Journal of Surgery Concepts & Practice ›› 2020, Vol. 25 ›› Issue (01): 45-49.doi: 10.16139/j.1007-9610.2020.01.010
• Original article • Previous Articles Next Articles
TONG Hui, CHEN Peng, ZHANG Jiaqiang, XIE Junjie, LI Tao(), ZHU Zhecheng, PENG Chenghong
Received:
2019-11-06
Online:
2020-01-25
Published:
2020-02-25
Contact:
LI Tao
E-mail:transplant@126.com
CLC Number:
TONG Hui, CHEN Peng, ZHANG Jiaqiang, XIE Junjie, LI Tao, ZHU Zhecheng, PENG Chenghong. Enhanced recovery after liver transplantation for patients with hepatocellular carcinoma[J]. Journal of Surgery Concepts & Practice, 2020, 25(01): 45-49.
管理措施 | ERAS组 | 对照组 |
---|---|---|
术前 | 对进入等待名单的病人,术前由专职护士和医师进行心理及饮食指导。对营养状态差、低蛋白血症(白蛋白<30 g/L)的病人,术前给予肠内营养支持。合并腹水的病人,术前3 d补充白蛋白并适当应用利尿剂 | 对进入等待名单的病人,术前进行常规心理及饮食指导 |
术前禁食、禁水 | 术前6 h禁食固体食物,术前2 h禁饮,2 h前口服5%葡萄糖盐水 250 mL | 术前6 h禁食、禁水 |
术前胃肠道准备 | 术前不使用泻药 | 术前晚口服导泻 |
术中补液 | 以目标为导向的液体管理,术中维持低中心静脉压 | 术中不限制补液 |
术中引流管放置 | 不常规放置引流管,必要时右肝下放置1根单腔引流管 | 常规放置3根引流管,分别位于右肝后、右肝下及左肝下 |
术后气管插管拔管 | 苏醒后无拔管禁忌即拔除气管插管 | 术后第1~2天无拔管禁忌即拔除气管插管 |
动脉导管拔除 | 气管插管拔除后即拔除 | 术后第1~2天拔除 |
深静脉导管拔除 | 术后第2~4天 | 术后第7~10天 |
导尿管拔除 | 术后第2~3天拔除 | 术后第5~7天拔除 |
胃肠减压管拔除 | 气管插管拔除后即拔除 | 术后第3~4天肛门排气后拔除 |
术后进食与营养 | 术后6 h可少量饮水,术后第1天进流质,第2~3天半流质,适当辅以肠内营养剂,第3~5天恢复正常饮食 | 肛门排气后饮水,术后第4~10天由流质过渡到正常饮食 |
引流管拔除 | 不放引流管,置右肝下单根引流管病人术后第2~3天拔除 | 术后第2~3天拔除右肝后及左肝下引流管,第7~10天拔除右肝下引流管 |
术后活动 | 术后第1~2天床上自由活动。第3天鼓励下床活动,每天3次,并逐渐增加活动时间 | 术后1~4 d床上自由活动。术后第5天逐渐下床活动 |
术后镇痛 | 预防性按时镇痛 | 不常规镇痛,因需用药 |
术后抗凝 | 术后第1~7天低分子肝素抗凝 | 不常规抗凝 |
项目 | ERAS组(n=24) | 对照组(n=28) | t或χ2值 | P值 |
---|---|---|---|---|
男/女 | 21/3 | 24/4 | 0.035 | 0.851 |
年龄(岁) | 46.9±6.7 | 48.1±7.6 | 0.600 | 0.551 |
BMI | 25.1±2.4 | 25.2±3.0 | 0.200 | 0.843 |
Child评分 | 6.8±1.3 | 6.7±1.1 | 0.371 | 0.712 |
ASA分级(Ⅰ/Ⅱ级) | 18/6 | 21/7 | 0.000 | 1.000 |
合并HBV (n) | 21 | 22 | 0.838 | 0.406 |
合并HCV (n) | 2 | 3 | 0.852 | 0.777 |
甲胎蛋白 (μg/L) | 1 639.8±2704.8 | 1 586.8±2562.0 | 0.072 | 0.943 |
肿瘤直径之和(cm) | 4.9±1.7 | 5.2±1.5 | 0.667 | 0.508 |
肿瘤平均数目(n) | 1.4±0.6 | 1.5±0.6 | 0.526 | 0.601 |
项目 | ERAS组(n=24) | 对照组(n=28) | t或χ2值 | P值 |
---|---|---|---|---|
供体冷缺血时间(h) | 8.3±1.7 | 8.4±1.8 | 0.228 | 0.820 |
手术时间(h) | 5.7±1.1 | 6.1±1.2 | 1.312 | 0.195 |
无肝期 (min) | 51.5±7.8 | 53.0±8.1 | 0.626 | 0.534 |
引流管放置例数[n(%)] | 12(50) | 28(100) | 18.200 | <0.001a) |
无输血例数[n(%)] | 7(29.2) | 8(28.6) | 0.002 | 0.962 |
出血量(mL) | 1 025.0±471.1 | 1 069.6±495.0 | 0.331 | 0.742 |
输血量(mL) | 483.3±381.9 | 514.3±370.9 | 0.296 | 0.768 |
术中输液总量(mL) | 4 229.2±706.8 | 6 071.4±1 006.6 | 7.513 | <0.001a) |
项目 | ERAS组(n=24) | 对照组(n=28) | t或χ2值 | P值 |
---|---|---|---|---|
早期<6 h拔除气管插管[n(%)] | 24(100) | 0 | 52.000 | <0.001a) |
再插管例数[n(%)] | 1(4.2) | 0 | 1.190 | 0.275 |
动脉导<6 h管拔除[n(%)] | 23(95.8) | 2(7.1) | 40.721 | <0.001a) |
深静脉导管拔除pod | 2.7±0.5 | 9.3±2.2 | 15.006 | <0.001a) |
胃管拔除pod | 1.0±0.0 | 3.6±0.6 | 23.757 | <0.001a) |
导尿管拔除pod | 3.5±0.5 | 6.0±0.9 | 12.277 | <0.001a) |
引流管拔除pod | 2.7±0.5 | 8.2±1.3 | 18.231 | <0.001a) |
恢复正常饮食pod | 3.7±0.8 | 7.3±1.2 | 12.708 | <0.001a) |
肝功能恢复pod | 13.6±3.8 | 18.1±3.2 | 4.680 | <0.001a) |
ICU治疗时间(d) | 2.2±0.9 | 6.8±1.3 | 14.041 | <0.001a) |
住院时间(d) | 15.8±4.1 | 22.6±3.8 | 6.093 | <0.001a) |
术后并发症 急性排异[n(%)] 胆道并发症[n(%)] 腹腔积液[n(%)] 胸腔积液[n(%)] 肺部感染[n(%)] | 0 1(4.2) 7(29.2) 6(25.0) 1(4.2) | 1(3.6) 2(7.1) 3(10.7) 9(32.1) 1(3.6) | 0.874 0.211 2.833 0.321 0.012 | 0.350 0.646 0.092 0.571 0.911 |
出院后1个月内再入院病人 [n(%)] | 1(4.2) | 0 | 1.190 | 0.275 |
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