结直肠癌患者围术期加速康复外科应用研究  

Application of ERAS of colorectal cancer patients in perioperative period

作　　者：孙亚超[1] 孙振强[2] 王琦三[1] SUN Ya-chao;SUN Zhen-qiang;WANG Qi-san(Department of Gastrointestinal Surgery ,Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi 830011 ,P. R. China;Department of Anorectal Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, P. R. China)

机构地区：[1]新疆医科大学附属肿瘤医院胃肠外科,新疆乌鲁木齐830011 [2]郑州大学第一附属医院肛肠外科,河南郑州450000

出　　处：《中华肿瘤防治杂志》2018年第7期494-498,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：新疆维吾尔自治区自然科学基金(2013211A066)

摘　　要：目的通过对加速康复外科(enhanced recovery after surgery,ERAS)与传统方法在结直肠癌患者围术期中的对比研究,探讨ERAS对结直肠癌患者术后临床指标及术后应激的影响。方法选取2016-03-01-12-31新疆医科大学附属肿瘤医院胃肠外科行结直肠癌根治术的65例患者进行研究,随机分为ERAS组33例和对照组32例。ERAS组围术期采用ERAS理念处理,对照组围术期采用传统处理方案。观察两组患者术后恢复、应激、并发症及术后住院时间、费用等情况。结果 ERAS组术后首次下床活动时间为(2.5±1.9)d,较对照组(4.6±1.6)d明显缩短,P<0.001;首次肛门通气时间为(3.1±1.4)d,较对照组(4.4±1.5)d缩短,P=0.010;术后住院时间为(7.2±4.1)d,较对照组(9.8±2.2)d明显缩短,P<0.001;住院费用为(6.3±1.2)万元,较对照组(7.2±1.5)万元减少,P=0.040;术后疼痛程度数字评估量表(NRS)评分数值为(1.7±0.8)分,较对照组(3.4±0.6)分减少,P=0.012;两组术后并发症发生率分别为12.1%(4/33)和18.7%(6/32),差异有统计学意义,P=0.46。ERAS组术后第1和3天的白细胞数、血糖及术后第1天的C-反应蛋白水平与对照组比较,差异有统计学意义,均P<0.05。两组术后30d再住院例数和生命质量测试评分差异无统计学意义,均P>0.05。结论 ERAS能够加速患者术后康复,减轻术后应激反应,缩短住院时间,减轻医疗经济负担,不增加术后并发症,应用于结直肠癌围术期有效可行。OBJECTIVE To investigate the ERAS on postoperative clinical indicators and postoperative stress in colorectal cancer patients, by comparing of enhanced recovery after surgery and traditional methods in colorectal cancer patients. METHODS A total of 65 patients, from March 1 to December 31,2016,that have undergone radical surgery for colorectal cancer in Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Xinjiang Medical University were selected for research. Patients enrolled in the standard randomization were randomly assigned to two groups： ERAS group （33 cases, treated by ERAS concept in perioperative period） and control group （32 cases,treated by traditional pro- cessing scheme in perioperative period）. Observing the postoperative recovery, stress, complications and postoperative hospital stay,costs and so on. RESULTS Two different groups showed the time to first bed ambulation in ERAS group was （2.5±1.9） d, which was significantly shorter than that in control group （4.6±1.6） d, P〈0. 001 ;the time of the first a- nal ventilation was （3.1±1.4） d,which was significantly shorter than control group （4.4±1.5） d,P〈0. 010. The post- operative hospital stay was （7.2±4.1） d,which was significantly shorter than that of the control group （9.8±2.2） d, P〈0. 001;the hospitalization expenses were （6. 3±1. 2） ten thousand yuan, significantly less than the control group, （7.2± 1.5）, P = 0. 040. The postoperative N RS pain score was （1.7± 0.8） points which was also declined when compared with the control group （3.4±0.6） points,P=0. 012. The incidence of complications of these two groups were 12.1% （4/33）, 18.7%（6/32）, P = 0.46, respectively. Comparing. the number of white blood cells, blood glucose, and C-RP in the first day,third day and fifth day after operation in the ERAS group with the control group（P〈0.05）, there was no statistical significance. Comparing the number of hospitalization 30 days later and the quality of life te

关 键 词：加速康复外科 结直肠癌 术后应激 术后康复 

分 类 号：R735.3[医药卫生—肿瘤]