ERAS在腹腔镜结直肠癌手术患者中的应用及对各临床指标的影响研究

doi:10.3760/cma.j.issn.1007-1245.2023.20.029

摘要/Abstract

摘要：

目的　观察加速康复外科（enhanced recovery after surgery，ERAS）理念在腹腔镜结直肠癌手术患者中的应用价值及对患者白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）等指标的影响。方法　选取平顶山市第二人民医院2020年6月至2022年12月期间收治的121例结直肠癌患者进行随机对照试验，所有患者均行腹腔镜手术治疗，经随机数字表法对入组患者进行分组，分别列为ERAS组［61例，男31例，女30例，年龄55～75（65.25±5.76）岁］和常规组［60例，男30例，女30例，年龄57～73（66.18±5.24）岁］。常规组实施常规围手术期管理辅助手术，ERAS组实施ERAS管理辅助手术，比较两组患者治疗前后的疼痛介质、炎症反应相关指标变化情况，术后康复情况及手术相关并发症发生情况。统计学方法采用χ²检验、t检验。结果　在不同围手术期管理模式下，ERAS组术后5-羟色胺（5-HT）、P物质（SP）、β-内啡肽（β-EP）均低于常规组［（0.41±0.13）μmol/L比（0.85±0.27）μmol/L、（10.27±3.25）ng/L比（12.66±3.71）ng/L、（46.25±10.16）ng/L比（51.12±10.46）ng/L］，差异均有统计学意义（t=11.450、3.771、2.598，均P<0.05）。ERAS组术后IL-6、TNF-α、白细胞介素-1β（IL-1β）均低于常规组［（14.62±5.13）ng/L比（17.76±5.26）ng/L、（48.45±10.25）ng/L比（52.65±10.36）ng/L、（9.06±2.15）ng/L比（12.29±4.34）ng/L］，差异均有统计学意义（t=3.324、2.242、5.200，均P<0.05）。在不同围手术期管理模式下，ERAS组术后恢复排气时间、进食时间、首次下床时间、住院时间均短于常规组［（20.12±5.16）h比（23.11±5.41）h、（22.25±5.31）h比（25.62±5.44）h、（1.27±0.33）d比（2.41±0.75）d、（8.41±2.32）d比（10.36±3.28）d］，差异均有统计学意义（t=3.111、3.448、10.852、3.781，均P<0.05）。ERAS组术后手术相关并发症发生率为4.92%（3/61），低于常规组［16.67%（10/60）］，差异有统计学意义（χ²=7.169，P<0.05）。结论　在结直肠癌腹腔镜手术患者围手术期实施ERAS管理策略能有效缓解患者疼痛并减轻炎症反应，对加快患者术后康复进程并降低相关并发症发生风险均有积极意义。

关键词:

结直肠癌, 腹腔镜手术, 加速康复外科理念, 炎症反应, 康复进程

Abstract:

Objective　To observe the value applying enhanced recovery after surgery (ERAS) in patients taking laparoscopic colorectal cancer surgery and its effect on the levels of interleukin (IL) -6 and tumor necrosis factor-α (TNF-α). Methods　One hundred and twenty-one patients with colorectal cancer treated at Pingdingshan Second People's Hospital from June 2020 to December 2022 were selected for the randomized controlled trial. All the patients were treated with laparoscopy. The patients were divided into an ERAS group (61 cases) and a conventional group (60 cases) by the random number table method. There were 31 males and 30 females in the ERAS group; they were 55-75 (65.25±5.76) years old. There were 30 males and 30 females in the conventional group; they were 57-73 (66.18±5.24) years old). The conventional group took routine perioperative management to assist the surgery, and the ERAS group took ERAS management to assist the surgery. The changes in pain mediators and inflammatory reaction related indicators before and after the treatment, postoperative rehabilitation, and incidences of surgical related complications were compared between the two groups. χ² and t tests were applied. Results　Through different managements, the levels of 5-hydroxytryptamine (5-HT), substance P (SP), and β-endorphin (β-EP) after the surgery in the ERAS group were lower than those in the conventional group [(0.41±0.13) μmol/L vs. (0.85±0.27) μmol/L, (10.27±3.25) ng/L vs. (12.66±3.71) ng/L, and (46.25±10.16) ng/L vs. (51.12±10.46) ng/L], with statistical differences (t=11.450, 3.771, and 2.598; all P<0.05). The levels of IL-6, TNF-α, and IL-1β after the surgery in the ERAS group were lower than those in the conventional group [(14.62±5.13) ng/L vs. (17.76±5.26) ng/L, (48.45±10.25) ng/L vs. (52.65±10.36) ng/L, and (9.06±2.15) ng/L vs. (12.29±4.34) ng/L], with statistical differences (t=3.324, 2.242, and 5.200; all P<0.05). The time to recover exhaustion, time to eat, and time for first off-bed activity after the surgery and hospital stay in the ERAS group were shorter than those in the conventional group [(20.12±5.16) h vs. (23.11±5.41) h, (22.25±5.31) h vs. (25.62±5.44) h, (1.27±0.33) d vs. (2.41±0.75) d, and (8.41±2.32) d vs. (10.36±3.28) d], with statistical differences (t=3.111, 3.448, 10.852, and 3.781; all P<0.05). The incidence of postoperative complications related to surgery in the ERAS group was lower than that in the control group [4.92% (3/61) vs. 16.67% (10/60)], with a statistical difference (χ²=7.169, P<0.05). Conclusion　The implementation of ERAS management strategy in the perioperative period of patients with colorectal cancer undergoing laparoscopy can effectively relieve their pain and reduce inflammatory reaction, and has positive significance in accelerating their postoperative rehabilitation process and reducing the risk of related complications.

Key words:

Colorectal cancer, Laparoscopy, Enhanced recovery after surgery, Inflammatory reaction, Rehabilitation process

李亚鸽姚玲玲.

ERAS在腹腔镜结直肠癌手术患者中的应用及对各临床指标的影响研究 [J]. 国际医药卫生导报, 2023, 29(20): 2961-2965.

Li Yage, Yao Lingling.

Application of ERAS in patients taking laparoscopic colorectal cancer surgery and its effects on clincal indicators [J]. International Medicine and Health Guidance News, 2023, 29(20): 2961-2965.

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