加速康复外科理念在结肠癌切除术后胃肠功能恢复中的临床效果
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摘要
目的探讨加速康复外科(FTS)理念在结肠癌切除术后胃肠功能恢复中的应用效果。方法选取2016年5月～2018年2月中国医科大学附属盛京医院收治的行结肠癌切除术的患者99例为研究对象,根据随机数字表法将患者分为对照组(n=49)和研究组(n=50)。对照组患者采用常规围术期处理,研究组在此基础上同时进行FTS护理干预。比较两组患者临床指标、胃肠功能情况。比较两组患者术前、术后3 d、术后7 d血清白细胞介素-6(IL-6)、C反应蛋白(CRP)及血清淀粉样蛋白A(SAA)水平。观察两组术后并发症发生情况。结果研究组住院时间、肛门首次排气时间、第1次排便时间、恢复普食时间均较对照组短,差异有统计学意义(P <0.05);而两组患者术中出血量、手术时间比较,差异无统计学意义(P> 0.05)。两组患者术后3、7 d IL-6、CRP以及SAA水平均较术前升高,术后7 d IL-6、CRP以及SAA水平均低于术后3 d(P <0.05);研究组术后3、7 d IL-6、CRP、SAA水平均低于对照组(P <0.05)。研究组术后并发症发生率为10.00%(5/50),显著低于对照组的30.61%(15/49),差异有统计学意义(P <0.05)。结论结肠癌切除术后给予FTS护理干预,可显著改善临床指标,促进胃肠功能恢复,并有效改善患者炎性反应,降低并发症发生率,具有一定的临床应用价值。
Objective To explore the application effect of fast-track surgery(FTS) concept in gastrointestinal function recovery after colon cancer resection. Methods A total of 99 patients who underwent colon cancer resection from May2016 to February 2018 in Shengjing Hospital of China Medical University were selected as study subjects. Patients were randomly divided into control group(n = 49) and research group(n = 50) according to the random number table method. Patients in the control group were treated with routine perioperative management, and patients in the study group were treated with FTS nursing intervention on this basis. Clinical indexes and gastrointestinal function were compared between the two groups. Serum levels of interleukin-6(IL-6), C-reactive protein(CRP) and serum amyloid protein A(SAA) were compared between the two groups before surgery, 3 days after surgery and 7 days after surgery. The postoperative complications of the two groups were observed. Results Hospitalization time, first anal exhaust time, first defecation time and recovery time of normal diet in the study group were all shorter than those of the control group, the differences were statistically significant(P < 0.05). However, there was no significant difference in intraoperative blood loss and operation time between the two groups(P > 0.05). 3, 7 days after surgery, IL-6, CRP and SAA levels of the two groups were higher than those before surgery, and IL-6, CRP and SAA levels at 7 days after surgery were lower than those 3 days after surgery. IL-6, CRP and SAA levels at 7 days after surgery were all lower than 3 days after surgery(P < 0.05). IL-6, CRP and SAA levels of the study group were lower than those of the control group 3, 7 days after surgery(P < 0.05). The incidence of postoperative complications in the study group was 10.00%(5/50), which was significantly lower than 30.61%(15/49) in the control group, and the difference was statistically significant(P <0.05). Conclusion After colon cancer resection, FTS nursing intervention can significantly improve clinical indicators,promote the recovery of gastrointestinal function, and effectively improve patients′ inflammatory response, reduce the incidence of complications, which has certain clinical application value.
Objective To explore the application effect of fast-track surgery(FTS) concept in gastrointestinal function recovery after colon cancer resection. Methods A total of 99 patients who underwent colon cancer resection from May2016 to February 2018 in Shengjing Hospital of China Medical University were selected as study subjects. Patients were randomly divided into control group(n = 49) and research group(n = 50) according to the random number table method. Patients in the control group were treated with routine perioperative management, and patients in the study group were treated with FTS nursing intervention on this basis. Clinical indexes and gastrointestinal function were compared between the two groups. Serum levels of interleukin-6(IL-6), C-reactive protein(CRP) and serum amyloid protein A(SAA) were compared between the two groups before surgery, 3 days after surgery and 7 days after surgery. The postoperative complications of the two groups were observed. Results Hospitalization time, first anal exhaust time, first defecation time and recovery time of normal diet in the study group were all shorter than those of the control group, the differences were statistically significant(P < 0.05). However, there was no significant difference in intraoperative blood loss and operation time between the two groups(P > 0.05). 3, 7 days after surgery, IL-6, CRP and SAA levels of the two groups were higher than those before surgery, and IL-6, CRP and SAA levels at 7 days after surgery were lower than those 3 days after surgery. IL-6, CRP and SAA levels at 7 days after surgery were all lower than 3 days after surgery(P < 0.05). IL-6, CRP and SAA levels of the study group were lower than those of the control group 3, 7 days after surgery(P < 0.05). The incidence of postoperative complications in the study group was 10.00%(5/50), which was significantly lower than 30.61%(15/49) in the control group, and the difference was statistically significant(P <0.05). Conclusion After colon cancer resection, FTS nursing intervention can significantly improve clinical indicators,promote the recovery of gastrointestinal function, and effectively improve patients′ inflammatory response, reduce the incidence of complications, which has certain clinical application value.
