探讨加速康复外科(ERAS)理念在胃癌根治性切除术中的临床应用及疗效分析。

回顾性分析2015年1月至2019年6月在解放军火箭军特色医学中心肝胆外科接受胃癌根治性切除术的50例患者病例资料，根据围手术期处理方案不同分为观察组和对照组，每组25例。观察组患者围手术期采用ERAS理念进行指导，对照组采取常规围手术期处理措施。观察2组患者麻醉后10、60、120 min的收缩压、舒张压、心排量、中心静脉压、血氧饱和度及体温等生命体征指标。分析围手术期患者相关并发症发生情况及术后苏醒情况。对比2组患者术后12 h疼痛视觉模拟法(VAS)评分、镇痛有效率及围手术期肛门排气时间、下床时间及进食时间等功能恢复情况。数据行t检验、χ²检验及重复测量方差分析。

麻醉后10、60、120 min，观察组患者收缩压、舒张压、心排量、中心静脉压、血氧饱和度及体温等指标无明显波动，差异均无统计学意义(P值均大于0.05)，心率随时间延长呈逐渐下降趋势，差异有统计学意义(P<0.05)。麻醉后10、60、120 min，对照组患者心排量及血氧饱和度无明显变化，差异均无统计学意义(P值均大于0.05)，收缩压、舒张压、心率及体温持续下降，中心静脉压指标呈逐渐升高趋势，差异均有统计学意义(P值均小于0.05)。麻醉后10 min，2组患者上述所有生命体征指标比较，差异均无统计学意义(P值均大于0.05)；麻醉后60、120 min，患者收缩压、舒张压、心排量及血氧饱和度指标比较，差异均无统计学意义(P值均大于0.05)，观察组心率、中心静脉压水平低于对照组，体温较对照组高，差异均有统计学意义(P值均小于0.05)。观察组和对照组均出现麻醉后眩晕及术后恶心和呕吐；另外，对照组肺部感染和下肢深静脉血栓的风险较观察组升高，差异均有统计学意义(P值均小于0.05)。观察组患者术后苏醒时间[(10.51±2.28) min]低于对照组[(16.42±4.74) min]，差异有统计学意义(t＝-3.624，P<0.05)，其苏醒评分[(5.58±0.46)分]与对照组[(4.71±0.89)分]相比，差异有统计学意义(t＝1.725，P＝0.016)。观察组疼痛等级(1.3±0.6)低于对照组(4.5±2.7)，差异有统计学意义(t＝1.658，P＝0.024)。观察组患者肛门排气时间[(3.60±1.05) d]、平均下床时间[(4.60±0.56) d]以及进食时间[(7.33±1.04) d]均低于对照组[(6.13±2.16)、(8.37±1.31)、(11.40±0.90) d]，差异均有统计学意义(P值均小于0.05)。

ERAS能有效减轻胃癌根治性切除术中患者的创伤应激反应，降低围手术期相关并发症发生风险，促进患者术后早期功能恢复。

To investigate the clinical application and efficacy analysis of enhanced recovery after surgery (ERAS) in patients with gastric cancer after radical resection.

From January 2015 to June 2019, the clinical data of 50 patients who underwent radical resection of gastric cancer in Department of Hepatobiliary Surgery, Rocket Army Characteristic Medical Center were retrospectively analyzed. According to the different perioperative treatment schemes, they were divided into observation group and control group, with 25 cases in each group. The observation group was guided by ERAS concept during the perioperative period, and the control group was given routine perioperative treatment measures. The vital signs such as systolic blood pressure, diastolic blood pressure, cardiac output, central venous pressure, oxygen saturation and body temperature were observed at 10, 60 and 120 min after anesthesia. The occurrence of related complications in perioperative period and postoperative recovery were analyzed. The level of postoperative pain visual analog scale (VAS) score, analgesic efficiency, peri operative anal exhaust time, ambulation time and eating time were compared at 12 h after surgery between the two groups. The data were analyzed by t test, chi-square test and analysis of variance for repeated measurement.

The systolic blood pressure, diastolic blood pressure, cardiac output, central venous pressure, blood oxygen saturation and body temperature of the observation group had no significant fluctuation at 10, 60 and 120 min after anesthesia, and the differences were not statistically significant (with P values above 0.05). The heart rate showed a gradual downward trend with the extension of time, and the difference was statistically significant (P<0.05). In the control group, there were no significant changes in cardiac output and blood oxygen saturation at 10, 60, 120 min after anesthesia, and the differences were not statistically significant (with P values above 0.05). Systolic blood pressure, diastolic blood pressure, heart rate and body temperature levels continued to decline, and the central venous pressure index showed a gradual increase trend, with statistical significance (with P values below 0.05). There were no significant differences in all the above vital signs at 10 min after anesthesia between the two groups (with P values above 0.05). There were no significant differences in systolic blood pressure, diastolic blood pressure, cardiac output and oxygen saturation at 60 and 120 min after anesthesia (with P values above 0.05). The heart rate and central venous pressure of the observation group were lower than those of the control group, and the body temperature was higher than that of the control group (with P values below 0.05). Dizziness after anesthesia, postoperative nausea and vomiting occurred in both the observation group and the control group. In addition, the risk of pulmonary infection and deep venous thrombosis in the control group were higher than that in the observation group (with P values below 0.05). The postoperative recovery time of the observation group [(10.51±2.28) min] was lower than that of the control group [(16.42±4.74) min], the difference was statistically significant (t=-3.624, P<0.05), and the recovery score [(5.58±0.46) points]was significantly higher than that of the control group [(4.71±0.89) points], the difference was statistically significant (t=1.725, P=0.016). The pain VAS score of the observation group [(1.3±0.6) points] was lower than that of the control group [(4.5±2.7) points], the difference was statistically significant (t=1.658, P=0.024). Anal exhaust time [(3.60±1.05) d], average out of bed time [(4.60±0.56) d] and eating time[(7.33±1.04) d] in the observation group were lower than those in the control group [(6.13±2.16), (8.37±1.31), (11.40±0.90) d], the differences were significant (with P values below 0.05).

The concept of ERAS can effectively reduce the traumatic stress reaction in radical surgery of gastric cancer, reduce the risk of perioperative complications, and promote the early functional recovery of patients after surgery.