癌擇期手術(shù)病例隨機(jī)的分為兩組,F(xiàn)T 組和對照組。FT 組的 40 例患者在圍手術(shù)期管理接受快速康復(fù)模式,進(jìn)行的項(xiàng)目有簡化腸道準(zhǔn)備、手術(shù)前夜可以進(jìn)行普通的飲食。手術(shù)后不待肛門排氣就對胃管進(jìn)行拔出恢復(fù)飲食,手術(shù)后強(qiáng)制進(jìn)行早期活動(dòng),不進(jìn)行常規(guī)的引流管放置和尿管早期拔出。對照組的 40 例患者進(jìn)行傳統(tǒng)模式,對兩組患者的手術(shù)后的住院時(shí)間、30d 內(nèi)的手術(shù)并發(fā)癥和再入院率進(jìn)行了統(tǒng)計(jì)學(xué)分析。結(jié)果 兩組患者的性別、合并癥、術(shù)式、腫瘤 TNM 分期等量變的構(gòu)成比、手術(shù)時(shí)間、年齡、失血量等計(jì)量的資料比較其差異沒統(tǒng)計(jì)學(xué)意義(P> 0.05)。快速康復(fù)組的患者住院的平均時(shí)間為(4.5±2.3)d,對照組的平均住院時(shí)間為(9.0±2.5)d,兩組患者對比 FT 組明顯的縮短(P < 0.01)。FT 組的患者一個(gè)月內(nèi)并發(fā)癥的發(fā)生率也明顯的比對照組的患者低(P < 0.05)。對兩組患者的再入院率進(jìn)行了對比,其差異沒有統(tǒng)計(jì)學(xué)意義(P> 0.05)。結(jié)論 結(jié)直腸外科快速康復(fù)模式可以應(yīng)用于擇期直腸癌圍手術(shù)期的臨床管理,能夠加速患者的康復(fù)。
結(jié)直腸外科;快速康復(fù)模式;直腸癌術(shù)后康復(fù);影響
結(jié)直腸外科快速康復(fù)模式是一種新的圍手術(shù)期臨床管理模式,這種模式逐漸的被歐美國家所認(rèn)同[1,2]。根據(jù)患者的并發(fā)癥和器官的功能障礙與手術(shù)創(chuàng)傷和圍手術(shù)期的疼痛、低溫、引流等創(chuàng)傷因子誘發(fā)炎性反應(yīng)密切相關(guān)的理論,將圍手術(shù)期的臨床管理提升與手術(shù)操作的意義同樣重要。將2009年2月至2011年3月來自我院的80例直腸癌擇期手術(shù)病例進(jìn)行了研究如下。
1.1 一般資料
所有的患者均在75歲以下,直腸惡性腫瘤的患者,擇期手術(shù)患者,在手術(shù)前沒有禁食和補(bǔ)液以及營養(yǎng)支持。對患者的肝腎功能檢查正常,身體各個(gè)器官系統(tǒng)沒有細(xì)菌和病毒感染。
1.2 方法
將80例直腸癌擇期手術(shù)病例隨機(jī)的分為兩組,F(xiàn)T組和對照組。對患者手術(shù)后連續(xù)性觀察,對方時(shí)間為1個(gè)月。FT組的患者手術(shù)前的飲食:進(jìn)行普通的飲食指導(dǎo)手術(shù)前12h,對照組為手術(shù)前的3d進(jìn)行素飲食,術(shù)前24h禁食。FT組腸道準(zhǔn)備為:手術(shù)前夜進(jìn)行灌腸清潔,不服用抗生素,對照組患者手術(shù)前16h服用聚二乙醇,手術(shù)的前夜進(jìn)行灌腸清潔,手術(shù)前3d服用抗生素;FT組的患者采取小切口手術(shù),對照組患者進(jìn)行常規(guī)的切口手術(shù);FT組的患者手術(shù)后的次日清晨進(jìn)行胃管的拔除,對照組患者等腸功能恢復(fù)之后再拔除;FT組的患者在引流上僅結(jié)肛溫和之后引流管留置1~2d,其余術(shù)式都不進(jìn)行引流,對照組的患者常規(guī)的防止引流管,3~9d之后拔除;FT組在手術(shù)后次日進(jìn)行液體飲食,腸功能恢復(fù)后進(jìn)行固體飲食,對照組的患者在腸功能恢復(fù)后先進(jìn)性液體飲食逐漸過渡到固體飲食。FT組的患者在手術(shù)后6h進(jìn)行下床活動(dòng),對照組的患者在手術(shù)后的72h開始下床。
1.3 統(tǒng)計(jì)學(xué)處理
對所得數(shù)據(jù)采用SPSS 18.0統(tǒng)計(jì)學(xué)處理。
兩組患者的性別、合并癥、術(shù)式、腫瘤TNM分期等量變的構(gòu)成比、手術(shù)時(shí)間、年齡、失血量等計(jì)量的資料比較其差異沒統(tǒng)計(jì)學(xué)意義(P>0.05)??焖倏祻?fù)組的患者住院的平均時(shí)間為(4.5±2.3)d,對照組的平均住院時(shí)間為(9.0±2.5)d,兩組患者對比FT組明顯的縮短(P<0.01)。FT組的患者1個(gè)月內(nèi)并發(fā)癥的發(fā)生率也明顯的比對照組的患者低(P<0.05)。對兩組患者的再入院率進(jìn)行了對比,其差異沒有統(tǒng)計(jì)學(xué)意義(P>0.05)。
對于結(jié)直腸手術(shù)的特點(diǎn),我們應(yīng)該更加關(guān)注怎樣去減少吻合口瘺、術(shù)后腸麻痹以及外科感染。對腸道準(zhǔn)備的治療的苛求沒有減少感染的發(fā)生,但是吻合口瘺的發(fā)生概率增加了。胃腸的減壓也不能使結(jié)直腸排空,但是能夠增加患者的痛苦增加患者肺炎的發(fā)生率。早期對飲食的恢復(fù)對吻合口瘺的發(fā)生也沒有直接的關(guān)系,不僅不能加重腸麻痹,反而會促進(jìn)腸功能的恢復(fù)是患者的營養(yǎng)狀況得到改善。
