Application of early removal of nasogastric tube after pancreaticoduodenectomy based on the enhanced recovery after surgery (快速康复外科理念指导下鼻胃管早期拔除在胰十二指肠切除术后的应用研究)

Abstract

Objective To investigate the feasibility of early removal of nasogastric tube after pancreaticoduodenectomy, and provide evidence for clinical practice based on the enhanced recovery after surgery and improve the quality of perioperative nursing. Methods A retrospective analysis on patients who underwent pancreaticoduodenectomy between April 2020 and January 2021 was conducted. Patients were divided into two groups: early removal group (≤48 h) and late removal group( >48 h). Univariate analysis and multiple logistic regression analysis were used to investigate the difference of perioperative rehabilitation between two groups. Results Of 257 patients included in the study, early removal of nasogastric tube was reported in 150(58. 37% patients. Univariate analysis showed that there was a significant difference in surgery duration (P=0. 024), nasogastric tube replacement(P=0. 002), complications (P=0. 002), length of hospital stay(P=0. 046)between two groups. Multiple logistic regression analysis showed that surgery duration(3～5 h) was the independent factor influencing the removal of nasogastric tube after pancreaticoduodenectomy(OR=0. 546, 95%CI: 0. 323-0. 921, P=0. 023). Conclusion Surgery duration was the independent factor influencing the removal of nasogastric tube after pancreaticoduodenectomy. Patients may benefit from early removal of nasogastric tube, and comprehensive evaluation should be carried out to ensure the safety of early removal of nasogastric tube. The establishment of a doctor-nurse integration team may contribute to the implementation of enhanced recovery after surgery-based comprehensive interventions and improvement of rehabilitation quality after surgery. (目的 对胰十二指肠切除手术后鼻胃管早期拔除可行性进行分析, 为临床医生遵循快速康复外科(ERAS)理念, 优化患者围手术期康复过程提供循证依据。方法 回顾性收集科室2020年4月—2021年1月接受胰十二指肠切除术治疗患者的临床资料。根据术后鼻胃管拔除时间分为早期拔除组(≤48 h)和晚期拔除组(>48 h), 采用单因素分析、Logistic回归多因素分析的方法, 分析两组患者围手术期康复情况的差异。结果 共有257例患者纳入本研究, 其中早期拔除鼻胃管150(58. 37%)例。单因素分析提示两组患者在手术时长(P=0. 024)、是否重置胃管(P=0. 002)、并发症(P=0. 002)、住院天数(P=0. 046)等方面差异有统计学意义。多因素分析提示两组患者手术时长(3～5 h)(OR=0. 546, 95%CI: 0. 323-0. 921, P=0. 023)差异有统计学意义。结论 手术时长是影响鼻胃管早期拔除直接因素; 胰十二指肠切除手术后早期拔除胃管可使患者获益; 在综合评估的基础上早期拔除鼻胃管是安全的; 医护一体化专业化团队有利于ERAS综合措施的贯彻执行开展, 帮助患者更好的理解配合, 实现加速康复目标。)

Keywords

• enhanced recovery after surgery
• nasogastric tube
• early removal
• pancreaticoduodenectomy
• 加速康复外科
• 鼻胃管
• 早期拔除
• 胰十二指肠切除术