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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2020, Vol. 06 ›› Issue (02) : 111 -116. doi: 10.3877/cma.j.issn.2095-9605.2020.02.007

所属专题： 文献；

论著

加速康复措施在减重代谢外科中的应用价值
梁銮盛1, 杨慧英1, 周霞1, 谷蓉1, 赵象文1,†()   
  1. 1. 528415　中山，南方医科大学附属小榄医院减重中心
  • 收稿日期:2019-11-20 出版日期:2020-05-30
  • 通信作者: 赵象文
  • 基金资助:
    中山市医学科研项目，快速康复措施在减重代谢外科的应用价值(2017J194)

Application value of Fast recovery measures in weight loss and metabolic surgery.

Luansheng Liang1, Huiying Yang1, Xia Zhou1, Rong Gu1, Xiangwen Zhao1,†()   

  1. 1. Southern medical university affiliated Xiaolan Hospital, Zhongshan 528415 China
  • Received:2019-11-20 Published:2020-05-30
  • Corresponding author: Xiangwen Zhao
  • About author:
    Corresponding author: Zhao Xiangwen, Email:
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引用本文：

梁銮盛, 杨慧英, 周霞, 谷蓉, 赵象文. 加速康复措施在减重代谢外科中的应用价值[J]. 中华肥胖与代谢病电子杂志, 2020, 06(02): 111-116.

Luansheng Liang, Huiying Yang, Xia Zhou, Rong Gu, Xiangwen Zhao. Application value of Fast recovery measures in weight loss and metabolic surgery.[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2020, 06(02): 111-116.

目的

通过在减重代谢外科围手术期实施各种加速康复外科（ERAS）措施，总结出加速康复外科措施在减重与代谢病外科中的应用价值。

方法

回顾性分析2015年1月至2018年1月南方医科大学附属小榄医院减重与代谢病外科收治的91例肥胖症或2型糖尿病患者的临床病例资料，将患者在围手术期实施快速康复措施的纳入加速康复外科组（ERAS组）；而仅采用传统胃肠外科围手术期措施的患者纳入对照组。对比两组患者在术后疼痛评分、肛门排气时间、并发症、平均住院时间、住院总费用、减重效果、再住院率、再手术率等方面的差异，分析ERAS实施在减重代谢外科中的应用价值。

结果

ERAS组术后疼痛NRS评分低于对照组(3.8±1.2) vs. (6.4±1.5)，P<0.05；术后肛门排气时间缩短(1.0±0.3)d vs.(1.9±0.7)d，P<0.05；无严重并发症；术后住院时间短(6.4±1.3)d vs.(13.7±1.5)d ，P<0.05，住院费用降低（46813±3070）元vs. (66973±4520)元，P<0.05；两组的平均术后1年多余体重减除率均>80%。

结论

在减重与代谢手术中，实施围手术期快速康复措施，可明显缩短住院时间，减少术后并发症，快速康复，节省费用，具有突出的应用价值。

关键词: 加速康复外科, 减重与代谢手术, 围手术期处理
Objective

To summarize the application value of rapid rehabilitation surgical measures in the surgery of weight loss and metabolic diseases by implementing various enhanced recovery after surgery (ERAS) measures in the perioperative period of weight loss metabolic surgery.

Methods

the clinical data of 91 patients with obesity or type 2 diabetes treated in the Department of weight loss and Metabolic Diseases, Xiaolan Hospital affiliated to Southern Medical University from January 2015 to January 2018 were retrospectively analyzed. According to the principle of random grouping, patients who received rapid rehabilitation measures during perioperative period were included in the rapid rehabilitation surgery group (ERAS group), while patients who only used traditional perioperative measures in gastrointestinal surgery were included in the control group. The differences of postoperative pain score, anal exhaust time, complications, average hospitalization time,total hospitalization cost, weight loss effect, rehospitalization rate and reoperation rate between the two groups were compared, and the application value of ERAS in weight loss metabolic surgery was analyzed and discussed.

Results

The NRS score of postoperative pain in the ERAS group was lower than that in the control group (3.81.2) vs. (6.41.5), P<0.05). The postoperative anal exhaust time was shortened (1.0 ±0.3) d vs. (1.9 ±0.7) d, P<0.05). There were no serious complications, the postoperative hospital stay was shorter (6.4 ±1.3) d vs. (13.7 ±1.5) d, P<0.05), and the hospitalization cost was reduced (46813 ±3070) ￥ vs. (66973 ±4520)￥, P<0.05. The average rate of excess weight loss 1 year after operation in both groups was more than 80%.

Conclusions

In the perioperative period of weight loss and metabolic surgery, the implementation of rapid rehabilitation measures is superior to the traditional mode, which can significantly shorten the time of hospitalization, reduce postoperative complications, rapid recovery and save cost, and has outstanding application value.

