加速康复外科策略对腹膜后恶性肿瘤患儿体液免疫功能及术后恢复的影响  

Effects of enhanced recovery after surgery protocols on humoral immune function and postoperative recovery in children with abdominal malignant tumors

作　　者：刘光 刘支娜 王会瑟 蔺颐 张玲 孟德光 王芳[4] Liu Guang;Liu Zhina;Wang Huise;Lin Yi;Zhang Ling;Meng Deguang;Wang Fang(Department of Anesthesiology,Baoding Branch of Beijing Children's Hospital,Baoding Children's Hospital,Baoding 071000,China;Baoding Key Laboratory of Clinical Research on Children Respiratory and Digestive Diseases,Baoding 071000,China;Baoding Ward of Oncology Surgery,Beijing Children's Hospital,Baoding 071000,China;Department of Anesthesiology,Beijing Children's Hospital Affiliated to Capital Medical University,Beijing 100045,China)

机构地区：[1]北京儿童医院保定医院(保定市儿童医院)麻醉科,071000 [2]保定市儿童呼吸消化疾病临床研究重点实验室,071000 [3]北京儿童医院肿瘤外科保定病区,071000 [4]首都医科大学附属北京儿童医院麻醉科,100045

出　　处：《国际麻醉学与复苏杂志》2021年第3期263-267,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨围手术期麻醉管理应用加速康复外科(enhanced recovery after surgery,ERAS)策略对腹膜后恶性肿瘤患儿体液免疫功能及术后恢复的影响。方法选择择期行腹膜后恶性肿瘤切除术患儿70例,年龄1~4岁,ASA分级Ⅱ、Ⅲ级。按照随机数字表法将患儿分为常规组(C组)和ERAS组(E组),每组35例。E组采用ERAS策略行围手术期麻醉管理,C组采用传统方式进行围手术期麻醉管理。术后采用疼痛相关行为学评分法(Face,Legs,Activity,Cry,and Consolability,FLACC)评估镇痛效果,记录患儿入室前及术后24、48、72 h时C-反应蛋白(C-reactive protein,CRP)、IL-6浓度以及免疫球蛋白A(immunoglobulin A,IgA)、免疫球蛋白G(immunoglobulin G,IgG)、免疫球蛋白M(immunoglobulin M,IgM)水平。记录两组患儿术中丙泊酚和瑞芬太尼总用量、术后不良反应及并发症发生情况、术后恢复情况、住院天数和总费用。结果最终共纳入64例,C组34例、E组30例。与入室前比较,术后两组患儿CRP和IL-6浓度均明显升高(P<0.05);与C组比较,E组术后72 h的CRP及术后48、72 h的IL-6浓度明显降低(P<0.05)。与入室前比较,术后24、48、72 h两组IgG、IgM水平均明显降低(P<0.05);术后48、72 h E组IgG、IgM明显高于C组(P<0.05)。E组患儿术中丙泊酚和瑞芬太尼总用量均明显低于C组(P<0.05)。两组患儿术后镇痛效果在各时间点差异无统计学意义(P>0.05)。E组术后不良反应及并发症发生率明显低于C组(P<0.05)。术后恢复方面,E组患儿术后首次肠鸣音时间、首次排气时间与首次下床活动时间明显早于C组(P<0.05),但在术后住院天数和住院总费用方面组间差异无统计学意义(P>0.05)。结论围手术期ERAS策略能降低腹膜后恶性肿瘤患儿应激反应、保护体液免疫功能,并在一定程度上促进患儿术后恢复。Objective To investigate the effects of perioperative anesthetic management with enhanced recovery after surgery(ERAS)protocols on humoral immunity function and postoperative recovery in children with abdominal malignant tumors.Methods A total of 70 children,aged 1-4 years,American Society of Anesthesiologists(ASA)gradeⅡ-Ⅲ,who were scheduled for abdominal malignant tumor resection were enrolled.They were divided into two groups(n=35)according to the random number table method:a control group(group C)and an ERAS group(group E).Patients in group E underwent perioperative anesthetic management by ERAS protocols,while traditional methods were adopted in group C.Postoperative analgesic effects were evaluated by Face,Legs,Activity,Cry,and Consolability(FLACC)method and the levels of C-reactive protein(CRP),interleukin 6(IL-6),immunoglobulin A(IgA),immunoglobulin G(IgG),and immunoglobulin M(IgM)were recorded before entry into the room and 24 h,48 h,and 72 h after operation.Their total dosage of propofol and remifentanil,postoperative adverse reactions and complications,postoperative recovery,the length of hospitalization stay,and total expenses were recorded.Results Sixty-four patients were finally included,including 34 cases in group C and 30 cases in group E.Compared with the levels before entry into the room,the levels of CRP and IL-6 in the two groups significantly increased after surgery(P<0.05).Compared with group C,the levels of CRP 72 h after operation and the levels of IL-648 h and 72 h after operation in group E significantly reduced(P<0.05).Compared with the levels before entry into the room,the levels of IgG and IgM in the two groups significantly reduced 24 h,48 h and 72 h after operation(P<0.05).But the levels of IgG and IgM in group E were significantly higher than those in group C 48 h and 72 h after operation(P<0.05).The total dosages of propofol and remifentanil in group E was significantly less than that those in group C(P<0.05).There was no difference in postoperative analgesia between the two gr

关 键 词：加速康复外科 儿童 恶性肿瘤 免疫功能 

分 类 号：R735.4[医药卫生—肿瘤]