快速康复理念对腹腔镜胃癌根治术后疼痛、炎性反应和胃肠功能的影响  

Effect of the concept of fast track surgery for the pain, inflammatory response and gastrointestinal function after laparoscopic radical gastrectomy

作　　者：蘧勐[1] 周群燕[2] 

机构地区：[1]哈尔滨医科大学附属第一医院急诊外科,黑龙江哈尔滨150001 [2]南京医科大学附属无锡人民医院营养科,江苏无锡214023

出　　处：《中国医药导报》2016年第17期97-100,共4页China Medical Herald

基　　金：江苏省无锡市卫生局青年科研项目(Q201404)

摘　　要：目的探究快速康复理念对腹腔镜胃癌根治术后疼痛、炎性反应和胃肠功能的影响。方法收集2014年10月-2015年10月于哈尔滨医科大学附属第一医院行腹腔镜手术的124例胃癌患者,按照随机数字表法将其分为两组,对照组和研究组,每组各62例。对照组患者行常规外科处理措施,研究组患者在此基础上应用快速康复理念进行治疗。观察比较两组患者的术后疼痛、炎性反应[超敏C-反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、白介素-8（IL-8）]、胃肠功能（肠鸣音恢复时间、排气和排便时间）以及术后不良反应（腹腔感染、吻合口瘘或破裂、术后出血、术后肠梗阻）等情况。结果对照组肛门排气时间[（58.2±6.5）h]、肠鸣音恢复时间[（28.2±7.4）h]、排便时间[（5.3±0.5）d]均长于研究组[（36.4±5.2）h、（15.8±5.3）h、（3.2±0.3）d],差异有统计学意义（P〈0.05）。对照组术后疼痛评分为（6.7±1.4）分,明显高于研究组[（4.5±1.3）分],差异有统计学意义（P〈0.05）。经秩和检验,研究组患者疼痛情况明显优于对照组（P〈0.05）。对照组术后hs-CRP、TNF-α、IL-6以及IL-8水平[（55.2±10.6）mg/L、（2.8±0.5）pg/m L、（56.2±9.5）ng/L、（28.2±4.3）ng/L]明显高于研究组[（48.5±8.2）mg/L、（1.5±0.2）pg/m L、（41.4±7.3）ng/L、（24.4±2.1）ng/L],差异有统计学意义（P〈0.05）。对照组术后并发症总发生率（32.26%）明显高于研究组（9.68%）,差异有统计学意义（P〈0.05）。结论在腹腔镜胃癌根治术的围术期应用快速康复理念可以明显促进胃肠功能恢复,缓解术后疼痛,降低术后炎性反应和术后并发症发生率,安全有效,值得推广。Objective To explore the effect of the concept of fast track surgery for the pain, inflammatory response and gastrointestinal function after laparoscopic radical gastrectomy. Methods One hundred and twenty four cases of patients with gastric cancer underwent laparoscopic surgery in the First Affiliated Hospital of Harbin Medical University from October 2014 to October 2015 were selected and divided into two groups according to random number table method,control group and study group, with 62 cases in each group. The control group was taken routine surgical treatment, on basis of which, the study group was taken the concept of fast track surgery for treatment. The conditions of postoperative pain, inflammatory response [high-sensitivity C-reactive protein（hs-CRP）, tumour necrosis factor-α（TNF-α）, interleukin-6（IL-6）, interleukin-8（IL-8）], gastrointestinal function（recovery time of bowel sounds, exhaust and defecation time） and postoperative adverse reactions（abdominal infection, anastomotic fistula or fracture, postoperative bleeding, postoperative intestinal obstruction） in the two groups were observed and compared. Results The anus exhaust time[（58.2±6.5） h], recovery time of bowel sounds [（28.2±7.4） h], defecation time [（5.3±0.5） d] of the control group was alllonger than those of study group [（36.4±5.2） h,（15.8±5.3） h,（3.2±0.3） d], the differences were statistically significant（P〈0.05）. The scores of postoperative pain inthe control group was（6.7±1.4） points, which was higher than that of study group [（4.5±1.3） points], the difference was statistically significant（P〈0.05）. According to rank sum test, the pain condition of study group was significantly better than that of control group（P〈0.05）. The levels of hs-CRP, TNF-α, IL-6 and IL-8 after operation in the control group[（55.2±10.6） mg/L,（2.8±0.5） pg/m L,（56.2±9.5） ng/L,（28.2±4.3） ng/L] were all higher than those of study group [（48.5±8.2） mg/L,（1.5

关 键 词：快速康复理念 腹腔镜胃癌根治术 疼痛 炎性反应 胃肠功能 

分 类 号：R735.7[医药卫生—肿瘤]