基于加速康复外科理念的结构化术前访视对腹腔镜胆囊切除术患者住院时间的影响

Effect of Structured Preoperative Visit Based on the Concept of Accelerated Rehabilitation Surgery on Hospitalization Time of Patients Undergoing Laparoscopic Cholecystectomy

摘要: 目的：探讨基于加速康复外科(ERAS)理念的结构化术前访视对腹腔镜胆囊切除术(LC)患者住院时间及术后早期康复指标的影响。方法：回顾性分析2023年1月~2026年6月珠海市中西医结合医院收治的100例LC患者的临床资料，根据围手术期是否接受手术室护士实施的结构化术前访视分为访视组(n = 50)和对照组(n = 50)。对照组接受常规围手术期护理，访视组在常规护理基础上实施基于ERAS理念的结构化术前访视。比较两组患者一般资料、住院时间、术后首次下床活动时间及术后首次肛门排气时间。结果：两组患者年龄、性别、ASA分级、疾病类型、体重指数(BMI)及手术时间比较，差异均无统计学意义(P > 0.05)，具有可比性。访视组住院时间为9.0 (8.0, 10.0) d，对照组为8.0 (7.0, 9.0) d，两组比较差异无统计学意义(Z = 1.876, P = 0.061)；访视组术后首次下床活动时间为(18.72 ± 4.43) h，对照组为(17.58 ± 4.43) h，两组比较差异无统计学意义(t = 1.288, P = 0.201)；访视组术后首次肛门排气时间为19.0 (17.0, 21.0) h，对照组为18.5 (17.0, 21.0) h，两组比较差异无统计学意义(Z = 0.315, P = 0.753)。两组住院时间分布(≤7 d、8~14 d、>14 d)构成比较，差异亦无统计学意义(P = 0.101)。结论：在LC围手术期管理日趋规范的背景下，基于ERAS理念的结构化术前访视未能显著缩短患者住院时间，亦未明显改善术后早期康复指标，住院时间更多受患者年龄、ASA分级等个体因素影响。术前访视的价值或更多体现在患者评估、心理支持及手术室护理质量管理等方面，其对住院时间的独立效应有待前瞻性、大样本研究进一步验证。未来研究应以术前焦虑评分(状态–特质焦虑问卷，STAI)为主要终点，并将围手术期流程知识掌握度、患者满意度、术后疼痛评分及恶心呕吐发生率等纳入次要终点，以更全面评价结构化术前访视的直接效果。

Abstract: Objective: To explore the influence of structured preoperative visit based on the concept of accelerated rehabilitation surgery (ERAS) on the hospitalization time and early postoperative rehabilitation index of patients undergoing laparoscopic cholecystectomy (LC). Methods: The clinical data of 100 LC patients admitted to Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from January, 2023 to June, 2026 were retrospectively analyzed, and they were divided into visiting group (n = 50) and control group (n = 50) according to whether they received structured preoperative visit from operating room nurses during perioperative period. The control group received routine perioperative care, and the visiting group implemented structured preoperative visit based on ERAS concept on the basis of routine care. The general data, hospitalization time, the time of getting out of bed for the first time after operation and the time of first anal exhaust after operation were compared between the two groups. Results: There was no significant difference in age, sex, ASA grade, disease type, body mass index (BMI) and operation time between the two groups (P > 0.05), which was comparable. The hospitalization time of the visiting group was 9.0 (8.0, 10.0) d, while that of the control group was 8.0 (7.0, 9.0) d, and there was no statistical difference between the two groups (Z = 1.876, p = 0.061). The time of getting out of bed for the first time after operation was (18.72 4.43) h in the visiting group and (17.58 4.43) h in the control group. There was no statistical difference between the two groups (t = 1.288, p = 0.201). The first postoperative anal exhaust time in the visiting group was 19.0 (17.0, 21.0) h, while that in the control group was 18.5 (17.0, 21.0) h, and there was no significant difference between the two groups (Z = 0.315, P = 0.753). There was no significant difference in the distribution of hospitalization time (≤7 d, 8~14 d, >14 d) between the two groups (P = 0.101). Conclusion: Under the background of increasingly standardized perioperative management of LC, structured preoperative visit based on ERAS concept failed to significantly shorten the hospitalization time of patients, and did not significantly improve the early postoperative rehabilitation index. The hospitalization time was more influenced by individual factors such as patients’ age and ASA grade. The value of preoperative visit is more reflected in patient evaluation, psychological support and nursing quality management in operating room, and its independent effect on hospitalization time needs to be further verified by prospective and large sample studies. Future research should take preoperative anxiety score (State-Trait Anxiety Questionnaire (STAI)) as the main end point, and include perioperative process knowledge, patient satisfaction, postoperative pain score and incidence of nausea and vomiting as the secondary end point, so as to evaluate the direct effect of structured preoperative visit more comprehensively.