探讨加速康复外科（ERAS）应用于腹腔镜袖状胃切除术（LSG）围手术期管理的有效性和安全性。

前瞻性分析2016年9月至2017年10月在徐州医科大学附属医院胃肠外科接受LSG的80例患者的临床资料，按照是否行ERAS模式分为ERAS组（研究组，40例）、非ERAS组（对照组，40例）。研究组采用ERAS流程管理，包括饮食、生理状态调整及心理状态评估，术前禁食6 h，非糖尿病患者术前2 h饮用250 ml糖水，糖尿病患者饮用250 ml生理盐水，全身麻醉后置入胃管及导尿管，术中电热毯或吹风机辅助保温。麻醉清醒后即进水，倡导早期进食，不使用镇痛泵，仅按需予以氟比洛芬酯镇痛。对照组采用传统模式管理，术前禁食12 h，禁水4 h，术前一晚口服泻药行肠道准备，术前置入胃管及导尿管，术后等待排气后开始进食，留置镇痛泵镇痛。记录两组患者手术信息、术后恢复情况、疼痛评分、应激指标和营养状态指标，两组间的差异采用t检验和Mann-Whitney检验进行分析。分类数据使用Fisher精确检验和Pearson卡方检验进行分析。

研究组较对照组缩短了术后住院时间[(3.3±1.2) d vs (5.0±2.4) d，P<0.05]、胃管留置时间[(0.05±0.2) d vs (1.18±0.59) d，P<0.05]，加快术后进食时间[(1.73±0.56) d vs (2.55±0.68) d，P<0.05]、排气时间[（1.88±0.69） d vs (2.50±0.72) d，P<0.05]，疼痛程度较对照组减轻（P<0.05），且术后白细胞及中性粒细胞计数水平均低于对照组（P<0.05），而术后白蛋白、前白蛋白水平均高于对照组（P<0.05）。

ERAS应用于LSG围手术期可显著缩短住院时间并加快术后营养恢复，值得在实践中推广应用。

To investigate the effectiveness and safety of enhanced recovery after surgery (ERAS) in the management of undergoing LSG patients during perioperative management.

Prospective study the clinical data of 80 patients undergoing LSG surgery in the Department of Gastrointestinal Surgery of the Affiliated Hospital of Xuzhou Medical University from September 2016 to October 2017. The patients were divided into ERAS group (experimental group, 40 cases), non-ERAS group (control group, 40 cases). The experimental group were managed using ERAS protocol, including psychological status assessment, preoperative fasting 6h, non-diabetic patients were given 250 ml of sugar water 2h before surgery, while diabetic patients received 250 ml saline, after induction of anesthesia NG tube and urine catheter were placed, intraoperative electric heater blanket or heater blower to help maintaining warm condition. Immediately after anesthesia recovery, water intake was allowed, promote early eating, analgesic pump were not used if not on-demand, only used flurbiprofenaxetil analgesia. On the other hand, the control group used the traditional model of management, which is preoperative fasting 12 h, water intake allowed up to 4 h before surgery, one night before surgery, oral laxative for bowel preparation, preoperative gastric tube and catheterization, food intake were only allowed after flatus, often used analgesia pump. The operation information, postoperative recovery, pain score, stress index and nutritional status were recorded. The differences between the two groups were analyzed by t-test and Mann-Whitney test. Classification data were analyzed by Fisher's exact test and Pearson's chi-square test.

Compared with the control group, the experimental group had shorter length of postoperative hospital stay (3.3±1.2d vs 5.0±2.4d, P<0.05) ,gastric tube indwelling time (0.05±0.2d vs 1.18±0.59d, P<0.05), accelerate postoperative first time food intake (1.73±0.56d vs2.55±0.68d, P<0.05 ), and flatus time (1.88±0.69d vs2.50±0.72d, P<0.05). The degree of postoperative pain lower than the control group (P<0.05), the postoperative white blood cells and neutrophil count levels were lower than those in the control group (P<0.05). On the other hand, postoperative albumin, prealbumin were higher in the experimental group than the control group (P<0.05).

The management of LSG surgery patients using ERAS protocol can shorten the length of hospital stay and accelerate the recovery of postoperative nutritional status. It is safe and reliable and worth popularizing in practice.