快速康复外科在进展期结直肠癌患者中的应用及临床价值  

The application and clinical value of enhanced recovery after surgery in patients with aggressive-phase colorectal cancer

作　　者：徐菲[1] 李娜[1] 杨媛 马建伟 王园园[1] 孟丽敏[1] XU Fei;LI Na;YANG Yuan(Department of Mental Health,The First Hospital of Hebei Medical University,Hebei,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第一医院,石家庄市050031

出　　处：《河北医药》2021年第16期2483-2486,共4页Hebei Medical Journal

基　　金：河北省医学科学研究课题计划项目(编号:20190445)。

摘　　要：目的探讨快速康复外科(enhanced recovery after surgery,ERAS)在结直肠癌择期手术患者中的临床价值。方法选取2018年1月至2019年12月收治的结直肠癌择期手术患者60例,随机分为试验组与对照组,每组30例。对照组实施常规围术期护理,试验组实施快速康复外科护理,并采用汉密尔顿焦虑量表(HAMA)评分及焦虑自评量表(SAS)评分评估2组患者心理状态;应用视觉模拟疼痛评分(VAS)量表评估患者术后6 h、12 h、24 h、48 h时的疼痛程度;检测患者血清白蛋白(albumin,Alb)、前白蛋白(prealbumin,PA)、转铁蛋白(transferrin,Tf)水平评估其营养状况,比较2组患者免疫功能。结果经护理干预,2组患者焦虑症状较干预前降低,试验组干预后HAMA评分及SAS评分与对照组比较,显著降低,差异有统计学意义(P<0.05);且术后同一时间点比较,试验组VAS评分均显著低于对照组,差异均有统计学意义(P<0.05)。手术后,2组营养状况均较治疗前有所降低,其中试验组Alb、PA及Tf水平均高于对照组,差异有统计学意义(P<0.01)。2组的CD^(+)_(4)、CD^(+)_(4)/CD^(+)_(8)水平均较术前升高,CD^(+)_(8)、CD^(+)_(4)CD25+水平较术前降低(P<0.05)。术后,试验组的CD^(+)_(4)、CD^(+)_(4)/CD^(+)_(8)水平高于对照组,CD^(+)_(8)水平低于对照组,差异有统计学意义(P<0.05);而试验组的CD^(+)_(4)CD25+水平虽低于对照组,但差异无统计学意义(P>0.05)。结论对行择期手术的结直肠癌患者实施加速康复外科护理,有助于缓解患者焦虑情绪,减轻患者术后疼痛,提高其营养状态。Objective To investigate the clinical effects of enhanced recovery after surgery(ERAS)in patients with aggressive-phase colorectal cancer.Methods A total of 60 patients with aggressive-phase colorectal cancer who underwent elective surgery in our hospital were randomly divided into experimental group and control group,with 30 case in each group.The patientsin control group were treated by routine perioperative nursing,however,the patients in experimental group were treated by ERAS nursing.The Hamilton Anxiety Scale(HAMA)score and Anxiety Self-Assessment Scale(SAS)score as well as visual analogue pain score(VAS)were used to evaluate the pain degree of patients at 6h,12h,24h,48h after operation,moreover,the serum levels of albumin(Alb),prealbumin(PA),transferrin(Tf)were detected to assess patient’s nutritional status,Compare the immune function of two groups of patients.Results After the nursing intervention,the anxiety symptoms of patients in both groups were significantly relieved,and the HAMA scores and SAS scores in experimental group were significantly lower than those in control group,moreover,the and the VAS scores in experimental group were significantly lower than those in control group(P<0.05).After the operation,the nutritional status of patients in both groups was improved,and the serum levels of Alb,PA and Tf in experimental group were significantly higher than those in control group(P<0.01).The levels of CD^(+)_(4),CD^(+)_(4)/CD^(+)_(8) in both groups were increased than before operation,and the levels of CD^(+)_(8),CD^(+)_(4)CD25+were decreased,P<0.05.After operation,the levels of CD^(+)_(4) and CD^(+)_(4)/CD^(+)_(8) in the experimental group were higher than those in the control group,and the levels of CD8+were lower than those in the control group(P<0.05);Although the CD^(+)_(4)CD25+level of the experimental group was lower than that of the control group,but the difference was not statistically significant(P>0.05).Conclusion ERAS nursing for patients with colorectal cancer undergoing elective sur

关 键 词：结直肠癌 快速康复外科 结直肠切除手术 围术期 

分 类 号：R735.37[医药卫生—肿瘤]