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研究生:余安琪
研究生(外文):Yu, An-Chi
論文名稱:術後加速康復療程(ERAS) 對食道癌術後病人預後比較
論文名稱(外文):Enhanced recovery after surgery (ERAS)for esophagectomy
指導教授:潘忠煜潘忠煜引用關係
指導教授(外文):Pan,Chung-Yu
口試委員:莊秀文陳南松潘忠煜
口試委員(外文):Chuang,Sheu-WenChen,Nan-SongPan,Chung-Yu
口試日期:2021-04-25
學位類別:碩士
校院名稱:東海大學
系所名稱:工業工程與經營資訊學系
學門:工程學門
學類:工業工程學類
論文種類:學術論文
論文出版年:2021
畢業學年度:109
語文別:中文
論文頁數:79
中文關鍵詞:食道癌食道切除手術術後快速康復療程
外文關鍵詞:EsophagectomyERASEnhanced recovery after surgery
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食道癌在台灣癌症發生率高居第九位,食道切除重建手術為外科重大手術之一,手術麻醉後對身體重要器官侵犯程度有著不等程度的影響,為了加快重大癌症手術後恢復速度,降低術後合併症的發生,達到手術後病人能早日重返日常生活的目的;近年來世界醫界的新議題:經由介入「術後加速康復療程(ERAS)」治療準則,此準則以實證醫學為基礎,從手術麻醉前、中、後,藉由跨團隊合作,提供手術麻醉病人全方位整合性全人醫療療程,據國外研究顯示,接受療程的病人將縮短手術後康復時間、減少住院天數、早日重返日常生活,也能降低醫療成本支出,增進有效醫療資源運用;本研究目的為比較加入術後快速康復療程之接受食道切除重建手術患者其預後狀態。
本研究結果顯示,經由ERAS準則介入食道癌病人與傳統療程的病人,比較其手術後的預後指標:呼吸管留置時間、開始下床坐時間、開始下床走路時間、侵入性管路(胸管、導尿管、鼻胃管)移除時間、手術後住院時間、總住院天數、出院後14日再入院的發生率,以上八項指標,統計結果p值皆小於0.05,顯示施行ERAS準則介入病人其預後皆有顯著改善;雖術後合併症皮下氣腫及72小時發燒之發生率,統計結果其p值並未小於0.05,顯示ERAS準則介入之病人其術後合併症發生率,效果並不顯著;然而,其他八項預後指標,皆有顯著影響,因此,術後快速康復療程(ERAS)用於食道癌手術病人實行上成效相當顯著,能明確改善手術病人預後,達到快速復原目的,值得推行此準則。

In order to speed up the recovery speed after major surgery, reduce the occurrence of complications, so that patients can return to daily life as soon as possible after surgery.
Esophagus carcinoma ranks 9th in cancer prevalence in Taiwan. Esophageal resection and reconstruction is among the major surgeries. In order to accelerate post-operation recovery, decrease complication rate and help the patients to return to their normal lives, the Enhanced Recovery After Surgery (ERAS) protocol was proposed, involving multidisciplinary team work and providing comprehensive patient care.
This study reveals that, compared to the control group, patients involved in ERAS had significant (p value <0.05) improvement in endotracheal tube dependency, recovery time to sitting-in-bed and walking-in-ward, time for removal of indwelling catheters, post-operation and total admission days and re-admission rate in 14 days. It concludes that EARS can improve the post-operation recovery for patient with esophageal resection and reconstruction.

摘 要 i
ABSTRACT ii
目 錄 iii
表目錄 iv
圖目錄 v
第一章 緒論
1.1 研究背景與動機 1
1.2 研究目的 3
1.3 名詞解釋 4
第二章 文獻查證
2.1 食道癌 6
2.2 術後快速恢復Enhanced Recovery After Surgery (ERAS) 15
第三章 研究方法與步驟
3.1 研究架構 43
3.2 研究步驟 44
3.3 資料收集 45
第四章 研究結果
4.1 基本屬性分布 46
4.2 食道癌術後預後各項指標之關係 48
4.3 食道癌術後各預後項指標多變項線性迴歸 50
第五章 結論與建議
5.1 結論 62
5.2 研究限制與建議 63
參考文獻-中文 64
參考文獻-英文 66

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