多学科协作治疗联合快速康复理念对直肠癌开腹手术患者的干预效果分析  

Effect of multidisciplinary team combined with the concept of enhanced recovery after surgery on patients with rectal cancer undergoing laparotomy

作　　者：何启雄 李盛海 黄铭祥 周成茂 谢启明[1] He Qixiong;Li Shenghai;Huang Mingxiang;Zhou Chengmao;Xie Qiming(Department of Surgery,Affiliated Hospital of Zhaoqing Medical College,Zhaoqing,Guangdong,526060,China)

机构地区：[1]肇庆医学高等专科学校附属医院外科,广东肇庆526060

出　　处：《结直肠肛门外科》2018年第4期351-354,共4页Journal of Colorectal & Anal Surgery

摘　　要：目的研究多学科协作(MDT)联合快速康复理念对于直肠癌开腹手术患者的干预效果。方法纳入62例接受直肠癌开腹手术的患者作为研究对象,随机分为两组,每组各31例。观察组术后在MDT指导下进行快速康复干预,对照组给予常规干预。比较两组术后基本情况、术后并发症情况及应激反应、免疫功能指标。结果观察组术后肠鸣音恢复时间、首次肛门排气时间、首次进食时间、首次下床活动时间、住院时间较对照组均缩短,术后3 d时VAS疼痛评分低于对照组,差异均有统计学意义(均P<0.05)。两组术后并发症总发生率差异无统计学意义(P>0.05)。术后两组CRP、皮质醇及CD8^+水平均高于组内术前,术后两组CD4^+水平低于组内术前,术后观察组CRP、皮质醇及CD8^+水平低于对照组,术后CD4^+水平高于对照组,对照组术后CD4^+/CD8^+水平低于术前,差异均有统计学意义(均P<0.05),观察组手术前后CD4^+/CD8^+水平差异无统计学意义(P>0.05)。结论 MDT联合快速康复理念用于直肠癌患者的术后治疗与护理,有助于促进患者早期康复及维持免疫功能稳定。Objective To investigate the effect of multidisciplinary team（MDT） combined with the concept of enhanced recovery after surgery on patients with rectal cancer undergoing laparotomy. Methods 62 patients who underwent laparotomy for rectal cancer were included in the study. They were divided into two groups, with 31 cases in each group. The treatment group received MDT combined with the concept of enhanced recovery after surgery while the control group received routine intervention. The postoperative general condition, the complication, the stress response and immune function indices were compared between the two groups. Results Time to postoperative bowel sound, time to the first anal exhaust, time to the first food intake, time to ambulation, and hospitalization duration were significantly shorter in the treatment group than in the control group（P〈0.05）. The VAS pain score 3 days after operation was significantly lower in the treatment group than in the control group（P〈0.05）. The total rate of postoperative complications did not differ significantly between the two groups（P〈0.05）. In both groups, the levels of CRP, cortisol and CD8＋ were higher and the levels of CD4＋ were lower after operation than pre-operation（P〈0.05）. The levels of CRP, cortisol and CD8＋ were lower and the levels of CD4＋ after operation were higher in the treatment group than in the control group. Compared with pre-operation, the ratio of CD4＋/CD8＋ was lower post-operation in the control group and the difference was significant（P〈0.05）. In the treatment group, the ratio of CD4＋/CD8＋ was comparable between pre-and post-operation（P〈0.05）. Conclusion MDT combined with the concept of enhanced recovery after surgery is effective in promoting early recovery and maintaining stable immune function in patients with rectal cancer undergoing laparotomy.

关 键 词：直肠癌 多学科协作治疗 快速康复 开腹手术 

分 类 号：R735.3[医药卫生—肿瘤]