加速康復外科策略對復發性膽道結石患者腹腔鏡手術后應激狀態的影響

鄧曉春

摘 要 目的：評價加速康復外科策略（enhanced recovery after surgery，ERAS）對復發性膽道結石患者腹腔鏡手術后應激狀態的影響。方法：選擇2018年6月至2020年7月于江西省撫州市南城縣人民醫院接受腹腔鏡手術的復發性膽道結石患者96例，按照隨機數表法分成兩組各48例。常規組接受常規圍術期干預，ERAS組在圍術期實施ERAS干預。采用視覺模擬評估量表（VAS）評估疼痛程度，應激反應問卷（SRQ）評估心理應激反應情況，比較兩組圍術期指標、心理應激、生理應激指標及術后并發癥。結果：ERAS組引流管拔除時間、術后進食時間、排氣時間及術后住院時間均比常規組短（P<0.05）。ERAS組術后48 h SRQ量表各維度評分、VAS評分、血清血管緊張素-2（ANG-2）、腎素（PRA）、醛固酮（ALD）水平均比常規組低（均P<0.05）。ERAS組術后并發癥發生率為6.25%，與常規組的12.50%相比差異無統計學意義（P>0.05）。結論：ERAS理念用于復發性膽道結石患者腹腔鏡手術可加快術后康復進程，降低圍術期心理、生理應激。

關鍵詞 復發性膽道結石；腹腔鏡手術；加速康復外科策略；應激狀態

中圖分類號：R657.4 文獻標志碼：A 文章編號：1006-1533（2021）20-0020-04

Effect of accelerated rehabilitation surgery strategy on the stress state of patients with recurrent biliary calculi after laparoscopic surgery

DENG Xiaochun（The Second Department of Surgery of Nancheng County Peoples Hospital， Fuzhou City， Jiangxi Province 244700， China）

ABSTRACT Objective： To evaluate the effect of accelerated rehabilitation surgery strategy on stress state of patients with recurrent biliary calculi after laparoscopic surgery. Methods： Ninety-six patients with recurrent biliary calculi who underwent laparoscopic surgery in Nancheng County Peoples Hospital， Fuzhou City， Jiangxi Province from June 2018 to July 2020 were selected， and according to the random number table method， divided into two groups with 48 cases each. The routine group received routine perioperative intervention， and the accelerated rehabilitation surgery strategy group received accelerated rehabilitation surgery strategy intervention during perioperative period. The visual analogue assessment scale（VAS） was used to assess the degree of pain， the stress response questionnaire（SRQ） was used to assess the psychological stress response， and the perioperative indicators， psychological stress， physiological stress indicators and postoperative complications were compared between the two groups. Results： The drainage tube extraction time， postoperative eating time， exhaust time and postoperative hospital stay in the accelerated rehabilitation surgery strategy group were shorter than those in routine group（P<0.05）； the SRQ scale scores， VAS scores， serum angiotensin-2（ANG-2）， renin and aldosterone（ALD） levels in the accelerated rehabilitation surgery strategy group were lower than those in the routine group at 48 h after surgery（all P<0.05） . The postoperative complication rate in the accelerated rehabilitation surgery strategy group was 6.25%， which was not statistically different from 12.50% in the routine group（P>0.05）. Conclusion： The concept of accelerated rehabilitation surgery strategy for laparoscopic surgery in patients with recurrent biliary calculi can speed up the postoperative recovery process and reduce perioperative psychological and physical stress.