引文
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[13]卢明,胡昇庠,陆志斌,等.快速康复外科理念在腹腔镜结肠切除术中的应用[J].山西医药杂志,2015,(16):1858-1861.
[14]严士光,丁友宏,罗志海,等.腹腔镜全结肠系膜切除术对结肠癌患者应激反应与免疫功能的影响[J].现代生物医学进展,2017,17(24):4747-4750.
[15]项海,项秉该,林振亮,等.结肠癌合并肠梗阻患者急诊术后切口感染的病原学与危险因素分析[J].中华医院感染学杂志,2017,27(5):1109-1112.
[16]苏慧慧,万春友,魏蔚,等.血清淀粉样蛋白A诱导中性粒细胞胞外诱捕网形成[J].天津医药,2016,44(2):146-148.
[17]黄花香.快速康复理念对腹腔镜结肠癌切除术后疼痛、炎性反应和胃肠功能的影响[J].检验医学与临床,2017,14(8):1181-1183.
[18]Liu Y.Application of fast track surgery in routine nursing for patient with colorectal cancer[J].Saudi J Biol Sci,2017,24(8):1939-1942.
[19]Monacelli F,Signori A,Prefumo M,et al.Delirium,Frailty,and Fast-Track Surgery in Oncogeriatrics:Is There a Link?[J].Dement Geriatr Cogn Dis Extra,2018,8(1):33-41.
[20]闫慧萱.结肠癌切除术后早期康复护理对患者胃肠功能恢复的效果分析[J].中国现代药物应用,2018,12(12):157-158.
[2]梁小波.2016版中国局部进展期直肠癌诊疗专家共识解读[J].临床外科杂志,2017,25(4):248-251.
[3]Sumer F,Karakas S,Gundogan E,et al.Totally laparoscopic resection and extraction of specimens via transanal route in synchronouscolon and gastric cancer[J].G Chir,2018,39(2):82-86.
[4]简红云,管丽丽,雷君,等.加速康复护理在结直肠癌患者围手术期应用的效果[J].中国实用护理杂志,2017,33(7):513-515.
[5]杨奇芳.结肠癌术前CT诊断及评价术后复发的价值分析[J].中国CT和MRI杂志,2015,13(8):77-79.
[6]程学远,黄忠.丙氨酰-谷氨酰胺强化肠外营养对结肠癌合并肠梗阻患者炎症反应及免疫功能的调节作用[J].中国现代医学杂志,2016,26(9):110-113.
[7]伏洁,王琛,樊勇,等.快速康复模式在腹腔镜结肠癌切除术围术期的应用[J].中国微创外科杂志,2017,17(10):899-901.
[8]Huang Z,Yi L,Zhong Z,et al.Comparison of Fast-Track Versus Conventional Surgery Protocol for Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy:A Chinese Experience[J].Sci Rep,2018,8(1):8017.
[9]江秋生,胡昇庠.快速康复理念在腹腔镜结肠癌切除术围术期中的应用效果[J].南昌大学学报:医学版,2015,55(4):57-59.
[10]Chiu C,Aleshi P,Esserman LJ,et al.Improved analgesia and reduced post-operative nausea and vomiting after implementation of an enhanced recovery after surgery(ERAS)pathway for total mastectomy[J].BMC Anesthesiol,2018,18(1):41.
[11]Umari M,Falini S,Segat M,et al.Anesthesia and fasttrack in video-assisted thoracic surgery(VATS):from evidence to practice[J].J Thorac Dis,2018,10(Suppl 4):S542-S554.
[12]樊倩红.快速康复外科护理在结肠癌患者围手术期护理中的应用[J].护理实践与研究,2016,13(4):81-82.
[13]卢明,胡昇庠,陆志斌,等.快速康复外科理念在腹腔镜结肠切除术中的应用[J].山西医药杂志,2015,(16):1858-1861.
[14]严士光,丁友宏,罗志海,等.腹腔镜全结肠系膜切除术对结肠癌患者应激反应与免疫功能的影响[J].现代生物医学进展,2017,17(24):4747-4750.
[15]项海,项秉该,林振亮,等.结肠癌合并肠梗阻患者急诊术后切口感染的病原学与危险因素分析[J].中华医院感染学杂志,2017,27(5):1109-1112.
[16]苏慧慧,万春友,魏蔚,等.血清淀粉样蛋白A诱导中性粒细胞胞外诱捕网形成[J].天津医药,2016,44(2):146-148.
[17]黄花香.快速康复理念对腹腔镜结肠癌切除术后疼痛、炎性反应和胃肠功能的影响[J].检验医学与临床,2017,14(8):1181-1183.
[18]Liu Y.Application of fast track surgery in routine nursing for patient with colorectal cancer[J].Saudi J Biol Sci,2017,24(8):1939-1942.
[19]Monacelli F,Signori A,Prefumo M,et al.Delirium,Frailty,and Fast-Track Surgery in Oncogeriatrics:Is There a Link?[J].Dement Geriatr Cogn Dis Extra,2018,8(1):33-41.
[20]闫慧萱.结肠癌切除术后早期康复护理对患者胃肠功能恢复的效果分析[J].中国现代药物应用,2018,12(12):157-158.