Application Of "LEER" Mode Enhanced Recovery After Surgery In Open Biliary Tract Exploration

BackgroundA large number of clinical practices have proved that enhanced recovery after surgery(ERAS)can reduce perioperative stress,shorten the length of hospital stay and reduce the incidence of complications,so as to promote postoperative recovery of patients.Studies have shown that patients can benefit from performing only the core components of ERAS,and that the idea of ERAS can be popularized.Therefore,some scholars put forward the"LEER"model,which contains four core contents of"less pain,early move,early eat and reassuring",to enhanced recovery after surgery concept,with a view to promoting the extensive application of ERAS concept in primary hospitals.Biliary stone disease is one of the common diseases in hepatobiliary surgery,and open biliary stone exploration is a classic operation.Previous studies have applied the concept of ERAS in open biliary exploration,shortening the length of hospital stay,reducing postoperative complications and achieving considerable clinical effects.However,previous studies were mostly described from the perspective of clinical macro rehabilitation indicators.Postoperative stress,nutrition and immune status of patients were also important factors affecting postoperative recovery of patients.This study focused on the influence of"LEER"mode ERAS on postoperative stress,nutrition and immune status of patients,so as to provide more theoretical basis for the application of"LEER"mode ERAS in open biliary exploration.ObjectiveThis project compares the perioperative clinical conditions of the experimental group and the control group of patients who implement the"LEER"mode ERAS program,this study explored:1.The safety and feasibility of the"LEER"mode ERAS program in the application of open biliary tract exploration.2.Explore the impact of the implementation of the"LEER"mode ERAS program on the stress response,nutrition and immune status of patients after open biliary exploration.3.It is expected to provide clinical reference and evidence-based evidence for patients with open biliary tract exploration using"LEER"mode ERAS program.Materials and methodsForty-six patients who received open cholecystectomy+biliary exploration in the Department of Hepatobiliary Surgery,Puyang People’s Hospital from March 2020 to January 2021 and met the inclusion criteria were selected and randomly divided into two groups according to the random number table method.Among them,24 patients were classified as the experimental group(enhanced recovery after surgery(ERAS)group),and their perioperative management was performed with the"LEER"mode ERAS regimen.The other 22 patients were listed as the control group and received traditional treatment regimens.The data of ERAS group and control group were statistically analyzed.1.Baseline dataAge,gender,body mass index(BMI),hypertension,diabetes,operation time,intraoperative blood loss.2.Stress response indexWhite Blood Cell(WBC),C-Reactive Protein(CRP).3.Nutritional indexPrealbumin(PA),lymphocyte count(LYM)4.Immune index IgM,IgG,IgA.5.Observation indicators of clinical rehabilitationPain visual analogue scale(VAS),first exhaust time,time to get out of bed,hospital stay,complications(bile leakage,nausea and vomiting,incision infection).Results1.General information of the research subjectsComparing the baseline data of the control group and the ERAS group,the age,gender,combined underlying diseases(hypertension,diabetes),intraoperative blood loss,operation time,postoperative complications,etc.There was no statistical difference between two groups patients(P>0.05).2.Postoperative stress response comparisonCompared with the control group and ERAS group(experimental group),the postoperative WBC count is:postoperative[(12.90±1.61)×10~9/L vs.(11.13±0.94)×10~9/L,t=-4.61,P<0.001];CRP postoperative concentration is postoperative[(27.90±3.48)mg/L vs.(25.10±2.89)mg/L,t=-2.971,P=0.005],The indexes of the control group were higher than those of the ERAS group(experimental group),and there was a significant difference with statistical significance(P<0.05).3.Postoperative nutritional status comparisonCompared with control group and ERAS group(experimental group)postoperatively,the postoperative PA is:[(132.28±15.05)mg/L vs.(156.76±9.94)mg/L,t=6.562,P<0.001];LYM after operation:[(1.37±0.34)×10~9/L vs.(1.69±0.24)×10~9/L,t=3.710,P=0.001],Control group indexes were lower than the ERAS group(experimental group),the difference was obvious and statistically significant(P<0.05).4.Comparison of postoperative immune statusComparison of control group and ERAS group(experimental group)after IgM operation:[(0.88±0.07)g/L vs.(1.13±0.16)g/L,t=6.797,P<0.001],IgG postoperative is:[(11.28±1.76)g/L vs.(13.44±2.65)g/L,t=3.23,P=0.002],IgA postoperative is:[(2.07±0.21)g/L vs.(2.27±0.25)g/L,t=2.830,P=0.007];the indexes of the control group are lower than those of the ERAS group(experimental group),the difference is significant and statistically significant(P<0.05).5.Comparison of postoperative rehabilitation indicatorsComparison of control group and ERAS group(experimental group),comparison of postoperative complications:Bile leakage:[1(4.54%)vs.0(0%),x~2=1.15,P=0.291],nausea and vomiting:[4(18.19%)vs.1(4.17%),x~2=2.327,P=0.127],incision infection:[2(9.10%)vs.1(4.17%),x~2=0.403,P=0.525],none of the three are statistically significant(P>0.05);but the total number of postoperative complications is:[7(31.81%)vs.2(8.33%),x~2=40.23,P=0.045],statistically significant(P<0.05).The postoperative pain score was:[(6.09±1.27)vs.(5.04±1.37)g/L,t=-2.691,P=0.010],which was statistically significant.Comparison of the time of first air exhaust in the anus:(42.27±6.76)h vs.(34.96±6.49)h,t=-3.744,P=0.001];length of hospital stay:[(11.50±1.10)d vs.(10.08±0.93)d,t=-4.728,P<0.001],the indexes of the control group were higher than those of the ERAS group(experimental group),the difference was significant and statistically significant(P<0.05).5.Safety problemsThere were no safety issues in the two groups of patients.Conclusion1."LEER"mode ERAS can reduce the postoperative stress response,improve the nutritional status and protect the immunity of the patient after the open biliary tract exploration.2.The application of"LEER"mode ERAS can reduce postoperative pain,reduce the total complication rate,shorten the length of hospital stay,accelerate postoperative recovery of patients,provide a good medical experience.3.The implementation of"LEER"mode ERAS in open biliary tract exploration is safe and feasible,with low implementation difficulty,easy to implement by clinical medical workers,easy to popularize and apply in primary hospitals,and has a good and wide application prospect.