中西医结合快速康复理念在腹腔镜直肠前切除术围手术期中的应用  

Application of Chinese medicine in enhanced recovery around surgery in perioperative period of laparoscopic anterior resection for rectal cancer patients

作　　者：蒋海锋[1] 阎良[1] 沙粒[1] 孔宪诚[1] 汤雪峰[1] 刘岗[1] 黄建平[1] Jiang Haifeng;Yan Liang;Sha Li;Kong Xiancheng;Tang Xuefeng;Liu Gang;Huang Jianping(Department of General Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China)

机构地区：[1]上海中医药大学附属曙光医院普外科,200021

出　　处：《国际中医中药杂志》2021年第4期335-339,共5页International Journal of Traditional Chinese Medicine

基　　金：上海市进一步加快中医药事业发展三年行动计划(2018年-2020年)项目(ZY﹝2018-2020﹞-ZYBZ-07)。

摘　　要：目的探讨中西医结合快速康复外科(Chinese medicine enhanced recovery around surgery,CMERAS)理念在腹腔镜直肠前切除术围手术期中的应用价值。方法将符合入选标准的2017年7月-2019年7月上海中医药大学附属曙光医院普外科行腹腔镜直肠前切除术的直肠癌患者100例,采用随机数字表法分为2组,每组50例。对照组采用加速康复外科(enhanced recovery after surgery,ERAS)理念的围手术期处理方案,观察组采用CMERAS理念的围术期处理方案。2组均治疗7 d。观察2组患者手术过程中肠道清洁度及术后康复质量,包括首次排气时间、术后住院时间和并发症发生率;采用免疫比浊法检测血清CRP水平,采用化学发光免疫分析法检测血清IL-6水平,采用流式细胞仪检测患者外周血CD4、CD8和CD4/CD8,记录不良反应。结果2组手术过程中肠道清洁度比较,差异无统计学意义(Z=-1.140,P=0.254)。观察组术后首次排气时间[(29.7±4.6)h比(36.1±3.8)h,t=7.590]早于对照组,术后住院时间[(4.2±0.5)d比(4.7±0.6)d,t=4.379]少于对照组,并发症发生率[8.0%(4/50)比30.0%(15/50),χ^(2)=6.498]低于对照组(P<0.01)。术后第3天,观察组血清CRP[(11.84±4.69)mg/L比(23.63±5.04)mg/L,t=12.106]、IL-6[(34.31±5.93)ng/L比(44.39±8.81)ng/L,t=6.714]水平低于对照组(P<0.05);CD4水平[(37.74±7.28)%比(33.55±5.07)%,t=-3.344]、CD4/CD8比值[(1.36±0.27)比(1.13±0.22),t=-4.920]高于对照组(P<0.01),CD8水平[(28.04±4.68)%比(30.22±4.04)%,t=2.487]低于对照组(P<0.05)。2组患者治疗过程中均未发生不良反应。结论CMERAS理念可促进腹腔镜直肠前切除患者围手术期恢复,且安全性较好。Objective To explore the application of enhanced recovery around surgery(CMERAS)by integrated Traditional Chinese Medicine&western medicine in perioperative period of laparoscopic anterior resection for rectal cancer patients.Methods 100 patients with rectal cancer who were treated by laparoscopic anterior resection in Shuguang Hospital from July 2017 to July 2019 were divided into two groups with random number table method,50 patients in each group.The control group received enhanced recovery after surgery(ERAS)perioperative treatment and the observation group received CMERAS perioperative treatment.Both groups were treated for 7 days.The degree of intestinal cleansing during the operation and postoperative rehabilitation quality were observed of the two groups,including the time of first exhaust,hospitalization time and the incidence of complications.Serum CRP level was detected by immunoturbidimetry,serum IL-6 level was detected by chemiluminescence immunoassay and peripheral blood CD4,CD8 and CD4/CD8 were detected by flow cytometry.Adverse reactions were recorded for the two groups.Results There was no significant difference in the degree of intestinal cleansing between the two groups during operation(Z=-1.140,P=0.254).The first postoperative exhaust time in the observation group(29.7±4.6 h vs.36.1±3.8 h,t=7.590)was earlier than that of the control group,the hospitalization time(4.2±0.5 d vs.4.7±0.6 d,t=4.379)was less than that of the control group,and the incidence of complications[8.0%(4/50)vs.30.0%(15/50),χ^(2)=6.498]was lower than that of the control group(P<0.01).On the third day after the operation,serum CRP(11.84±4.69 mg/L vs.23.63±5.04 mg/L,t=12.106)and IL-6(34.31±5.93 ng/L vs.44.39±8.81 ng/L,t=6.714)in the observation group were lower than those in the control group(P<0.05).CD4 levels[(37.74±7.28)%vs.(33.55±5.07)%,t=-3.344],CD4/CD8 ratio(1.36±0.27 vs.1.13±0.22,t=-4.920)were higher than those in the control group(P<0.01),and CD8 levels[(28.04±4.68)%vs.(30.22±4.04)%,t=2.487]was lower tha

关 键 词：直肠肿瘤 直肠切除术 加速康复外科 中西医结合 围手术期 康复 

分 类 号：R735.37[医药卫生—肿瘤]