ERAS结合术前口服营养补充在直肠癌患者中的应用及对术后应激反应的影响  

ERAS combined with preoperative oral nutrition supplement in patients with rectal cancer and its effect on postoperative stress response

作　　者：王永仓 宁忠良 郑文琳 WANG Yongcang;NING Zhongliang;ZHENG Wenlin(Department of Gastrointestinal Tumor Surgery,Western District of the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Tumor Hospital),Hefei 230001,P.R.China)

机构地区：[1]中国科学技术大学附属第一医院西区(安徽省立医院西区安徽省肿瘤医院)胃肠肿瘤外科,合肥230001

出　　处：《中国普外基础与临床杂志》2019年第4期438-442,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨加速康复外科(enhanced recovery after surgery, ERAS)结合术前口服营养补充在直肠癌患者中的应用及其对术后患者应激反应的影响。方法选取2018年1–8月期间在笔者所在医院行手术治疗的直肠癌患者80例按抽信封方法随机分为对照组和观察组,对照组患者行腹腔镜辅助直肠癌根治术+围手术期采用加速康复外科理念措施,观察组患者行腹腔镜辅助直肠癌根治术+围手术期采用加速康复外科理念措施+术前口服营养补充肿瘤全营养配方倍康素TM。观察2组患者术后24 h的应激反应(平均收缩压、平均舒张压、平均心率、平均血氧饱和度、疼痛评分及空腹血糖)。同时分析2组患者术后第2天时血清蛋白水平、首次肛门排气时间、术后并发症发生率、住院时间及住院费用的差异。结果观察组术后24 h的平均收缩压、平均舒张压、平均心率、平均血氧饱和度、疼痛评分及空腹血糖水平均显著低于对照组(P<0.05);而观察组患者术后第2天血清总蛋白、白蛋白和前白蛋白水平均明显高于对照组(P<0.05);观察组术后的住院时间和住院费用也短于(或少于)对照组(P<0.05);观察组较对照组患者术后肛门首次排气时间提前而术后并发症发生率降低,但差异无统计学意义(P>0.05)。结论 ERAS结合术前应用倍康素TM可降低直肠癌患者术后应激反应及术后并发症发生率,改善患者术后营养状况并促进患者术后快速康复。Objective To investigate the effect of enhanced recovery after surgery(ERAS)combined with preoperative oral nutrition supplement(Ensource.)in patients w让h rectal cancer and its effect on postoperative stress response.Methods From January 2018 to August 2018,80 patients with laparoscopic assisted radical resection of rectal cancer in our hospital were divided into two groups according to different perioperative management.Forty patients who had used enhanced recovery after surgery combine preoperative application of tumor total nutrition formula enteral nutrition solution were as observation group,while other 40 patients who only had used enhanced recovery after surgery in perioperative as control group.We observed the stress response(mean systolic blood pressure,mean diastolic blood pressure,mean heart rate,mean blood oxygen saturation,pain score and fasting blood glucose)at 24 hours after surgery and the time of the first anal exhaust,complication rate,hospitalization time,and hospitalization cost after surgery in both groups.We also compared the early postoperative(on the second day after operation)nutritional status of the two groups like the levels of serum total protein,albumin and proalbumin.Results The mean systolic blood pressure,mean diastolic blood pressure,mean heart rate,mean blood oxygen saturation,pain score and fasting blood glucose of the observation group at 24 hours after surgery were significantly lower than those of the control group(P<0.05),while the total serum protein,albumin and prealbumin concentrations of the observation group were significantly higher than those of the control group on the second day after surgery(P<0.05).Postoperative hosp让alization time and hospitalization cost in the observation group were also shorter or less than those in the control group(P<0.05).Compared with the control group,the first postoperative anal exhaust time was earlier and the incidence of postoperative complications was reduced in the observation group,but the difference was not statistically sign

关 键 词：加速康复外科 术前肠内营养 直肠癌 应激反应 

分 类 号：R735.37[医药卫生—肿瘤]