选择性结肠手术中的ERAS失败和重大并发症:常见的危险因素
Suvi Rasilainen1, Tuukka Tiainen2, Matti Pakarinen2
1Department of Gastrointestinal Surgery, Abdominal Center, Helsinki University Hospital, Jorvi Hospital, Espoo and University of Helsinki, Turuntie 150, Espoo 02740, Finland.
这项研究确定了手术后增强恢复 (ERAS) 协议失败和选择性结肠切除并发症的风险因素. 男性性别,高ASA类和开放性手术增加风险,需要针对性的手术前干预.
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.
- 手术结果研究研究.
背景情况:
- 手术后增强恢复 (ERAS) 协议优化了手术期间的管理,减少了并发症和成本.
- 确定ERAS失败和重大术后并发症的危险因素对于选择性结肠切除患者至关重要.
研究的目的:
- 为了确定ERAS协议失败的潜在风险因素.
- 在接受选择性结肠切除的患者中识别重大术后并发症的潜在风险因素.
主要方法:
- 连续接受选择性结肠切除的患者的单中心回顾性分析 (2017年6月 - 2019年6月).
- 所有患者都是在升级的ERAS计划下进行管理的.
- 采用多变量回归分析来确定ERAS故障和特定并发症的独立预测因素.
主要成果:
- 更高的ERAS遵守率 (>70%) 与更低的并发症指数和更短的住院时间相关.
- 独立预测ERAS失败的预测因素包括男性性别,ASA PS Class IV,开放式手术和低白蛋白 (<34).
- 术后骨髓风险因素包括男性性别,特定的癌症位置,开放式手术,延迟动员和高氧使用. 解剖切除与卷积,转换为开放性手术,延迟动员和低手术前血红蛋白有关.
结论:
- 患有男性性别,高ASA类,流动性问题或在开放手术中存在高风险的患者需要加强手术前咨询和物理治疗.
- 应考虑在高风险病例中与两名高级结肠直肠外科医生一起进行手术,以尽量减少转化和并发症.
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