切换至 "中华医学电子期刊资源库"

中华胸部外科电子杂志 ›› 2017, Vol. 04 ›› Issue (03) : 149 -154. doi: 10.3877/cma.j.issn.2095-8773.2017.03.04

所属专题: 文献

论著

加速康复外科措施完成率对高龄肺部手术患者临床结局的影响
张真榕1, 李伟峰1, 刘德若1,()   
  1. 1. 100029 北京,中日友好医院胸外科
  • 收稿日期:2017-05-10 出版日期:2017-08-28
  • 通信作者: 刘德若
  • 基金资助:
    国家临床重点专科建设项目([2011]873)

The influence of completion ratio of enhanced recovery after lung surgery on the prognosis of the elderly patients

Zhenrong Zhang1, Weifeng Li1, Deruo Liu1,()   

  1. 1. Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
  • Received:2017-05-10 Published:2017-08-28
  • Corresponding author: Deruo Liu
  • About author:
    Corresponding author: Liu Deruo, Email:
引用本文:

张真榕, 李伟峰, 刘德若. 加速康复外科措施完成率对高龄肺部手术患者临床结局的影响[J/OL]. 中华胸部外科电子杂志, 2017, 04(03): 149-154.

Zhenrong Zhang, Weifeng Li, Deruo Liu. The influence of completion ratio of enhanced recovery after lung surgery on the prognosis of the elderly patients[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2017, 04(03): 149-154.

目的

探讨在胸外科高龄患者中实施加速康复外科(ERAS)理念对术后住院时间、并发症和住院总费用的影响。

方法

回顾性分析中日友好医院胸外科1999—2016年行肺部手术治疗的194例高龄(≥75岁)患者的临床资料。按照实施围手术期ERAS措施的完成度分为三组,A组(n=81):ERAS措施完成度≤33%;B组(n=54):ERAS措施完成度33%~50%;C组(n=59):ERAS措施完成度≥50%。主要临床结局指标为术后并发症、术后住院时间以及住院总费用。单因素分析三组间临床结局指标的差异,并采用多因素分析影响临床结局指标的可能风险因素。

结果

术后并发症发生率、术后住院时间、住院总费用均为A组>B组>C组,三组间比较差异均有统计学意义(P<0.01)。单因素分析显示,性别、吸烟、手术方式、手术时间、术中出血量、ERAS完成率与术后并发症发生率、术后住院时间均显著相关(P<0.05)。性别、肺功能、ASA分级、手术时间、手术方式、术中出血量、ERAS完成率与住院总费用相关(P<0.05)。二元Logistic回归模型在调整了性别、吸烟、手术时间、手术方式、术中出血量、ERAS完成率后,结果显示性别和手术时间是术后并发症的危险因素(HR=0.207,95% CI:0.086~0.495,P<0.001;HR=1.346,95% CI:1.095~1.654,P=0.005)。多元线性回归显示,仅ERAS完成率是延长术后住院时间的危险因素(β=-3.933,95% CI:-5.975~-1.892,P<0.001);性别是增加患者住院总费用的危险因素(β=-1.171,95% CI:-2.312~-0.031,P=0.044)。

结论

ERAS措施可以缩短高龄肺部手术患者的住院时间。

Objective

To evaluate the effects of ERAS(enhanced recovery after surgery) on postoperative hospitalization time, complications and total cost in the elderly who underwent pulmonary surgery.

Methods

Retrospective analysis was performed on effects of enhanced recovery after surgery on the elderly who underwent pulmonary surgery between 1999 and 2016. A total of 194 patients with the median age of 76 (75 to 78) years old were included. Based on the completion ratio of ERAS in the perioperative treatments, they were divided into three groups. Group A: ≤33% of all the ERAS measures were completed among the patients (81 cases); Group B: 33%-50% of all the ERAS measures were completed (54 cases); Group C: ≥50% of all the ERAS measures were completed among the patients(59 cases). Postoperative complications, postoperative hospital stay, and the total cost were analyzed. The differences between postoperative hospital stay, complication rates, and hospitalization costs were analyzed between groups with univariate analysis. Multivariate analysis was used to explore the potential risk factors of these clinical outcomes.

Results

Postoperative complication ratio was significantly higher in group A when compared with group B and C (P<0.01). Postoperative hospital stay was longer in group A when compared with group B and C (P<0.01). Total cost was more expensive in group A when compared with group B and C(P<0.01). Univariate analysis showed gender, smoking history, surgery type, surgery duration, intraoperative blood loss, ERAS completion ratio and postoperative complication ratio were all risk factors of postoperative complications (P<0.05). Gender, pulmonary, ASA score, operation, surgery duration, intraoperative blood loss, and ERAS completion ratio were all risk factors of total cost(P<0.05). Binary logistic regression showed gender and surgery duration were risk factors of postoperative complications(HR=0.207, 95% CI: 0.086-0.495, P<0.001; HR=1.346, 95% CI: 1.095-1.654, P=0.005). Linear regression showed ERAS completion ratio was the only risk factor of postoperative hospital stay(β=-3.933, 95% CI: -5.975~-1.892, P<0.001=. Gender was the only risk factor of total cost(β=-1.171, 95%CI: -2.312~-0.031, P=0.044).