FT需要麻醉醫(yī)師、護(hù)士以及心理醫(yī)師功能的參與才能完整的實(shí)施,這是一個(gè)典型的多學(xué)科團(tuán)隊(duì)進(jìn)行協(xié)作的模式,也是我們長期努力的方向。
[1]Wind J,Polle SW,Fung PH,et a1.Systematic review of enhanced recovery programmes in colonic surgery[J].Br J Surg,2006,93(7): 800-809.
[2]許劍民,鐘蕓詩,朱德祥,等.促進(jìn)術(shù)后恢復(fù)綜合方案在結(jié)直腸癌根治術(shù)中的應(yīng)用[J].中華胃腸外科雜志,2007,10(3):238.
Surgical the Rapid Rehabilitation Model Accelerated Colorectal Cancer Postoperative Rehabilitation Clinical Research
ZHANG Yong
(Anyang People′s Hospital, Anyang 455000, China)
ObjectiveTo evaluate the role of accelerated rehabilitation after cancer surgery patients quicker recovery mode colorectal surgery.MethodsFebruary 2009 to March 2011 from our hospital 80 cases of patients with rectal cancer undergoing elective surgery were randomly divided into two groups, FT group and the control group. FT group of 40 patients in the perioperative management for rapid rehabilitation model, the project conducted a simplified bowel preparation the night before surgery can ordinary diet. Not wait for anal exhaust after surgery on the stomach tube to pull out the recovery diet, mandatory early after surgery, not a glutton drainage tube placement and catheter early pull out. 40 patients in the control group, the traditional mode, the length of stay in the two groups of patients after surgery, within 30 days of surgery complications and readmission rates were statistically analyzed.ResultsThe quantitative composition than the gender of the two groups of patients, complications, surgical, cancer TNM staging, surgery time, age, blood loss measured data to compare the difference was not statistically significant (P>0.05). The average time of rapid rehabilitation group patients hospitalized for (4.5 ±2.3)d, the control group, the average length of stay was (9.0±2.5)d, the two groups were compared FT group was significantly shorter (P<0.01). FT group of patients within one month of the incidence of complications is significantly lower than patients in the control group (P<0.05). Readmission rates of the two groups of patients were compared, the difference was not statistically significant (P>0.05).ConclusionColorectal surgery rapid rehabilitation mode can be applied to elective rectal perioperative clinical management, to accelerate the rehabilitation of patients.
Colorectal surgery; Rapid rehabilitation model; Cancer post operative rehabilitation; Impact
R735.3+7
:B
:1671-8194(2013)07-0061-02