加速康复外科理念与技术在胃肠外科中的应用研究

doi:10.3969/j.issn.1009-976X.2023.04.005

摘要/Abstract

摘要： 目的观察加速康复外科理念与技术（FTS）在胃肠外科中的应用效果。方法选取2021年1月至2022年6月期间在我院接受胃癌、结直肠癌根治术的患者共计110例,对患者采用电脑随机分组,每组各55例,对照组行传统临床路径治疗,加速康复外科组（FTS组）行加速康复外科程序进行围手术期治疗。记录两组患者术前及术后7 d的血常规、胰岛素抵抗指数、皮质醇、C反应蛋白（CRP）的水平,采用数字评价表（NRS）评估患者腹痛、腹胀等相关临床指标,观察患者术后并发症的发生情况。结果术前两组患者的血红蛋白、血清白蛋白、胰岛素抵抗指数、皮质醇、CRP水平比较差异不明显,无统计学意义（P>0.05）,但与对照组相比较,FTS组患者的血红蛋白、血清白蛋白水平更高,胰岛素抵抗指数、皮质醇、CRP水平更低,差异具有统计学意义（P<0.05）。两组患者术前NRS评分比较差异无统计学意义（P>0.05）,术后FTS组患者的NRS较对照组明显降低,差异有统计学意义（P<0.05）。加速康复外科组患者中吻合口瘘1例、尿路感染2例,并发症发生率为5.45%,对照组中吻合口瘘2例,3例尿路感染,2例肺部感染,3例切口感染,并发症发生率为18.18%,两组间比较差异具有统计学意义（P<0.05）。结论对进行胃癌、结直肠癌根治术患者采用FTS与技术,可促进患者恢复,降低并发症发生。

关键词: 加速康复外科理念, 胃肠外科, 胃癌, 结直肠癌根治术, 胰岛素抵抗指数

Abstract: Objective To explore the postoperative outcome of enhanced recovery after surgery （ERAS） protocol on patients in gastrointestinal surgery. Methods A total of 110 patients underwent radical resection of gastric cancer and colorectal cancer in our hospital from January 2021 to June 2022 were included in the study, and were randomized into two groups with 51 in each group. The patients treated by the traditional clinical pathway were the control group, and those treated with ERAS protocol were assigned ERAS group. Inclusion criteria： All patients completed radical resection of gastric cancer and colorectal cancer and were cured and discharged from hospital with complete clinical data. The compliance of patients in ERAS group was more than 80%. The levels of blood routine, insulin resistance index, cortisol, C-reactive protein （CRP） before and 7 d after surgery were recorded The abdominal pain and abdominal distension scores were recorded, and the postoperative clinical indicators were recorded in detail to observe the occurrence of postoperative complications. Results Before surgery, the levels of hemoglobin, serum albumin, insulin resistance index, cortisol and CRP in the two groups were not statistically significant （P>0.05）. Compared with the control group, hemoglobin and serum albumin in ERAS group were increased, and the levels of insulin resistance index, cortisol, CRP were decreased, the differences between two groups were statistically significant （P<0.05）. The NRS of patients in the ERAS group was significantly lower than that in the control group, and the difference was statistically significant （P<0.05）. There were one case of anastomotic leakage and two cases of urinary tract infection in ERAS group, and the complication rate was 5.45 %, and two cases of anastomotic leakage, three cases of urinary tract infection, two cases of pulmonary infection and three cases of incision infection in the control group with complication rate 18.18 %. The difference between the two groups was statistically significant （P<0.05）. Conclusion In this study, ERAS protocol promoted the recovery of patients and reduced the incidence of complications in patients with gastric cancer and colorectal cancer.

Key words: fast-track surgery, gastrointestinal surgery, gastric cancer, colorectal cancer, insulin resistance index

中图分类号:

宋顺心, 郭硕浩. 加速康复外科理念与技术在胃肠外科中的应用研究[J]. 岭南现代临床外科, 2023, 23(04): 315-319.

SONG Shun-xin, GUO Shuo-hao. Study on enhanced recovery after surgery in gastrointestinal surgery[J]. Lingnan Modern Clinics In Surgery, 2023, 23(04): 315-319.

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