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快速康复外科方案对腹腔镜结直肠癌手术患者预后及炎症反应的影响

Effect of enhanced recovery after surgery on prognosis and inflammatory response of patients undergoing laparoscopic colorectal cancer surgery

    摘要
  • 摘要:
      目的  探讨快速康复外科（ERAS）方案对腹腔镜结直肠癌手术患者预后及炎症反应的影响。
      方法  选取80例择期行腹腔镜下结直肠癌切除术的患者作为研究对象，随机分为对照组和研究组，每组40例。对照组按照传统方案实施围术期管理，研究组按照ERAS方案实施围术期管理。比较2组患者术前（T1时点）、术后12 h（T2时点）、术后24 h（T3时点）和术后48 h（T4时点）的血清炎症因子白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）水平，并比较2组术中出血量、围术期阿片类药物使用剂量、腹腔引流管放置时间和术后排气排便时间、住院时间、视觉模拟评分法（VAS）评分、并发症发生情况。
      结果  T2、T3、T4时点，2组血清炎症因子水平均高于T1时点，差异有统计学意义（P < 0.05）；T1时点，2组血清炎症因子水平差异无统计学意义（P>0.05）；T2、T3、T4时点，研究组血清炎症因子水平均低于对照组，差异有统计学意义（P < 0.05）。研究组围术期阿片类药物使用剂量少于对照组，腹腔引流管留置时间、术后住院时间短于对照组，术后VAS评分、并发症发生率低于对照组，差异有统计学意义（P < 0.05）。
      结论  ERAS方案应用于腹腔镜结直肠癌手术患者中能有效降低患者炎症因子水平，减轻疼痛，缩短住院时间，减少术后并发症的发生。

     

    Abstract:
      Objective  To compare the effects of enhanced recovery after surgery (ERAS) on prognosis and inflammatory response of patients undergoing laparoscopic colorectal cancer surgery.
      Methods  Eighty patients who underwent elective laparoscopic resection of colorectal cancer were selected as research subjects and randomly divided into control group (n=40) and study group (n=40). The control group was given perioperative management according to the traditional scheme, while the study group was given perioperative management based on ERAS. Serum levels of inflammatory cytokinesinterleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α)at time points of preoperation (T1), postoperative 12 hours (T2), postoperative 24 hours (T3), and postoperative 48 hours (T4) of two groups were compared. The amount of intraoperative blood loss, perioperative dose of opioids, indwelling time of abdominal drainage tube and postoperative exhaust defecation, length of hospital stay, Visual Analog Scale (VAS) score and incidence of complications were compared between the two groups.
      Results  Compared with T1, the serum levels of inflammatory factors at time points of T2 to T4 were significantly higher (P < 0.05). At T1, there was no significant difference in serum inflammatory cytokines between the two groups (P>0.05). The serum inflammatory factors of the study group at T2, T3 and T4 were significantly lower than those in the control group (P < 0.05). Compared with the control group, the perioperative opioid dosage of the study group was significantly less, indwelling time of abdominal drainage tube and postoperative hospitalization time were shorter, and postoperative VAS score and complication rate were significantly lower than the control group than those of the control group (P < 0.05).
      Conclusion  ERAS for patients undergoing laparoscopic colorectal cancer surgery can effectively reduce the level of inflammatory factors, relieve pain, shorten the length of hospital stay and reduce the incidence of postoperative complications.

     

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