腹部创伤手术后实施改良的术后强化恢复（ERAS）；可行性和结果评估：随机对照试验 (RCT)

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2024-09-19 DOI:10.1016/j.amjsurg.2024.115975

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引用次数: 0

摘要

研究背景术后强化恢复（ERAS）是一套多重围手术期护理方案，而非僵化的方案，可改善择期手术的疗效。本研究旨在评估接受开腹手术的创伤患者的可行性和疗效。研究设计前瞻性单中心随机对照试验（RCT）。在创伤后接受紧急开腹手术的患者在手术后24小时被随机分为ERAS组（早期拔除导管、早期活动和开始饮食、使用阿片类稀释多模式镇痛）和常规护理组。结果50名患者被随机分为ERAS组（25人）和常规护理组（25人）。92%的患者为年轻男性，58%的患者为腹部钝性创伤，最常见的手术指征为空腔脏器损伤（88%）。ERAS 组的中位 LOH（天数）减少（6 对 8，p = 0.007），肠道功能恢复早（p = 0.010），鼻胃管（p = 0.001）、导尿管（p = 0.007）和引流管（p = 0.006）拔除时间短。除了深部手术部位感染[ERAS 组明显较低(p = 0.009)]，两组的并发症情况相当。

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Implementation of modified enhanced recovery after surgery (ERAS) following surgery for abdominal trauma; Assessment of feasibility and outcomes: A randomized controlled trial (RCT)

Background

Enhanced recovery after surgery(ERAS) is a set of multiple perioperative care component not a rigid protocol with improved outcomes for elective surgeries. This study aimed to assess the feasibility and outcomes in trauma patients undergoing laparotomy.

Study design

Prospective single-centre randomized controlled trial(RCT). Patients undergoing emergency laparotomy following trauma were randomized into ERAS(early removal of catheters, early mobilization and initiation of diet, use of opioid-sparing multimodal analgesia) and conventional care groups 24 h post-surgery. Outcome measures included length of hospitalization(LOH), recovery of bowel function, duration of removal of catheters and 30-day complications(Clavien-Dindo).

Results

Fifty patients were randomized into ERAS(n = 25) and conventional care(n = 25) groups. Ninety-two percent of patients were young males, 58 % had blunt trauma to the abdomen and the most common indication of surgery was hollow viscus injury(88 %). ERAS group had a reduced median LOH(days) (6 versus 8, p = 0.007), early recovery of bowel function(p = 0.010) and shorter times for nasogastric tube(p = 0.001), urinary catheter(p = 0.007) and drain(p = 0.006) removal. The complications were comparable in both groups except for deep surgical site infection[significantly lower in ERAS group(p = 0.009)].

Conclusion

ERAS is safe and significantly reduces LOH in select trauma patients undergoing laparotomy.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.