| BackgroundEnhanced recovery after surgery（ERAS）is a change of traditional treatment mode based on the premise of evidence-based medicine.The concept of enhanced recovery after surgery was first proposed by Danish scholars.The core of enhanced recovery after surgery is to adopt a series of optimized treatment measures to alleviate the psychological and physiological traumatic stress response of patients,so as to achieve systemic homeostasis;and then reduce complications,shorten hospital stay,reduce the risk of readmission and death.It also reduces complications,length of stay,risk of readmission,and risk of death,the ultimate goal is to promote rapid recovery of patients.Gallbladder disease is a common disease in hepatobiliary surgery.Surgical resection is the main clinical treatment.With the acceptance of minimally invasive concept and the improvement of doctors’technology,the gold standard for the treatment of gallbladder disease is laparoscopic cholangiotectomy at present,but postoperative complications still need to be paid attention to.Gastrointestinal dysfunction and stress response are the most common factors for postoperative complications of laparoscopic cholangiotectomy patients[3].Some scholars have applied the concept of enhanced recovery after surgery in laparoscopic cholangiotectomy and achieved good clinical effects,but most of them were described from the perspective of clinical indicators.This project focused on the study of the effects of enhanced recovery after surgery on the stress response and gastrointestinal hormone level of patients after laparoscopic cholangiotectomy surgery,so as to provide more theoretical basis for the application of enhanced recovery after surgery in laparoscopic cholangiotectomy surgery.ObjectiveBy comparing the postoperative clinical conditions of the experimental group and the control group of patients with enhanced recovery after surgery,this study explored:1.The feasibility and safety of the application of eras in laparoscopic cholangiotectomy.2.To explore the influence of the application of eras concept on gastrointestinal hormones and related indicators of stress response after laparoscopic cholangiotectomy.3.It can provide evidence-based basis and clinical reference for the use of eras in laparoscopic cholangiotectomy.MethodsFrom February 2019 to January 2020,98 patients in the same treatment group of general surgery of Puyang people’s hospital were selected for cholecystectomy,and 2patients who were converted to open surgery were excluded.According to the principle of statistics,46 patients with cholecystectomy were listed as the study group,and a series of treatments were performed with eras program;another 50 patients with cholecystectomy were listed as the control group（non enhanced recovery after surgery,neras group）,and received routine treatment measures.Statistical analysis study group（eras group）and control group（neras group）.1.Baseline dataGender,age,body mass index（BMI）,operation time,intraoperative hemorrhage.2.Stress response indexesWhite blood cell（WBC）,tumor necrosis factor-α（TNF-α）,C-reactive protein（CRP）,serum cortisol（COR）3.Gastrointestinal function index3.1 gastrointestinal hormones:Motilin（MTL）,gastrin（gas）3.2 clinical observation indexes:Time of first exhaust,time of getting out of bed activity,and hospitalization expenses.Results1.General information of the investigated objectsCompared with the common indexes of eras group and neras group（traditional treatment group）,there was no significant difference in sex,age,intraoperative hemorrhage,operation time and postoperative complications between the two groups（P>0.05）,which was comparable.2.Gastrointestinal function2.1 Compared with the neras group,the first postoperative anal exhaust in the eras group was（19.04±4.01）H（43.24±5.49）h,t=24.476,P<0.001),hospitalization cost[（11019.15±1497.27）yuan vs.（11923.62±1681.86）,t=2.774,P<0.007],and the values in the neras group were significantly higher than those in the eras group（P<0.01）.2.2 Comparison of postoperative gastrointestinal hormones:the MTL concentration of eras group and neras group was[（210.20±56.72）pg/ml vs.（186.81±43.18）pg/ml,t=-2.284,P=0.025],The concentration of gas was（106.32±42.17）pg/ml vs.（75.90±15.69）pg/ml,t=--4.757,P=0.000).The eras values of ERAS group of MTL and GAS were higher than those of NERAS group,with significant differences（P<0.05）.3.Stress response comparisonComparison of stress response:the postoperative WBC count of ERAS group and NERAS group was[（7.5±2.01）X109/L vs.（8.34±2.12）X109/L,t=3.187,P=0.002].CRP concentration for postoperative[（32.40+/-16.74 mg/L vs（39.97+/-13.53 mg/L,t=2.424,P=0.017）.COR postoperative concentration for[（22.84+1.14）ug/L vs（25.59+3.26）ug/L,t=5.224,P<0.005];Postoperative concentration of TNF alpha[pg/mL（8.72+3.36）vs（11.12+4.40）pg/mL,t=3.018,P=0.003）.Values of ERAS group of WBC,CRP,COR and TNF-were all lower than those of NERAS group,with significant differences（P<0.05）.4.Safety problemsNone of the subjects had safety problems.Conclusion1.It is safe and effective for LC patients to implement eras.2.By using the idea of eras to intervene the patients after LC,we can reduce the stress response,promote the recovery of gastrointestinal hormone level and improve the recovery of patients’body state and gastrointestinal function.3.The idea of eras can accelerate the postoperative rehabilitation of LC patients,reduce the length of stay,reduce the financial burden of stay,and save the cost of medical treatment,which is worth popularizing and applying. |
PDF Full Text Request