基于数字病房导向的液体治疗在老年结直肠癌患者术后的应用
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摘要
目的:探讨基于数字病房导向的液体治疗在老年结直肠癌患者术后的应用。方法:选取2017年10月-2018年10月于本院行结直肠癌手术的患者60例,将其随机分为导向性液体治疗组和开放性液体治疗组,每组30例,开放性液体治疗组采用传统的外科补液方法补液,导向性液体治疗组采用基于数字病房导向的液体治疗方法,比较两组患者手术及肠道功能恢复指标、生化指标及术后并发症的发生情况的比较。结果:导向性液体治疗组术后平均每天补液量、平均每天尿量均较开放性液体治疗组显著减少(P<0.05),平均每天经口进食量较开放性液体治疗组显著增加(P<0.05),术后首次下床活动、首次排气时间均较开放性液体治疗组提前,住院药费显著少于开放性液体治疗组(P<0.05),住院时间显著短于开放性液体治疗组(P<0.05)。术后第1、3、5天,两组血清肌酐、尿素氮、钾离子、钠离子水平相比差异均无统计学意义(P>0.05),术后第5天,两组外周血WBC、CRP水平均较术后第1、3天明显降低,术后第3天较术后第1天明显降低,差异均有统计学意义(P<0.05),且术后第5天导向性液体治疗组外周血WBC、CRP水平均较开放性液体治疗组明显降低,差异均有统计学意义(P<0.05)。术后导向性液体治疗组低白蛋白血症、心力衰竭及肺水肿发生率均显著低于开放性液体治疗组(P<0.05),但两组术后出血、伤口感染液化、吻合口瘘发生率比较差异均无统计学意义(P>0.05)。结论:对老年结直肠癌患者术后应用基于数字病房导向的液体治疗,可明显减少术后补液量,促进肠道功能恢复,减轻炎症反应,降低术后并发症发生率,加快患者术后康复进程。
Objective:To investigate the application of digital ward-oriented liquid therapy in elderly patients with colorectal cancer after operation.Method:From October 2017 to October 2018,60 patients with colorectal cancer underwent surgery in our hospital were randomly divided into two groups:the guided liquid therapy group and the open liquid therapy group,30 cases in each group.In the open liquid therapy group,the traditional surgical rehydration method was used,and in the guided liquid therapy group,the digital ward-oriented fluid therapy method was used.The operation and intestinal function recovery index,biochemical index and the occurrence of complications of two groups were compared.Result:The average daily fluid infusion and urine volume in the guided liquid therapy group were significantly lower than those in the open liquid therapy group(P<0.05),the average daily oral intake was significantly higher than that in the open liquid therapy group(P<0.05),the first time out of bed and exhaust time were earlier than those in the open liquid therapy group after operation,and the hospitalization cost was significantly lower than that in the open liquid therapy group(P<0.05),and the hospitalization time was significantly longer than that in the open liquid therapy group(P<0.05).It was shorter than that in the open liquid therapy group(P<0.05).There were no significant differences in serum creatinine,urea nitrogen,potassium ion and sodium ion levels between two groups on the 1 st,3 rd and 5 th day after operation(P>0.05).On the 5 th day after operation,the levels of WBC and CRP in peripheral blood of two groups were significantly lower than those on the 1 st and 3 rd days after operation,and significantly lower than those on the 1 st day after operation(P<0.05).The levels of WBC and CRP in peripheral blood of the guided liquid therapy group were significantly lower than those of the open fluid replacement group on the 5 th day after operation(P<0.05).The incidence of hypoalbuminemia,heart failure and pulmonary edema in the guided liquid therapy group were significantly lower than those in the open fluid group(P<0.05),but there were no significant differences in the incidence of bleeding,wound infection liquefaction and anastomotic leakage between two groups(P>0.05).Conclusion:The application of digital ward-oriented fluid therapy in elderly patients with colorectal cancer after operation can significantly reduce the volume of fluid infusion,promote the recovery of intestinal function,reduce inflammatory reaction,reduce the incidence of complications and accelerate the recovery process of patients after operation.
