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Возможности оценки и уменьшения выраженности периоперационной стрессовой реакции в экстренной хирургии у больных острым холециститом

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Цель. Изучить возможность оценки и уменьшения периоперационной стрессовой реакции в экстренной хирургии у больных острым холециститом. Материал и методы. С января 2017 г. по январь 2019 г. набрано 207 пациентов с острым холециститом. Пациентов случайным образом распределили на группы. В основной группе применяли методы ускоренной реабилитации. Для изучения уровня периоперационной стрессовой реакции и выявления биохимических предикторов осложнений острого холецистита измеряли уровень кортизола и интерлейкина 6. Результаты. Число послеоперационных осложнений между группами статистически значимо не различалось. Продолжительность послеоперационного пребывания в основной группе была меньше (33,3 ± 19,6 и 53,7 ± 32,7 ч; р 0,0001). В течение 24 ч после операции 54,5% пациентов основной группы и 19,8% пациентов контрольной группы были выписаны. Ранняя активизация и энтеральное питание позволили сократить сроки возвращения физической активности и перехода к привычной диете в основной группе. Также в ней отмечена меньшая частота послеоперационной боли в плече и (или) шее: 12 (13,6%) по сравнению с 35 (34,7%) наблю- дениями. Применение протокола ускоренной реабилитации не оказало значимого влияния на уровень кортизола после операции в основной группе. Заключение. У оперированных пациентов с острым холециститом ускоренная реабилитация позволяет улучшить качество послеоперационного периода: уменьшаются сила и частота послеоперационной боли, френикус-синдрома, симптомов диспепсии. Применение методов ускоренной реабилитации позволяет сократить срок госпитализации без увеличения частоты осложнений и повторных госпитализаций.

Ключевые слова:
лапароскопическая холецистэктомия, острый холецистит, методы ускоренной реабилитации, дополнительное обезболивание, лапароскопия низкого давления

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Assessing and reducing severity of perioperative stress response to emergency surgery in patients with acute cholecystitis

Aim. To explore the possibilities for assessing and reducing the severity of perioperative stress response to emergency surgery in patients with acute cholecystitis. Materials and methods. 207 patients with acute cholecystitis were registered from January 2017 to January 2019. Patients were randomized into groups. Enhanced recovery techniques were used in the main group. Cortisol and Interleukin-6 levels were measured to examine the perioperative stress response and to identify biochemical predictors of complications associated with acute cholecystitis. Results. The groups did not reveal a statistically significant difference in the number of postoperative complications. The length of postoperative stay was shorter in the main group (33.3 ± 19.6 h and 53.7 ± 32.7 h; p 0.0001). Within 24 postoperative hours, 54.5% of patients in the main group and 19.8% of the control group were discharged from hospital. Early mobilization and enteral feeding reduced the time of return to physical activity and transition to habitual diet in the main group, which was also noted with a lower incidence of postoperative pain in the shoulder and/or neck: 12 (13.6%) compared to 35 (34.7%) observations. The application of the enhanced recovery protocol provided no significant effect on postoperative cortisol levels in the main group. Conclusion. In surgical patients with acute cholecystitis, enhanced recovery improves the quality of the postoperative period, reducing the severity and frequency of postoperative pain, phrenicus and dyspepsia symptoms. The enhanced recovery techniques diminish the length of hospital stay without increasing the incidence of complications and re-hospitalizations.

Keywords:
gallbladder, acute cholecystitis, laparoscopic cholecystectomy, enhanced recovery, analgesia, low-pressure laparoscopy