加速康复外科理念在术前存在营养风险的胃癌患者中的应用效果观察  

Application of the concept of accelerated rehabilitation surgery in patients with gastric cancer with preoperative nutritional risk

作　　者：赵明佐 王建[1] 吴建强[1] 马小明 饶丽华[1] ZHAO Ming-zuo;WANG Jian;WU Jian-qiang(Department of Gastrointestinal Surgery,Suqian People's Hospital,Nanjing Gulou Hospital Group,Suqian Jiangsu 223800,China)

机构地区：[1]南京鼓楼医院集团宿迁市人民医院胃肠道外科,江苏宿迁223800

出　　处：《临床和实验医学杂志》2018年第24期2667-2670,共4页Journal of Clinical and Experimental Medicine

基　　金：江苏省科技支撑计划项目(编号:S201611)

摘　　要：目的观察加速康复外科理念在术前存在营养风险的胃癌患者中的临床效果。方法回顾性分析2015年2月至2017年2月南京鼓楼医院集团宿迁市人民医院收治的70例胃癌手术患者的临床资料,依据治疗方法不同分为观察组与对照组,每组各35例。观察组患者应用加速康复外科理念,对照组患者给予常规措施。观察两组患者围手术期的临床指标、免疫功能变化情况及并发症发生情况等。结果两组患者术后1 d血红蛋白水平分别为(124. 74±13. 99) g/L、(121. 14±13. 22) g/L,较治疗前均降低(P <0. 05),组间比差异无统计学意义(P> 0. 05);观察组患者术后通气时间(50. 98±13. 21) h、进半流质饮食时间(52. 68±11. 61) h、下床活动时间(29. 84±12. 22) h及术后住院时间(13. 91±1. 93) d均少于对照组的术后通气时间(74. 59±13. 30) h、进半流质饮食时间(79. 68±12. 32) h、下床活动时间(57. 6±13. 10) h及术后住院时间(14. 05±1. 66) d,组间比较差异具有统计学意义(P <0. 05)。观察组患者术后CD4+(31. 54±7. 12)%、CD8+(20. 95±7. 69)%较治疗前无变化(P> 0. 05),CRP(66. 63±17. 85) mg/L升高,CD3+(54. 95±5. 58)%降低(P <0. 05);对照组患者术后CRP(86. 47±18. 37) mg/L升高,CD3+(51. 5±7. 62)%、CD4+(30. 59±4. 19)%、CD8+(20. 45±6. 26)%降低(P <0. 05);两组患者术后CRP及CD3+指标变化情况组间比较差异具有统计学意义(P <0. 05)。观察组患者围手术期并发症发生率为5. 71%,低于对照组患者的25. 71%。结论加速康复外科理念应用于术前存在营养风险的胃癌患者临床中,可改善围手术期临床指标,减少住院天数及治疗费用,降低手术对患者的免疫功能影响,减少并发症,临床应用前景广泛。Objective To observe the clinical effect of the concept of accelerated rehabilitation surgery in patients with gastric cancer with preoperative nutritional risk.Methods Clinical data of 70 patients with gastric cancer who were operated in our hospital were analyzed retrospectively.The patients in the observation group received the nursing with the concept of accelerated rehabilitation surgery,while the patients in the control group received routine nursing care.Perioperative clinical indicators,changes in immune function and complications were observed.Results The hemoglobin levels in the two groups were(124.74±13.99)g/L and(121.14±13.22)g/L,respectively,which were lower than those before treatment(P<0.05).There was no significant difference between the two groups(P>0.05);postoperative ventilation time(50.98±13.21)h,half-liquid diet time(52.68±11.61)h,get out of bed activity time(29.84±12.22)h and postoperative hospital stay(13.91±1.93)d were less than the control group's postoperative ventilation time(74.59±13.30)h,semi-liquid diet time(79.68±12.32)h,get out of bed activity time(57.6±13.10)h and postoperative hospital stay(14.05±1.66)d,the difference between the groups was statistically significant(P<0.05).Postoperative CD4+(31.54±7.12)%,CD8+(20.95±7.69)%in the observation group had no change than those before treatment(P>0.05),CRP(66.63±17.85)mg/L increased and CD3+(54.95±5.58)%decreased(P<0.05);postoperative CRP(86.47±18.37)mg/L increased,CD3+(51.5±7.62)%,CD4+(30.59±4.19)%,CD8+(20.45±6.26)%decreased(P<0.05).The difference of postoperative CRP and CD3+index between the two groups was statistically significant(P<0.05).The perioperative complication rate was 5.71%in the observation group and 25.71%in the control group.Conclusion The concept of accelerated rehabilitation surgery is applied to the clinical care of patients with gastric cancer with preoperative nutritional risk,to speed up the postoperative ventilation,reduce the length of stay and treatment costs,reduce the impact of surgery on th

关 键 词：胃癌 术前存在营养风险 加速康复外科理念 应用效果 

分 类 号：R735.2[医药卫生—肿瘤]