加速康复外科理论对保留左结肠动脉直肠癌根治术老年病人的干预效果研究  

The intervention effect of accelerated rehabilitation surgery on elderly patients with left colorectal cancer

作　　者：于浩[1] 田景中[1] 李光云[1] 许建国[1] 黄宝玉[1] 彭杰 谢坤领 YU Hao;TIAN Jingzhong;LI Guangyun;XU Jianguo;HUANG Baoyu;PENG Jie;XIE Kunling(Gastrointestinal Surgery,Bozhou People's Hospital,Bozhou,Anhui 236800)

机构地区：[1]亳州市人民医院胃肠外科,安徽亳州236800

出　　处：《安徽医药》2022年第1期132-136,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨加速康复外科理论对老年保留左结肠动脉(LCA)直肠癌根治术病人的干预效果。方法将亳州市人民医院2017年3月至2019年2月行保留LCA腹腔镜直肠癌Dixon根治术治疗的104例老年病人作为研究对象,并按照入院顺序排号,由随机数字表获得随机数,对随机数进行升序排列,从排序后的随机数中规定前52个对应的编号为对照组,其余的52个随机数对应的编号为干预组。对照组采取常规围术期护理,干预组则应用加速康复外科理论干预。对比两组手术相关指标、术后疼痛状况、炎性因子水平及并发症发生率。结果干预组进食时、排便时间、下床活动时间、住院时间分别为(1.24±0.49)d、(1.24±0.49)d、(1.06±0.35)d、(5.69±1.62)d,均较对照组的(3.18±0.55)d、(3.18±0.55)d、(2.84±0.67)d、(10.85±2.41)d少(P<0.05),两组间首次排气时间比较差异无统计学意义(P>0.05);干预组术后12 h、24 h、48 h疼痛数字评分法(NRS)评分分别为(2.56±0.42)分、(1.40±0.37)分、(1.18±0.31)分,均较对照组的(4.19±0.81)分、(3.66±0.75)分、(2.64±0.62)分低(P<0.05);两组术后C反应蛋白(CRP)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平均随着时间推移逐渐下降(P<0.05),干预组术后24 h、48 h IL-8水平分别为(36.14±7.25)pg/mL、(16.75±4.26)pg/mL,术后24 h、48 h TNF-α水平分别为(4.60±0.87)pg/mL、(2.01±0.52)pg/mL,术后24h CRP水平为(18.95±6.64)mg/L,均较对照组的(43.82±8.22)pg/mL、(25.51±6.38)pg/mL、(5.34±1.27)pg/mL、(3.96±0.85)pg/mL、(41.06±13.59)mg/L低(P<0.05);干预组术后并发症发生率9.62%低于对照组32.69%(P<0.05)。结论对老年保留LCA直肠癌根治术病人行加速康复外科理论,可明显减轻术后疼痛,显著降低术后炎症程度及并发症发生率,有效缩短术后恢复时间。Objective To explore the intervention effect of the theory of accelerated rehabilitation surgery on the elderly patients with left colon artery(LCA)rectal cancer radical operation.Methods From March 2018 to February 2019,104 elderly patients who underwent laparoscopic Dixon radical resection of rectal cancer preserving left colon artery in Bozhou People's Hospital were selected as research objects.According to the sequence of admission,the random number was obtained from the random number table,and the random number was arranged in ascending order.From the sorted random number,the first 52 corresponding numbers were defined as the control group,and the other 52 corresponding numbers were defined as the intervention group.The control group received routine perioperative nursing,while the intervention group received accelerated rehabilitation surgery theory.The surgical related indicators,postoperative pain,inflammatory factors and the incidence of complications were compared between the two groups.Results The time of eating,defecation,getting out of bed activity and hospitalization in the intervention group were(1.24±0.49)d,(1.24±0.49)d,(1.06±0.35)D and(5.69±1.62)d,respectively,which were less than those in the control group(3.18±0.55)d,(3.18±0.55)d,(2.84±0.67)d and(10.85±2.41)d(P<0.05),there was no significant difference in the first exhaust time between the two groups(P>0.05);The NRS scores of the intervention group at 12 h,24 h and 48 h after operation were(2.56±0.42),(1.40±0.37)and(1.18±0.31),respectively,which were lower than those of the control group(4.19±0.81),(3.66±0.75)and(2.64±0.62)(P<0.05).The levels of C-reactive protein(CRP),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)in the two groups decreased gradually with time(P<0.05),and the levels of IL-8 at 24 h and 48 h after operation in the intervention group were(36.14±7.25)pg/ml and(16.75±4.26)pg/ml,the levels of TNF-αat 24 h and 48 h after operation were(4.60±0.87)pg/ml and(2.01±0.52)pg/ml respectively,the levels of CRP at 24

关 键 词：直肠肿瘤 围手术期护理 直肠结肠切除术 重建性 腹腔镜检查 加速康复外科 保留左结肠动脉 并发症 老年人 

分 类 号：R473.73[医药卫生—护理学]