在老年患者中实施手术后增强恢复 (ERAS) 协议,这些患者因穿孔性胃潰瘍接受紧急手术:比较分析
Mohamed Wael1,2, Ahmed S Shehab3,4, Islam El-Sayes3,5
1Alexandria Main University Hospital, Alexandria, Egypt. m_mohamed12@alexmed.edu.eg.
BMC gastroenterology
|October 14, 2025
概括
手术后增强恢复 (ERAS) 协议可以安全地加速接受紧急穿孔性胃潰瘍 (PPU) 手术的老年患者的康复. 埃拉斯可以改善疼痛控制,减少住院时间,而不会增加并发症.
科学领域:
- 老年人手术是一门老年手术.
- 外科手术的结果
- 在外科手术后的护理.
背景情况:
- 手术后增强恢复 (ERAS) 协议已为选择性手术建立,但在紧急手术中未得到充分研究,特别是在老年患者中.
- 老年人代表了在紧急外科设置中的脆弱子组.
- 这项研究是首次比较ERAS结果,特别是在为穿孔性胃潰瘍 (PPU) 接受紧急手术的老年患者中.
研究的目的:
- 评估ERAS协议在接受紧急PPU修复的老年患者 (≥60岁) 的有效性和安全性.
- 为了比较ERAS和传统护理组之间的功能恢复,并发症,疼痛和停留时间.
- 为了确定ERAS的实施是否会影响该群体的再接收或重新运营率.
主要方法:
- 从2020年8月到2024年7月,对137名患有PPU的老年患者 (≥60岁) 进行了回顾性比较分析.
- 患者被分为ERAS组 (n=67) 和常规治疗组 (n=70).
- 主要结局包括术后功能恢复参数;次要结局包括并发症,疼痛评分和停留时间.
主要成果:
- 在ERAS组显示显著更快的肠道排便 (1.21比2.20天,p=0.008) 和动员 (1.26比3.51天,p<0.001).
- ERAS患者的住院时间更短 (5.24 vs. 7.03天,p=0.001) 和优异的疼痛控制与减少阿片类药物使用 (8.49 vs. 18.73毫克,p=0.001).
- 手术后的恶心和吐减少了 (22.4%对41.8%,p=0.013),并发症,再入院和重新手术率相似.
结论:
- 对于接受紧急PPU修复的老年患者,ERAS协议是安全有效的,导致加速康复和减少住院时间.
- 这些发现挑战了在这个人群中对外科手术期间护理的保守方法.
- 结果可能不适用于虚弱或重病的老年患者,这表明需要在不同老年人亚组进行进一步研究.
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