Key words: Enhanced recovery after surgery (ERAS), Weight loss and metabolic surgery, Perioperative management
表1 两组患者术前资料统计表（例）
? ERAS组 对照组
病例数 49 42
男性 16 20
女性 13 22
肥胖合并代谢综合征 30 18
肥胖合并2型糖尿病 18 24
单纯肥胖症 1 0
表2 两组患者手术术式统计表（例）
手术方式 ERAS组 对照组
腹腔镜胃旁路术 20 25
腹腔镜袖状胃切除术 23 3
腹腔镜袖状胃切除+十二指肠空肠吻合术 0 4
腹腔镜袖状胃切除+空肠空肠吻合术 6 8
修正手术——腹腔镜胃旁路术 0 1
表3 两组患者手术后指标
? ERAS组 对照组 P值
平均住院时间（d） 6.4±1.3 13.7±1.5 < 0.05
术后疼痛NRS评分 3.8±1.2 6.4±1.5 < 0.05
腹腔引流管留置时间（d） 0 4.4±2.1 < 0.05
术后下床时间（d） 0.75±0.5 1.6±0.9 < 0.05
开始进食时间（d） 1.1±0.3 3.0±0.42 < 0.05
肛门排气时间（d） 1.0±0.3 1.9±0.7 < 0.05
手术出血量（ml） 24.3±13.2 50.4±20.0 < 0.05
术后并发症发生率（%） 2.0%(1/49) 9.5%(4/42) < 0.05
平均住院费用（元） 46813 66973.8 < 0.05
术后1年%EWL 84.5 80.2 < 0.05
再住院率（%） 0 2.38 < 0.05
再手术率（%） 0 7.14 < 0.05
[1]
Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review[J]. JAMA Surg, 2017, 152(3): 292-298..
[2]
Memtsoudis SG, Fiasconaro M, Soffin EM, et al. Enhanced recovery after surgery components and perioperative outcomes: a nationwide observational study[J] .Br J Anaesth, 2020.
[3]
李新营, 王文龙. 加速康复外科和日间手术在甲状腺手术中的应用现状及发展前景[J]. 西安交通大学学报（医学版）, 2019, 40(3): 491-494.
[4]
Haapanen H, Tsang V, Kempny A, et al. Grown-up Congenital Heart Surgery in 1093 Consecutive Cases: A 'Hidden' Burden of Early Outcome.[J] .Ann. Thorac. Surg., 2020, 01: 071.
[5]
Memtsoudis SG, Fiasconaro M, Soffin EM, et al. Enhanced recovery after surgery components and perioperative outcomes: a nationwide observational study[J] .Br J Anaesth, 2020.
[6]
Li Neill Y, Gruppuso PA, Kalagara S, et al. Critical Assessment of the Contemporary Orthopaedic Surgery Residency Application Process[J]. J Bone Joint Surg Am, 2019, 101(21): e114.
[7]
Noel Patrick, Eddbali Imane, Nedelcu Marius, et al. The Interest of Enhanced Recovery After Surgery in a New Bariatric Center.[J] .J Laparoendosc Adv Surg Tech A, 2020, 30: 6-11.
[8]
中国研究型医院学会糖尿病与肥胖外科专业委员会. 减重代谢外科围术期处理专家共识(2019版)[J]. 中华消化外科杂志, 2019,18(9):811-821.
[9]
车璐, 徐仲煌. 加速康复外科在麻醉医学中的应用与展望[J].临床误诊误治, 2017,30(4):1-4.
[10]
张鹏, 郑成竹. 减重代谢手术治疗2型糖尿病全球联合指南解读[J]. 中华胃肠外科杂志, 2017,20(4): 372-377.
[11]
梁辉, 林士波, 管蔚. 减重代谢外科手术方式的选择[J]. 中华胃肠外科杂志, 2017,20(4): 388-392.
[12]
Ripollés-Melchor Javier,Ramírez-Rodríguez José M,Casans-Francés Rubén et al. Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study.[J] .JAMA Surg, 2019, undefined: undefined.
[13]
Hughes MA, Culpin E, Darley R, et al. Enhanced recovery and accelerated discharge after endoscopic transsphenoidal pituitary surgery: safety, patient feedback, and cost implications[J]. Acta Neurochir (Wien), 2020,.
[14]
吴璐宁, 孙晓东. 快速康复外科在腹腔镜减重代谢手术的研究进展[J]. 浙江临床医学, 2019, 21(2): 290-292.
[15]
Malczak P, Pisarska M, Piotr M, et al. Enhanced Recovery after Bariatric Surgery: Systematic Review and Meta-Analysis[J]. Obes Surg, 2017, 27(1): 226-235.
[16]
Ruiz TJ, Sanchez SR, Martín GAE, et al. Enhanced recovery after bariatric surgery[J]. Cir Esp, 2019.
[17]
Jochum SB, Ritz EM, Bhama AR, et al. Early feeding in colorectal surgery patients: safe and cost effective[J].Int J Colorectal Dis, 2020, 35: 465-469.
[18]
Mannaerts GHH, Allatif REA, Hashmi FY, et al. First Successful Large-Scale Introduction of an Enhanced Recovery after Bariatric Surgery (ERABS) Program in the Middle East: The Results and Lessons Learned of Tawam Hospital/Johns Hopkins, a Tertiary Governmental Center in the UAE[J]. Obes Surg, 2019, 29: 2100-2109.
[19]
Wenyue, Wang, Chengcan, et al. Meta-analysis on safety of application of enhanced recovery after surgery to laparoscopic bariatric surgery [J]. Chinese Journal of Gastrointestinal Surgery, 2018, 21: 1167-1174.
[20]
胡瑞翔, 杨景哥, 杨华, 等. 450例腹腔镜Roux-en-Y胃旁路术后并发症的分析及处理[J]. 中华消化外科杂志, 2017, 16(6): 582-586.
[21]
Bamgbade OA, Oluwole O, Khaw RR, et al. Perioperative Analgesia for Fast-Track Laparoscopic Bariatric Surgery[J] .Obes Surg, 2017, 27: 1828-1834.
[22]
Trotta M, Ferrari C, D'Alessandro G, et al. Enhanced recovery after bariatric surgery (ERABS) in a high-volume bariatric center[J] .Surg Obes Relat Dis, 2019, 15: 1785-1792.
[23]
朱江帆. 控制血压是防止腹腔镜胃袖状切除术出血的重要措施[J/CD]. 中华肥胖与代谢病电子杂志, 2017, 3(3): 127-129.
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