ERAS在胰腺手术中的安全性及疗效分析：基于倾向值匹配
法
liker摘要：
目的：基于倾向值匹配分析探讨加速康复外科（enhanced recovery after surgery, ERAS）在胰腺手术中的安全性和疗效，为ERAS在胰腺手术中的应用推广提供参考依据。
方法：采用回顾性队列研究方法，收集南华大学附属第一医院2014年1月至2018年11月实施的95例胰腺手术患者的临床资料。其中，2016年8月至2018年11月54例胰腺手术患者围术期实施ERAS 流程，设为ERAS组即实验组；2014年1月至2016年7月41例胰腺手术患者围术期实施传统处理流程，设为传统组即对照组。使用包括患者基本情况、疾病诊断、手术方式及手术时间等基线特征对病例进行1:1的倾向性匹配，比较匹配后两组的临床疗效。观察指标：（1）术后实验室检查指标：术后（postoperative day，POD）1、3、5、7天白细胞（white blood cell，WBC）、血红蛋白（hemoglobin，HGB）、白蛋白（albumin，ALB）、总胆红素（total bilirubin，TBIL）、直接胆红素（direct bilirubin，DBIL）值。（2）术后临床观察指标：首次下床活动时间、首次进食时间、首次排便时间、胃管拔除时间（单纯胃肠减压和输入袢减压）、导尿管拔除时间、腹腔引流管拔除时间、术后住院时间、术后住院费用。（3）术后并发症情况：中重度疼痛发生率、胰瘘、胆漏、出血、再手术率、病死率、并发症发生率。
结果：两组患者的基线资料经倾向评分匹配后平衡良好，匹配后
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每组患者37名。（1）实验室检查指标：两组患者术前的白细胞、血红蛋白、白蛋白、总胆红素和直接胆红素相比较无明显差异（P＞0.05）；两组患者术后1、3、5、7天的白细胞、血红蛋白、总胆红素、直接胆红素相比较无明显差异（P＞0.05），而术后的白蛋白值相比较ERAS组高于传统组(P＜0.05)。（2）术后临床指标：ERAS组术后首次下床活动时间、首次进食时间、首次排便时间、导尿管拔除时间、术后住院时间及术后住院费用分别为(2.69±2.05)d、(5.86±3.88)d、(4.32±2.12)d、(3.03±1.56)d、(19.38±11.72)d、(4.06±2.09)万元，传统组上述指标分别为(3.82±2.22)d、(8.16±5.28)d、(5.35±2.09)d、(4.08±2.30)d、(25.43±12.35)d、(5.13±2.12)万元，两组相比较均有明显差异（t=2.209, 2.131,2.056, 2.308, 2.163, 2.185,P＜0.05）。（3）术后并发症情况：ERAS组术后的中重度疼痛发生率比传统组少（P＜0.05）。两组术后并发症总发生率相比较无明显差异（P＞0.05）。ERAS组B、C级胰瘘发生率分别为10.8％（4/37）、2.7％（1/37），传统组的上述指标分别为16.2％（6/37）、5.4％（2/37），两组胰瘘发生率相比较无明显差别（χ2=0.840, P＞0.05）；两组间的胆漏相比较无明显差别（P＞0.05）；ERAS组胰瘘腐蚀腹腔血管出血、吻合口出血、上消化道出血的发生率分别为0％（0/37）、5.4％（2/37）、2.7％（1/37），传统组的上述指标分别为 2.7％（1/37）、5.4％（2/37）、2.7％（1/37），两组术后出血发生率相比较无明显差别（χ2=0.158,
tastedP＞0.05）。ERAS组与传统组各有1例因术后发生严重并发症而导致死亡，各有1例因术
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后出血而行二次手术。
结论：ERAS应用于胰腺手术围术期安全有效，可加快术后机体功能的恢复，缩短术后住院时间及减少术后住院费用，并提高患者住院的舒适度及满意度，值得临床推广应用。xerox parc
关键词：加速康复外科；胰腺手术；围术期；倾向值匹配分析coleman
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THE ANALYSIS OF SAFETY AND EFFICACY OF ERAS IN PANCREATIC SURGERY：BASED ON PROPENSITY SCORE MATCHED ANALYSIS
thismorningJun Qiu (Hepatobiliary and pancreatic surgery)长五b火箭首飞成功
丹尼尔哈里斯Directed by Professor Jun He
女英文名
Abstract：
Objective: Bad on Propensity Score Matched Analysis, to investigate the safety and efficacy of enhanced recovery after surgery (ERAS) in pancreatic surgery, and then provide references for the application of ERAS in pancreatic surgery.
Methods：By using the method of retrospective cohort study, collected the clinical data of ninety-five patients who had pancreatic surgery in the First Affiliated Hospital of University of South China from January 2014 to November 2018. Among them, 54 patients who underwent pancreatic surgery from August 2016 to November 2018 ud the ERAS treatment during the operation, tting it as the ERAS group(experimental group). And 41 patients who underwent pancreatic surgery from January 2014 to July 2016 ud the traditional treatment during the operation, tting it as the traditional group(the control group). The baline characteristics including the basic information of the patients, dia diagnosis, surgical procedure and time of operation were ud to match the cas to 1:1 by Propensity Score Matched Analysis，and
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the clinical effects of the two groups were compared. Obrvation indicators: (1) postoperative laboratory examination indicators: the value of white blood cells (WBC), hemoglobin (HGB), albumin
(ALB), total bilirubin (TBIL), direct bilirubin (DBIL) on the 1st ,the 3rd,the 5th and the 7th day among the POD. (2) Postoperative clinical indicators: the first leaving bed time, the first feeding time, the first anal defecation time, gastric tube removal time (simple gastrointestinal decompression and input loop decompression), the catheter removal time, abdominal drainage tube removal time, postoperative hospital stay, postoperative hospitalization expens. (3) Postoperative complications: morbidity of moderate to vere pain, pancreatic fistula, bile leakage, hemorrhage, reoperation rate, mortality, and complication rate.
中英文互译在线Results:The baline data of the two groups of patients were well balanced after using Propensity Score Matched Analysis, and 37 patients in each group after matching. (1) Laboratory examination indicators: there was no significant difference between two groups(P＞0.05) about the white blood cells, hemoglobin, albumin, total bilirubin, direct bilirubin before the surgery; there was no significant difference between two groups(P＞0.05) about the white blood cells, hemoglobin, total bilirubin, direct bilirubin In terms of in the 1st, 3rd, 5th, 7th days after surgery. The postoperative albumin value in the ERAS group was higher than that in the traditional group (P＜0.05). (2) Postoperative clinical V I
