加速康复外科在结直肠癌患者中的应用价值  

Application value of enhanced recovery after surgery in patients with colorectal cancer

作　　者：王刚[1] 陆峰 周井荣 张强 邱磊[1] 杨修伟 苗永昌[1] Wang Gang;Lu Feng;Zhou Jingrong;Zhang Qiang;Qiu Lei;Yang Xiuwei;Miao Yongchang(Department of General Surgery,the Second People′s Hospital of Lianyungang,Lianyungang,Jiangsu 222006,China)

机构地区：[1]连云港市第二人民医院普外科,江苏省222006

出　　处：《中国基层医药》2020年第13期1559-1563,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：江苏省连云港市科技局资助项目(SH1619);江苏省连云港市卫生和计划生育委员会资助项目(201516);江苏省连云港市第二人民医院中青年医学人才成长基金项目(TQ201708)。

摘　　要：目的探讨加速康复外科(ERAS)在结直肠癌患者中的应用价值。方法前瞻性选取连云港市第二人民医院2017年1月至2018年12月收治的结直肠癌患者60例为研究对象,采用随机数字表法分为ERAS组、对照组各30例,对照组采用常规围手术期处理,ERAS组采用ERAS进行围手术期处理,比较两组的炎症和营养指标、免疫指标、手术前后的临床指标。结果术后第1天、术后第3天,ERAS组C反应蛋白(CRP)分别为(70.2±10.3)mg/L、(82.5±8.2)mg/L,均低于对照组的(81.5±9.9)mg/L、(110.2±12.9)mg/L(t=4.324、9.911,均P<0.05);术后第3天,ERAS组白蛋白、前白蛋白分别为(31.6±4.8)g/L、(196.8±40.6)g/L,均高于对照组的(28.0±5.8)g/L、(172.1±38.8)g/L(t=2.621、2.409,均P<0.05);ERAS组各项免疫指标(IgA、IgM、IgG、CD4^+、CD4^+/CD8^+)均高于对照组(t=2.132、2.223、6.063、4.253、2.828,均P<0.05);ERAS组手术当天口渴、饥饿发生例数分别为3例、7例,均少于对照组的21例、25例(χ^2=22.500、21.696,均P<0.05);ERAS组术后首次排气时间、排便时间、住院时间分别为(36.2±12.1)h、(63.4±13.4)h、(9.5±3.2)d,均短于对照组的(54.7±13.8)h、(96.5±18.8)h、(12.1±4.0)d(t=5.513、7.845、2.761,均P<0.05);两组并发症发生例数差异无统计学意义(P>0.05)。结论ERAS技术用于结直肠癌手术患者,可以明显减少患者生理及心理的创伤应激,缩短住院时间,达到快速康复的效果。Objective To explore the application value of enhanced recovery after surgery(ERAS)in colorectal cancer patients.Methods From January 2017 to December 2018,60 patients with colorectal cancer who admitted to the Second People′s Hospital of Lianyungang were selected and divided into ERAS group and control group according to the random digital table method,with 30 patients in each group.The inflammation,nutritional indicators,immune indicators and clinical manifestations before and after surgery in the two groups were compared.Results At 1 d and 3 d after surgery,the C-reactive protein(CRP)levels in the ERAS group were(70.2±10.3)mg/L,(82.5±8.2)mg/L,respectively,which were lower than those in the control group[(81.5±9.9)mg/L,(110.2±12.9)mg/L](t=4.324,9.911,all P<0.05).On the third day after operation,the levels of albumin and prealbumin in the ERAS group were(31.6±4.8)g/L,(196.8±40.6)g/L,respectively,which were higher than those in the control group[(28.0±5.8)g/L,(172.1±38.8)g/L](t=2.621,2.409,all P<0.05).The immune parameters(IgA,IgM,IgG,CD4^+,CD4^+/CD8^+)in the ERAS group were higher than those in the control group(t=2.132,2.223,6.063,4.253,2.828,all P<0.05).The number of cases with thirsty and hunger on the day of surgery in the ERAS group was 3 cases and 7 cases,respectively,which were less than 21 cases and 25 cases of the control group(χ^2=22.500,21.696,all P<0.05).The first exhaust time,defecation time and hospital stay time in the ERAS group were(36.2±12.1)h,(63.4±13.4)h and(9.5±3.2)d,respectively,which were shorter than those in the control group[(54.7±13.8)h,(96.5±18.8)h and(12.1±4.0)d](t=5.513,7.845,2.761,all P<0.05).The incidence of complications between the two groups had no statistically significant difference(P>0.05).Conclusion ERAS can significantly reduce the physical and psychological traumatic stress of patients with colorectal cancer,achieve rapid recovery,improve the treatment effect,shorten the length of hospital stay,reduce social and family burden,and provide a basis for the c

关 键 词：结直肠肿瘤 外科手术 腹腔镜检查 加速康复外科 炎症 营养状况 免疫活性 手术后并发症 

分 类 号：R735.34[医药卫生—肿瘤]