快速康复外科理在基层医院LC终稿.docVIP

快速康复理念在基层医院腹腔镜胆囊切除术中的应用 王鸿波王为忠摘要目的探讨快速康复外科理念在基层医院实施的。方法收集65例拟行腹腔镜胆囊切除术的患者，随机分为观察组和对照组观察组围手术期采用快速康复外科理念处理。对照组围手术期采用传统腹腔镜胆囊切除术处理。结果观察组比对照组的患者术后进食时间早，术后肛门排气时间早，术后住院日缩短、住院费用减少。术后并发症及患者住院满意度无差异。结论快速康复外科理念指导下的腹腔镜胆囊切除术治疗胆囊结石胆囊息肉疗效好，值得推广。 关键词基层医院快速康复外科理念腹腔镜胆囊切除术Abstract] Objective Our research focused on the effect of fast-track surgery (FTS) in the curative effect of primary hospital. Method A total of 65 patients undergoing laparoscopic cholecystectomy ,in Xian Yang center hospital from March 2012 to March 2013 ,were randomly divided into the observation group and the control group. The patients in the control group received conventional perioperative care, while those in the observation group underwent optimization included preoperative oral carbohydrate , Intraoperative temperature maintenance, transfusion control and disuse of abdominal drainage,early postoperative mobilization, oral feeding and potent analgesia, etc. Results Compared with control group, the observation group was associated with significantly the gastrointestinal function recovery in advance, but they have less postoperative hospital stay and medical cost. The two groups of patients satisfaction and hospitalization complications are no different.Conclusion The application of the fast-track surgery in laparoscopic cholecystectomy is safe and effective, and it can reduce medical cost, shorten postoperative hospital stay and accelerate early recovery of inpatients. 快速康复外科理念是综合围手术期的措施，减少手术创伤的应激反应，达到并发症更少、医疗成本更低、术后疼痛更轻与住院时间更短，更快地恢复工作和正常生活[1]。快速康复外科理念提出至今已经11年，《中国实用外科杂志》率先介绍快速康复外科理念已经6年[2]。其发展速度超出人们的想象，可以说快速康复外科理念已应用所有择期手术，安全可靠，能够减少医疗费用、缩短住院时间[3～5]。本文收集了咸阳市中心医院的腹腔镜手术病例65例，35例围手术期采用快速康复理念指导，30例采用围手术期传统腹腔镜胆囊切除术处理。 资料与方法 一般资料选择20123月～20133月在咸阳市中心医院拟行腹腔镜胆囊切除术的胆囊结石胆囊息肉共65例。其中胆囊结石58例，胆囊息肉7例男40例，女25例，年龄28～65岁，平均年龄49岁，病程2月～5年。分为观察组和对照组。两组患者性别、年龄病程等差异无统计学意义（P 0.05）具有可比性。排除患有严重心肺疾病、糖尿病、肝硬化等，中转开腹者。 1.2方法 1.2.1 观察组围手术期处理术前12口服14%糖水1 000 ml，术前3小时口服14%糖水350 ml，术中维持体温37.0°C，麻醉医师控制输液量，术后根据患者血压、心率尿量适当补液。手术结束关闭切口前，给