Conclusions

The implementation of ERAS in the elderly can reduce postoperative hospital stay.

表1 三组患者临床特征比较
表2 三组患者术后相关指标比较
表3 术后并发症危险因素的单因素分析及多因素分析
表4 术后住院时间和住院总费用的相关因素分析[中位数(第一四分位数~第三四分位数)]
1
Engelman RM, Rousou JA, Flack JE, 3rd, et al. Fast-track recovery of the coronary bypass patient[J]. Ann Thorac Surg, 1994, 58(6): 1742-1746.
2
Kehlet H, Wilmore DW. Fast-track surgery[J]. Br J Surg, 2005, 92(1): 3-4.
3
江志伟,李宁. 结直肠手术应用加速康复外科中国专家共识(2015版)[J]. 中国实用外科杂志,2015(08): 841-843.
4
Gustafsson UO, Oppelstrup H, Thorell A, et al. Adherence to the ERAS protocol is associated with 5-year survival after colorectal cancer surgery: aretrospective cohort study[J]. World J Surg, 2016, 40(7): 1741-1747.
5
Campos JH. Fast track in thoracic anesthesia and surgery[J]. Curr Opin Anaesthesiol, 2009, 22(1): 1-3.
6
Agostini P, Cieslik H, Rathinam S, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors?[J] Thorax, 2010, 65(9): 815-818.
7
王京弟,闫天生,刘丹丹,等. 高龄肺癌外科治疗及围术期处理95例[J]. 中国肿瘤临床,2008(18): 1024-1027.
8
周卫东,姚传,黄纪木. 快速康复外科在老年肺癌手术中的应用[J]. 实用癌症杂志,2013, 28(5): 502-504.
9
Rosman M, Rachminov O, Segal O, et al. Prolonged patients' in-hospital waiting period after discharge eligibility is associated with increased risk of infection, morbidity and mortality: a retrospective cohort analysis[J]. BMC Health Serv Res, 2015, 15: 246.
10
Tovar EA, Roethe RA, Weissig MD, et al. One-day admission for lung lobectomy: an incidental result of a clinical pathway[J]. Ann Thorac Surg, 1998, 65(3): 803-806.
11
Cakir H, van Stijn MF, Lopes Cardozo AM, et al. Adherence to enhanced recovery after surgery and length of stay after colonic resection[J]. Colorectal Dis, 2013, 15(8): 1019-1025.
12
Nicholson A, Lowe MC, Parker J, et al. Systematic review and meta-analysis of enhanced recovery programmes in surgical patients[J]. Br J Surg, 2014, 101(3): 172-188.
13
何湛,程可洛,蔡小碧,等. 快速康复外科在老年肺叶切除手术中的应用[J]. 广东医学,2010, 31(3): 367-368.
14
Roulin D, Donadini A, Gander S, et al. Cost-effectiveness of the implementation of an enhanced recovery protocol for colorectal surgery[J]. Br J Surg, 2013, 100(8): 1108-1114.
15
Nelson G, Kiyang LN, Crumley ET, et al. Implementation of enhanced recovery after surgery (ERAS) across a provincial healthcare system: The ERAS Alberta Colorectal Surgery Experience[J]. World J Surg, 2016, 40(5): 1092-1103.
16
Tanaka R, Lee SW, Kawai M, et al. Protocol for enhanced recovery after surgery improves short-term outcomes for patients with gastric cancer: a randomized clinical trial[J]. Gastric Cancer, 2017.
17
王才英,殷章红,贺桂文. 快速康复理念对肺癌手术患者住院费用的影响[J]. 现代肿瘤医学,2015, 23(19): 2744-2746.
[1] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[2] 刘世君, 马杰, 师鲁静. 胃癌完整系膜切除术+标准D2根治术治疗进展期胃癌的近中期随访研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 27-30.
[3] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[4] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[5] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[6] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[7] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[8] 许杰, 李亚俊, 冯义文. SOX新辅助化疗后腹腔镜胃癌D2根治术与常规根治术治疗进展期胃癌的近期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 647-650.
[9] 刘柏隆, 周祥福. 女性尿失禁吊带手术并发症处理的经验分享[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 127-127.
[10] 嵇振岭, 陈杰, 唐健雄. 重视复杂腹壁疝手术并发症的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 601-606.
[11] 江志鹏, 钟克力, 陈双. 复杂腹壁疝手术后腹腔高压与腹腔间室综合征的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 612-615.
[12] 王学虎, 赵渝. 复杂腹壁疝手术中血管损伤并发症的预防和处理[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 616-619.
[13] 马东扬, 李斌, 陆安清, 王光华, 雷文章, 宋应寒. Gilbert 与单层补片腹膜前疝修补术疗效的随机对照研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 629-633.
[14] 王浩源, 汪海洋, 孙建明, 陈以宽, 祁小桐, 唐博. 腹腔镜与开放修补对肝硬化腹外疝患者肝功能及凝血的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 654-659.
[15] 宋俊锋, 张珍珍. 单侧初发性腹股沟斜疝老年患者经腹腹膜前疝修补术中残余疝囊腹直肌下缘固定效果评估[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 670-674.
阅读次数
全文


摘要