Application of ERAS combined with pathway mode management in PCNL
patients

doi:10.3760/cma.j.issn.1007-1245.2022.12.008

Abstract

Abstract:

Objective　To investigate the safety and efficacy of enhanced recovery after surgery (ERAS) combined with pathway mode management in patients undergoing percutaneous nephrolithotomy (PCNL). Methods　A total of 60 patients with comparable upper ureteral stones and/or kidney stones admitted to Yingde People's Hospital from January 2020 to November 2021 were collected and were divided into 2 groups by the random number table method. The observation group included 16 males and 14 females, aged (47.63±2.42) years; the control group included 17 males and 13 females, aged (51.07±2.16) years. The patients in the observation group were managed by ERAS combined pathway mode, and the patients in the control group were given conventional mode management. The clinical indicators of stone clearance, operation time, postoperative complications, postoperative pain, postoperative out-of-bed activity time, catheter removal time, hospitalization cost, and hospital stay of the two groups were analyzed. Independent sample t test was used for the measurement data, and chi-square test or Fisher's exact test was used for the count data. Results　In the observation group, the preoperative fasting time, postoperative first feeding time, out-of-bed activity time, catheter removal time, postoperative pain score, length of hospital stay, and hospitalization cost were (6.00±0.00) h, (5.00±0.19) h, (12.8±1.95) h, (2.67±0.12) d, (1.73±0.19), (6.27±0.23) d, (12 744±296.70) yuan, which were all lower than those in the control group [(9.60±0.22) h, (6.00±0.00) h, (68.0±2.33) h, (6.03±0.06) d, (3.93±0.33), (9.47±0.22) d, and (14 136±217.90) yuan], with statistically significant differences (all P<0.05). There were no statistically significant differences in the age, gender, stone size, stone distribution, hemoglobin decrease value, postoperative complications (hemorrhage, perirenal hematoma, and infection), fever rate, and stone clearance rate between the two groups (all P>0.05). Conclusions　The application of ERAS combined with pathway mode management in patients undergoing PCNL is safe and effective, compared with conventional medical and nursing modes, the patients' comfort is improved, the postoperative recovery is accelerated, the length of hospital stay is shortened, and the hospitalization cost is reduced, which is worthy of clinical promotion and application. At the same time, the ERAS concept can optimize and revise the implementation content of pathway, and the pathway management can effectively improve the execution rate of medical activities under the ERAS concept.

Key words: Enhanced recovery after surgery, Clinical pathway management, Percutaneous nephrolithotomy, Tubeless

摘要： 目的　研究快速康复外科（ERAS）理念联合路径模式管理在经皮肾镜取石术（PCNL）患者中应用的安全性、有效性。方法　前瞻性收集英德市人民医院2020年1月至2021年11月期间收治的结石负荷相当的输尿管上段结石和/或肾结石患者60例作为研究对象，随机数字表法分为两组，各30例。观察组男16例、女14例，年龄（47.63±2.42）岁，采用ERAS联合路径模式管理；对照组男17例、女13例，年龄（51.07±2.16）岁，采用常规模式管理。比较两组患者手术结石清除率、手术时间、术后并发症、术后疼痛、术后下床活动时间、拔除尿管时间、住院费用、住院时间等临床指标。计量资料采用独立样本t检验，计数资料采用χ²检验或Fisher确切概率法。结果　观察组术前禁食时间、术后首次进食时间、下床活动时间、拔除尿管时间、术后疼痛评分、住院时间、住院费用分别为（6.00±0.00）h、（5.00±0.19）h、（12.8±1.95）h、（2.67±0.12）d、（1.73±0.19）分、（6.27±0.23）d、（12 744±296.70）元，均低于对照组（9.60±0.22）h、（6.00±0.00）h、（68.0±2.33）h、（6.03±0.06）d、（3.93±0.33）分、（9.47±0.22）d、（14 136±217.90）元，差异均有统计学意义（均P<0.05）。两组患者年龄、性别、结石长径、结石分布、血红蛋白下降值、术后并发症（出血、肾周血肿、感染）、发热率、结石清除率等比较，差异均无统计学意义（均P>0.05）。结论　ERAS联合路径模式管理在PCNL患者中的应用是安全有效的，相对于常规医疗及护理模式，患者术后恢复加快、住院时间短、住院费用减少，值得临床推广应用。同时ERAS理念可优化修订路径实施内容，而路径管理可有效提高ERAS理念下医疗活动的执行率。

关键词: 快速康复外科, 临床路径管理, 经皮肾镜取石术, 无管化

Pan Xiaolong, Feng Zaosheng, Wu Qiuhua, Li Xiao, Heng Baoli, Wu Fanyu. Application of ERAS combined with pathway mode management in PCNL patients[J]. International Medicine and Health Guidance News, 2022, 28(12): 1660-1665.

潘小龙, 冯灶生, 巫秋花, 李晓, 衡宝利, 吴凡宇.

快速康复外科理念联合路径模式管理在经皮肾镜取石术患者中的应用 [J]. 国际医药卫生导报, 2022, 28(12): 1660-1665.

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Application of ERAS combined with pathway mode management in PCNL patients

快速康复外科理念联合路径模式管理在经皮肾镜取石术患者中的应用

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