以ERAS为基础的多学科管理路径在妇科手术相关性尿脓毒血症防治中的作用

Role of ERAS-based Multidisciplinary Management Pathway Plays on the Prevention and Treatment of Urinary Sepsis Associated with Gynecological Surgery

关键词:  临床药师  加速康复外科  多学科管理路径  输尿管支架  尿脓毒血症

Key words:  clinical pharmacist  enhanced recovery after surgery(ERAS)  multidisciplinary management pathway  ureteral stent tube  urinary sepsis

摘要:

目的 探讨临床药师主导的以加速康复外科（enhanced recovery after surgery，ERAS）理念为基础的多学科管理路径在妇科恶性肿瘤手术相关性尿脓毒血症防治中的作用。方法 选取2017年7月-2018年12月在重庆市妇幼保健院因妇科恶性肿瘤手术留置及取出输尿管支架的患者109例。随机分成实验组（55例）和对照组（54例），分别给予多学科管理路径和常规诊疗措施。比较2组患者尿脓毒血症、术后并发症和药物不良反应发生率以及诊疗费用、住院天数和抗菌药物使用情况。结果 实验组2次手术的诊疗费用、西药费、抗菌药物费用以及尿脓毒血症的发生率、药物不良反应的发生率均低于对照组，实验组缩短了2次手术抗菌药物的疗程，差异具有统计学意义（P<0.05）。产超广谱β-内酰胺酶的大肠埃希菌是尿脓毒血症重要的病原菌。结论 临床药师主导的以ERAS理念为基础的多学科管理路径有利于减少留置及取出支架诱发的尿脓毒血症风险，弥补妇科恶性肿瘤ERAS措施中药物治疗管理的缺失和临床药师工作的空白。

Abstract:

OBJECTIVE To explore the role that enhanced recovery after surgery(ERAS)-based multidisciplinary management proposed by clinical pharmacists plays on the prevention and treatment of urinary sepsis associated with gynecological malignancy surgery. METHODS One hundred and nine patients who were planted and removed indwelling ureteral stents due to operations of gynecologic malignant tumors from July, 2017 to December, 2018 in Chongqing Health Center for Women and Children were selected. Patients were randomly divided into the experimental group(55 patients) and the control group(54 patients) and given the multidisciplinary management approach and the routine medical treatment respectively. The two groups were compared in terms of the incidence of urinary sepsis, postoperative complications, incidence of adverse drug reactions, clinical costs, hospitalization days and use of antibiotics. RESULTS The experimental group showed lower results in clinical costs for the two operations, western medicine costs, antibiotics costs, incidence of urinary sepsis, and the incidence of adverse drug reactions than the control group. The experimental group also abbreviated the treatment courses of antibiotics in the two operations, and the difference was statistically significant(P<0.05). Escherichia coli producing extended-spectrum β-lactamases was an important pathogenic bacterium of urinary sepsis. CONCLUSION ERAS-based multidisciplinary management proposed by clinical pharmacists will help minimize the urosepsis risks caused by indwelling or taking out stent, which comes as a supplement to ERAS-based gynecological malignancy medication management and work of clinical pharmacists.