Objective:To investigate the application of digital ward-oriented liquid therapy in elderly patients with colorectal cancer after operation.Method:From October 2017 to October 2018,60 patients with colorectal cancer underwent surgery in our hospital were randomly divided into two groups:the guided liquid therapy group and the open liquid therapy group,30 cases in each group.In the open liquid therapy group,the traditional surgical rehydration method was used,and in the guided liquid therapy group,the digital ward-oriented fluid therapy method was used.The operation and intestinal function recovery index,biochemical index and the occurrence of complications of two groups were compared.Result:The average daily fluid infusion and urine volume in the guided liquid therapy group were significantly lower than those in the open liquid therapy group(P<0.05),the average daily oral intake was significantly higher than that in the open liquid therapy group(P<0.05),the first time out of bed and exhaust time were earlier than those in the open liquid therapy group after operation,and the hospitalization cost was significantly lower than that in the open liquid therapy group(P<0.05),and the hospitalization time was significantly longer than that in the open liquid therapy group(P<0.05).It was shorter than that in the open liquid therapy group(P<0.05).There were no significant differences in serum creatinine,urea nitrogen,potassium ion and sodium ion levels between two groups on the 1 st,3 rd and 5 th day after operation(P>0.05).On the 5 th day after operation,the levels of WBC and CRP in peripheral blood of two groups were significantly lower than those on the 1 st and 3 rd days after operation,and significantly lower than those on the 1 st day after operation(P<0.05).The levels of WBC and CRP in peripheral blood of the guided liquid therapy group were significantly lower than those of the open fluid replacement group on the 5 th day after operation(P<0.05).The incidence of hypoalbuminemia,heart failure and pulmonary edema in the guided liquid therapy group were significantly lower than those in the open fluid group(P<0.05),but there were no significant differences in the incidence of bleeding,wound infection liquefaction and anastomotic leakage between two groups(P>0.05).Conclusion:The application of digital ward-oriented fluid therapy in elderly patients with colorectal cancer after operation can significantly reduce the volume of fluid infusion,promote the recovery of intestinal function,reduce inflammatory reaction,reduce the incidence of complications and accelerate the recovery process of patients after operation.
引文
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[2]魏东.结直肠癌外科治疗中值得关注的问题[J].临床外科杂志,2017,25(4):262-265.
[3]杨超杰,高晓增,谭志斌,等.以SVV为指导的液体治疗对复合麻醉下老年腹腔镜结肠癌根治术患者肠道屏障的影响[J].山东医药,2018,28(18):18-22.
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[8]白丽红,张树波,刘铁军.目标导向液体治疗对老年患者结肠癌手术肠道屏障的影响[J].实用医学杂志,2016,32(10):1612-1615.
[9]Bistrian B.Is Positive Fluid Balance a Problem?[J].Journal of Parenteral&Enteral Nutrition,2016,40(1):10.
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[11]赵洋,邹小华,刘艳秋,等.脉搏灌注变异指数指导结肠癌根治术患者液体治疗的效果[J].贵州医药,2016,40(9):958-960.
[12]姜红梅.目标导向液体治疗对结肠癌手术肠道屏障的影响[J].中国妇幼健康研究,2017,28(S1):340-341.
[13]郑捷.控制性输液用于腹腔镜胃肠道肿瘤围手术期的临床研究[J].临床外科杂志,2017,25(7):520-522.
[14]吕艳冰,沃西文,曾子耘,等.限制性液体治疗应用于老年结肠癌患者的效果观察及护理[J].西南军医,2015,13(5):552-554.
[15]胡浩威,张勤,蔡文伟,等.围手术期液体管理与术后肠功能恢复的研究进展[J].全科医学临床与教育,2015,13(1):40-42.
[16]刘丽霞,胡振杰.液体超负荷与急性肾损伤:孰因孰果?[J/OL].中华重症医学电子杂志(网络版),2017,3(1):73-77.
[17]司向,吴健锋,陈娟,等.限制性与非限制性补液对腹部手术病人血流动力学及组织氧代谢影响研究[J].中国实用外科杂志,2016,36(11):1227-1230.
