协和医学杂志

2018, v.9(06) 526-532

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围手术期营养干预加速胃肠外科术后康复:单中心前瞻队列研究
Perioperative Nutrition Intervention Enhanced Recovery after Gastrointestinal Surgery: a Prospective Single-center Cohort Study

薛志刚;于健春;康维明;马志强;叶欣;闫超;李子建;蒋林;林国乐;肖毅;陆君阳;吴斌;牛备战;裴丽坚;黄宇光;
XUE Zhi-gang;YU Jian-chun;KANG Wei-ming;MA Zhi-qiang;YE Xin;YAN Chao;LI Zi-jian;JIANG Lin;LIN Guo-le;XIAO Yi;LU Jun-yang;WU Bin;NIU Bei-zhan;PEI Li-jian;HUANG Yu-guang;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Graduate School,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Anaesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking U

摘要(Abstract):

目的探索围手术期营养干预的加速康复外科(enhanced recovery after surgery,ERAS)流程对胃肠外科手术患者的安全性和有效性。方法本研究为单中心前瞻性队列研究,连续纳入2015年12月至2018年4月期间在北京协和医院基本外科行胃肠手术的患者,在胃肠与营养代谢专业组接受手术治疗及ERAS管理的患者进入ERAS组,在其他专业组接受传统围手术期管理者进入对照组。ERAS组围绕术前营养评估、口服或管饲营养补充、术后早期肠内营养等措施,结合其他ERAS管理流程,主要包括微创手术、全身麻醉或联合硬膜外阻滞等多模式镇痛、术后镇痛以非甾体类抗炎药为主;对照组采用传统围手术期措施,主要包括开腹或微创手术、全身麻醉、术后镇痛应用阿片类镇痛药物等。主要结局指标为术后住院天数,次要结局指标包括住院总费用、术后并发症发生率、术后60 d内再入院率。结果共纳入204例患者,ERAS组和对照组各102例。ERAS组术后住院天数较对照组明显缩短[(7. 2±4. 5) d比(9. 8±4. 8) d,P<0. 001],住院总费用亦显著降低[(41 125±18 593)元比(51 512±19 453)元,P<0. 001]。两组术后Clavien-Dindo分级Ⅱ级及以上并发症发生率和术后60 d内再入院率无统计学差异(9. 8%比13. 7%,2. 9%比2. 0%,P均>0. 05)。结论围手术期营养干预在胃肠外科中应用安全有效,有利于患者术后实现加速康复。
Objective The aim of this study was to evaluate the safety and efficacy of enhanced recovery after surgery( ERAS) program focusing on the concept of integrative clinical nutrition for the gastrointestinalsurgery. Methods This study was a prospective single-center cohort study. Patients who underwent gastrointestinal surgery in the Department of General Surgery of Peking Union Medical College Hospital from December 2015 to April 2018 were continuously enrolled in the study. Patients who were treated by the professional team of gastrointestinal and nutritional metabolism and received ERAS management were assigned to the ERAS group,and patients who were treated by the other professional teams and received traditional perioperative management were assigned to the control group. The ERAS program included especially focusing on the preoperative nutritional assessment,nutritional supplements by oral or tube feeding,early postoperative enteral nutrition,combination with other series of ERAS items including minimally invasive surgery,multimodal analgesia,non-steroidal antiinflammatory drugs as major postoperative analgesic meditation,and so on. The control group was under traditional perioperative management including open or minimally invasive surgery,general anesthesia,opioid analgesia,and so on. The primary outcome was the postoperative length of stay,the secondary outcomes included total hospitalization cost, the incidence of postoperative complications, and readmission rate within postoperative 60 days. Results Two hundred and four patients undergoing gastrointestinal surgery were enrolled,102 patients in the ERAS group and the other 102 in the control group. The postoperative length of stay in the ERAS group was significantly shorter than that in the control group [( 7. 2±4. 5) days vs.( 9. 8±4. 8)days,P<0. 001] and total hospitalization cost in the ERAS group was significantly lower than that in the control group [( 41 125±18 593) Yuan vs.( 51 512±19 453) Yuan,P<0. 001] as well. There was no significant difference in the incidence of postoperative complications( Clavien-Dindo classification ≥ grade Ⅱ,ERAS group 9. 8% vs. control group 13. 7%,P = 0. 646) and readmission rate within postoperative 60 days( ERAS group 2. 9% vs. control group 2. 0%,P = 1. 000) between the two groups. Conclusion Perioperative nutrition-focused ERAS programs are safe and effective for the gastrointestinal surgery and might enhance the recovery after surgery.

关键词(KeyWords): 加速康复外科;营养风险;术后早期肠内营养;预康复;胃肠外科
enhanced recovery after surgery;nutritional risk;postoperative early enteral nutrition;pre-habilitation;gastrointestinal surgery

Abstract:

Keywords:

基金项目(Foundation): 国家卫生计生委公益性行业科研专项基金(201502022);; 北京市科技计划项目(D141100000414002)

作者(Author): 薛志刚;于健春;康维明;马志强;叶欣;闫超;李子建;蒋林;林国乐;肖毅;陆君阳;吴斌;牛备战;裴丽坚;黄宇光;
XUE Zhi-gang;YU Jian-chun;KANG Wei-ming;MA Zhi-qiang;YE Xin;YAN Chao;LI Zi-jian;JIANG Lin;LIN Guo-le;XIAO Yi;LU Jun-yang;WU Bin;NIU Bei-zhan;PEI Li-jian;HUANG Yu-guang;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Graduate School,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Anaesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking U

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