摘要
目的探讨自行设计的防胃胀气充盈装置在腹腔镜胆囊切除术围术期加速康复外科中的应用效果。方法选取2021年4—12月在西安交通大学第一附属医院行择期腹腔镜胆囊切除术的患者96例,采用随机数字表法分为对照组和观察组,每组48例。对照组按传统胆囊切除手术行术前准备,术前留置胃肠减压管;观察组行常规术前准备,但不留置胃肠减压管,而在全身麻醉开始前使用自制的防胃胀气充盈装置,待插入气管插管之后撤出。比较两组患者的满意度、术后康复情况(首次下床活动时间、进食时间、自理能力恢复时间、住院时间)、术后并发症发生率及疼痛视觉模拟量表(visual analogue scale,VAS)评分、布鲁格曼舒适度量表(Bruggrmann comfort scale,BCS)评分。结果观察组患者术后满意度(95.8%)明显高于对照组(75.0%),差异有显著性(P<0.05)。观察组患者术后首次下床活动时间、进食时间、自理能力恢复时间及住院时间均明显短于对照组,差异有显著性(P<0.05)。观察组术后并发症发生率为14.6%,明显低于对照组的62.5%,差异有显著性(P<0.05)。观察组术后VAS评分明显低于对照组,BCS评分明显高于对照组,差异均有显著性(P<0.05)。结论接受腹腔镜胆囊切除术的患者应用防胃胀气充盈装置可避免术前留置胃管,符合加速康复外科的理念,有助于促进围术期恢复,并能提高患者的舒适度,值得临床应用。
Objective Exploring the application effect of self-designed anti gastric bloating and filling device in accelerated rehabilitation surgery during the perioperative period of laparoscopic cholecystectomy Method A total of 96 patients who had signed the informed consent form and were to going to undergo laparoscopic cholecystectomy(LC)in our hospital were selected and divided into control group(48 cases)and experimental group(48 cases).The control group underwent preoperative preparation according to the traditional cholecystectomy,and a gastrointestinal decompression tube was left before the operation;The experimental group underwent routine preoperative preparation,but the stomach tubes were not removed,and no gastrointestinal decompression devices were left.A self-made anti-flatulence filling device was used before general anesthesia and withdrawn after endotracheal intubation was inserted.The postoperative satisfaction,the patients’recovery and various indicators,and the incidence of postoperative complications were recorded and compared between the two groups.Result The comparison shows that the total satisfaction of the experimental group(95.8%)was significantly higher than the total satisfaction of the control group(75.0%)(P<0.05).In terms of the data of postoperative recovery and various indicators of patients,the postoperative leaving bed time,the feeding time,the time for recovery of self-care ability and the average length of hospital stay of patients in experimental group were(5.71±0.94)h,(7.67±0.88)h,(9.27±0.98)h,and(3.46±1.22)d,respectively.The difference was statistically significant(P<0.05).The postoperative leaving bed time,the feeding time,the time for recovery of self-care ability and the average length of hospital stay of patient in control group were(7.58±1.22)h,(9.15±1.44)h,(11.21±2.0)h,and(4.35±0.84)d,respectively.The difference was statistically significant(P<0.05);In terms of postoperative complications,the incidence of postoperative dysphagia and postoperative nausea and vomiting of patients in the experimental group were 3/48(6.3%)and 2/48(4.2%),respectively;and the incidence of postoperative dysphagia and postoperative nausea and vomiting of patients in the experimental group were 10/48(20.8%)and 12/48(25%),respectively;the difference was statistically significant(P<0.05);There was no statistically significant difference between the two groups in the incidence of pulmonary infection,wound bleeding and drainage tub placement(P>0.05).Comparison of postoperative VAS score and postoperative BCS score between the two groups showed that the postoperative VAS score of the experimental group(1.38±0.23)was lower than that of the control group(2.57±0.53),and the postoperative BCS score of the experimental group(2.79±0.53)was higher than that of the control group(1.53±0.30)(P<0.05).Conclusion The application of this anti-flatulence-and-inflation device in patients undergoing laparoscopic cholecystectomy can avoid indwelling gastric tubes in patients before surgery,can avoid various physical and mental discomfort and related complications caused by indwelling gastric tubes,and can avoid the failure of exposure of the Calot triangle due to surgical patients’over gaseous distention caused by inhaling too much gas(O2)during induction of general anesthesia.It not only meets the concept of Enhanced Recovery After Surgery(ERAS)proposed by modern surgery,but also accelerates the recovery of patients during perioperative period,reduces invasive operations,increases the comfort of surgical patients,and reflects humanized care,so it is worth promoting and applying.
作者
唐乐
李硕
刘涛
张琳娟
邱洪波
陈晨
Tang Le;Li Shuo;Liu Tao;Zhang Linjuan;Qiu Hongbo;Chen Chen(Department of Orthopedics,First Affiliated Hospital of Xi’an Jiaotong University,Shaanxi Xi’an 710061,China;Department of Hepatobiliary Surgery,First Affiliated Hospital of Xi’an Jiaotong University,Shaanxi Xi’an 710061,China)
出处
《中国医刊》
CAS
2023年第12期1326-1329,共4页
Chinese Journal of Medicine
基金
陕西省重点研发计划(2020SF-070)。
关键词
防胃胀气充盈装置
腹腔镜胆囊切除术
加速康复外科
Anti-flatulence-and-inflation device
Laparoscopic cholecystectomy,Enhanced recovery after surgery