[18]Gargalionis A N,Papavassiliou A G.Liquid Biopsies in Colorectal Cancer:Monitoring Genetic Heterogeneity[J].Trends Cancer,2017,3(3):166-168.
[19]Sidaway P.Colorectal cancer:Liquid biopsy provides highly sensitive detection of RAS mutations[J].Nature Reviews Clinical Oncology,2017,14(11):650.
[20]王攀,曹益瑞,程建,等.对比观察创伤性休克早期即刻补液和延迟补液复苏的临床效果[J].中国综合临床,2018,34(4):368.
[2]魏东.结直肠癌外科治疗中值得关注的问题[J].临床外科杂志,2017,25(4):262-265.
[3]杨超杰,高晓增,谭志斌,等.以SVV为指导的液体治疗对复合麻醉下老年腹腔镜结肠癌根治术患者肠道屏障的影响[J].山东医药,2018,28(18):18-22.
[4]Sun Q,Liu Y,Liu B,et al.Use of Liquid Biopsy in Monitoring Colorectal Cancer Progression Shows Strong Clinical Correlation[J].American Journal of the Medical Sciences,2018,355(3):220-227.
[5]白净,白洁,马伟,等.不同BIS值对每搏变异度指导补液的老年结肠癌根治术患者应激反应的影响[J].广东医学,2017,38(18):2786-2789.
[6]蒋金华,余健.限制性和开放性输液对老年结直肠癌手术患者预后及IL-6的影响[J].实用临床医药杂志,2015,19(19):114-115.
[7]Gilligan L C,Gondal A,Tang V,et al.Estrone Sulfate Transport and Steroid Sulfatase Activity in Colorectal Cancer:Implications for Hormone Replacement Therapy[J].Frontiers in Pharmacology,2017,8(CD004143):103.
[8]白丽红,张树波,刘铁军.目标导向液体治疗对老年患者结肠癌手术肠道屏障的影响[J].实用医学杂志,2016,32(10):1612-1615.
[9]Bistrian B.Is Positive Fluid Balance a Problem?[J].Journal of Parenteral&Enteral Nutrition,2016,40(1):10.
[10]Brotfain E,Koyfman L,Toledano R,et al.Positive fluid balance as a major predictor of clinical outcome of patients with sepsis/septic shock after ICU discharge[J].American Journal of Emergency Medicine,2016,34(11):2122-2126.
[11]赵洋,邹小华,刘艳秋,等.脉搏灌注变异指数指导结肠癌根治术患者液体治疗的效果[J].贵州医药,2016,40(9):958-960.
[12]姜红梅.目标导向液体治疗对结肠癌手术肠道屏障的影响[J].中国妇幼健康研究,2017,28(S1):340-341.
[13]郑捷.控制性输液用于腹腔镜胃肠道肿瘤围手术期的临床研究[J].临床外科杂志,2017,25(7):520-522.
[14]吕艳冰,沃西文,曾子耘,等.限制性液体治疗应用于老年结肠癌患者的效果观察及护理[J].西南军医,2015,13(5):552-554.
[15]胡浩威,张勤,蔡文伟,等.围手术期液体管理与术后肠功能恢复的研究进展[J].全科医学临床与教育,2015,13(1):40-42.
[16]刘丽霞,胡振杰.液体超负荷与急性肾损伤:孰因孰果?[J/OL].中华重症医学电子杂志(网络版),2017,3(1):73-77.
[17]司向,吴健锋,陈娟,等.限制性与非限制性补液对腹部手术病人血流动力学及组织氧代谢影响研究[J].中国实用外科杂志,2016,36(11):1227-1230.
[18]Gargalionis A N,Papavassiliou A G.Liquid Biopsies in Colorectal Cancer:Monitoring Genetic Heterogeneity[J].Trends Cancer,2017,3(3):166-168.
[19]Sidaway P.Colorectal cancer:Liquid biopsy provides highly sensitive detection of RAS mutations[J].Nature Reviews Clinical Oncology,2017,14(11):650.
[20]王攀,曹益瑞,程建,等.对比观察创伤性休克早期即刻补液和延迟补液复苏的临床效果[J].中国综合临床,2018,34(4):368.