围手术期应用糖皮质激素对胃癌患者术后康复的影响

Influence of perioperative glucocorticoid administration on rehabilitation in patients underwent gastrectomy

目的探讨围手术期应用糖皮质激素(GC)对胃癌患者术后康复的影响。方法39例接受胃癌根治切除术的患者,分成GC组(20例)和对照(C)组(19例)。两组均应用早期肠内营养支持。GC组术前2 h及术后24 h加用琥珀酸钠氢化可的松(Cor)静脉滴注。比较两组患者的血清白蛋白、前清蛋白、总蛋白、血钠、血糖、肝肾功能、总淋巴细胞计数及并发症的发生率等指标。结果GC组术后第7天的血清白蛋白水平明显高于C组[(34.9±2.1)g/L v.s(31.4±3.1)g/L](P<0.01)。两组术后第7天前清蛋白均明显低于术后第1天(P<0.05)。两组血糖、血钠、肝肾功能改变以及术后并发症的发生率均无明显改变。结论胃癌患者围手术期应用糖皮质激可有效改善患者术后白蛋白水平,促进康复。

Objective To evaluate the influence of perioperative glucocorticoid administration on rehabilitation in patients underwent gastrectomy for gastric carcinoma. Methods A total of 39 patients underwent D2 radical gastrectomy were randomized into two groups of GC（20 cases） and C （29 cases）. The patients in both groups were given conventional early enteral nutrition support, who in group C,C were given additional intravenous hydrocortisone sodium succinate（Cor） at 2 h before and 24 h after the operation. Serum albumin, prealbumin protein, total protein, blood glucose, sodium, ALT, AST, BUN, and Cor were measured on one day brfore, on the ist and 7th day after surgery. The complications were compared between the two groups as well. Results Serum albumin of group CA2 was obviously higher than that of group C[（34.9±2.1） g/L vs. （31.4±3.1） g/L] on the 7th day after operation （P〈0.01）. Compared with the day before operation, the pre-albumin protein of the two groups were significantly decreased on the 7th day after operation （P〈0.05）. There were no significant differences in blood sugar, sodium retention, and the changes of liver and kidney function between the two groups. So did the incidences of postoperative complications. Conclusion Perioperative glucocorticoid administration may effectively improve the serum albumin level and promote postoperative rehabilitation in the patients underwent gastrectomy for gastric carcinoma.