选择性结直肠手术后晚期康复的决定因素
M Ceresoli1,2, L Ripamonti3, C Pedrazzani4
1Colorectal Surgery Unit, Department of General Surgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Techniques in coloproctology
|September 24, 2024
概括
优化增强恢复协议是结直肠手术后患者更快恢复的关键. 坚持特定的手术前和手术期间的要素可以显著降低延迟恢复率.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 在外科手术期间的医学.
- 增强的恢复协议 恢复协议
背景情况:
- 增强恢复协议 (ERP) 旨在优化患者手术后的恢复.
- 尽管实施了ERP,但仍有大量患者的康复延迟.
- 确定延迟恢复的决定因素对于改善患者的治疗结果至关重要.
研究的目的:
- 确定影响选择性结直肠切除患者早期术后康复的关键因素.
- 确定增强恢复协议中的特定元素,这些元素会显著影响恢复时间.
主要方法:
- 使用前性收集的注册表 (2015-2022) 进行回顾性观察研究.
- 涉及22个经过ERP培训的意大利大容量结直肠外科手术中心.
- 分析了1535名接受选择性结肠直肠切除术的患者,评估了术后第二天的康复状态.
主要成果:
- 在31.7%的患者中观察到延迟恢复 (未能在术后第二天达到≥2个恢复指标).
- 六个ERP项目独立促进了早期康复:入院前咨询,手术前碳水化合物饮料,限制性手术内液体 (<7毫升/千克/小时),避免胸部外围镇痛,早期鼻胃管切除和成功的腹腔镜检查.
- 增加对这六项项的坚持与延迟恢复的显著下降相关,在完全坚持的情况下达到13.0%.
结论:
- 坚持特定的术前和术后ERP组件对于促进选择性结直肠手术后早期康复至关重要.
- 关键干预措施包括患者咨询,手术前的碳水化合物摄入,优化液体管理,特定的止痛选择,早期的鼻胃管切除和腹腔镜方法.
- 这些发现可以为ERP的改进提供信息,以进一步改善患者的康复轨迹.
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