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加速康复外科在老年肝移植受者围手术期临床应用中的效果

蔺建宇, 崔臣, 高艳平, 等. 加速康复外科在老年肝移植受者围手术期临床应用中的效果[J]. 器官移植, 2023, 14(2): 288-294. doi: 10.3969/j.issn.1674-7445.2023.02.016
引用本文: 蔺建宇, 崔臣, 高艳平, 等. 加速康复外科在老年肝移植受者围手术期临床应用中的效果[J]. 器官移植, 2023, 14(2): 288-294. doi: 10.3969/j.issn.1674-7445.2023.02.016
Lin Jianyu, Cui Chen, Gao Yanping, et al. Effect of perioperative clinical application of enhanced recovery after surgery on elderly recipients undergoing liver transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(2): 288-294. doi: 10.3969/j.issn.1674-7445.2023.02.016
Citation: Lin Jianyu, Cui Chen, Gao Yanping, et al. Effect of perioperative clinical application of enhanced recovery after surgery on elderly recipients undergoing liver transplantation[J]. ORGAN TRANSPLANTATION, 2023, 14(2): 288-294. doi: 10.3969/j.issn.1674-7445.2023.02.016

加速康复外科在老年肝移植受者围手术期临床应用中的效果

doi: 10.3969/j.issn.1674-7445.2023.02.016
基金项目: 

北京市自然科学基金面上项目 7212042

详细信息
    作者简介:
    通讯作者:

    王苑,硕士,研究方向为肝移植与肝胆胰肿瘤,E-mail: 5124wangyuan@163.com

  • 中图分类号: R617

Effect of perioperative clinical application of enhanced recovery after surgery on elderly recipients undergoing liver transplantation

More Information
  • 摘要:   目的  探索加速康复外科(ERAS)指导下的围手术干预策略在老年肝移植受者中的应用价值。  方法  回顾性分析405例肝移植受者的临床资料,根据年龄分为老年组(≥60岁,122例)和非老年组(< 60岁,283例),所有患者均进行ERAS指导下的围手术期干预处理,分析两组受者术中、术后相关指标,并发症发生情况及出院情况。  结果  两组受者麻醉时间,手术时间,无肝期,出血量,输血量,关腹前乳酸水平,呼吸机辅助时间,重症监护室(ICU)入住时间,Caprini评分,CHIPPS评分,胃管、尿管、引流管拔除时间,首次饮水时间,首次下地活动时间和首次肛门排气时间差异均无统计学意义(均为P > 0.05),老年组首次进食时间晚于非老年组(P < 0.05)。两组受者发热、腹腔积液、肺部感染、胃排空障碍、出血、非活动性静脉血栓发生率差异均无统计学意义(均为P > 0.05)。两组受者出院前天冬氨酸转氨酶、总胆红素、直接胆红素、血清肌酐水平及总住院时间差异均无统计学意义(均为P > 0.05);老年组受者丙氨酸转氨酶值比非老年组低,差异有统计学意义(P < 0.05)。非老年组与老年组受者术后30 d内均无非计划再次手术发生,出院后30 d内再入院率差异无统计学意义(P > 0.05)。  结论  ERAS干预策略有助于老年肝移植受者围手术期的恢复,达到与非老年肝移植受者同等的术后恢复水平。

     

  • 表  1  两组肝移植受者术中资料比较

    Table  1.   Comparison of intraoperative data of liver transplant recipients between the two groups

    指标 非老年组(n=283) 老年组(n=122) 统计值 P
    麻醉时间(x±s,h) 11.0±2.2 10.5±1.9 1.870 0.062
    手术时间(x±s,h) 8.8±2.0 8.4±1.8 1.922 0.055
    无肝期(x±s,min) 69±26 71±32 -0.495 0.621
    出血量[MP25, P75),mL] 800(500,1 200) 800(500,1 000) -1.165 0.244
    输血量[MP25, P75),mL] 1 200(400,2 000) 900(400,1 775) -0.899 0.368
    关腹前乳酸[MP25, P75),mmol/L] 2.2(1.6,3.7) 2.7(1.7,4.9) -1.346 0.178
    呼吸机辅助时间[MP25, P75),h] 20(12,37) 22(14,39) -1.317 0.188
    下载: 导出CSV

    表  2  两组肝移植受者术后恢复情况比较

    Table  2.   Comparison of postoperative recovery of liver transplant recipients between the two groups

    指标 非老年组(n=283) 老年组(n=122) 统计值 P
    ICU入住时间[MP25, P75),d] 3.5(2.5,6.0) 4.0(3.0,6.5) -1.581 0.114
    Caprini评分(x±s,分) 5.7±1.9 5.7±2.2 0.091 0.928
    CHIPPS评分(x±s,分) 6.9±0.7 6.9±0.7 -1.221 0.223
    胃管拔除时间(x±s,h) 24± 7 27±10 -1.391 0.165
    首次饮水时间(x±s,h) 27±14 30±16 -0.196 0.051
    尿管拔除时间(x±s,h) 37±14 40±18 -1.767 0.078
    首次下地活动时间(x±s,d) 4.0±1.0 4.1±1.3 -1.378 0.169
    首次肛门排气时间(x±s,d) 4.4±1.7 4.7±2.1 -1.672 0.095
    首次进食时间(x±s,d) 3.3±1.6 3.7±1.2 -1.305 0.011
    引流管拔除时间(x±s,d) 6.0±2.1 6.1±2.6 -0.652 0.514
    下载: 导出CSV

    表  3  两组肝移植受者术后并发症发生率比较

    Table  3.   Comparison of incidence of postoperative complications of liver transplant recipients between the two groups[n(%)]

    并发症 非老年组(n=283) 老年组(n=122) 统计值 P
    发热 45(15.9) 19(15.6) 0.007 0.934
    腹腔积液 43(15.2) 20(16.4) 0.093 0.760
    肺部感染 23(8.1) 18(14.8) 3.361 0.057
    胃排空障碍 3(1.1) 5(4.1) 2.647 0.104
    出血 6(2.1) 2(1.6) 0.005 0.944
    非活动性静脉血栓 90(31.8) 48(39.3) 2.159 0.142
    下载: 导出CSV

    表  4  两组肝移植受者出院前相关指标比较

    Table  4.   Comparison of relevant indexes of liver transplant recipients between the two groups before discharge

    指标 非老年组(n=283) 老年组(n=122) 统计值 P
    天冬氨酸转氨酶[MP25, P75),U/L] 25(18,41) 22(16,36) -1.548 0.101
    丙氨酸转氨酶[MP25, P75),U/L] 29(19,55) 23(15,48) -2.560 0.015
    总胆红素[MP25, P75),μmol/L] 23(15,31) 19(14,31) -0.204 0.831
    直接胆红素[MP25, P75),μmol/L] 12(7,20) 9(5,16) -1.263 0.294
    血清肌酐[MP25, P75),μmol/L] 67(56,85) 69(57,82) -1.435 0.130
    住院时间(x±s,d) 30±15 28±11 1.518 0.129
    下载: 导出CSV
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  • 收稿日期:  2022-12-06
  • 网络出版日期:  2023-03-15
  • 刊出日期:  2023-03-15

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