快速流程围手术期临床管理降低结直肠癌手术炎性反应的随机临床研究

Relationship of Fast-Track Perioperative Period Clinical Care Mode and Inflammatory Response in Colorectal Operation. A Randomized Clinical Trial

目的评价在非微创手术条件下快速流程(fast-track,FT)围手术期临床管理对结直肠癌围手术期炎性反应的影响。方法将55例择期结直肠癌手术患者随机分为2组,分别接受FT围手术期管理(FT组,n=29)和传统围手术期管理(传统组,n=26),均接受常规非微创开腹手术,检测2组患者术前24h及术后24h、72h和7d共4个截点的血浆C反应蛋白(CRP)和血浆淀粉样蛋白(SAA)浓度并作统计学分析。结果 2组患者均无影响实验结果的并发症发生,均无手术死亡。2组内患者的CRP和SAA浓度变化趋势一致。FT组患者CRP和SAA浓度在术后24h即达到峰值〔CRP:(72.36±60.94)mg/L;SAA:(328.97±267.20)mg/L〕,传统组峰值推后,出现于术后72h〔CRP:(112.71±63.92)mg/L;SAA:(524.18±331.03)mg/L〕;术后72h时FT组CRP和SAA浓度已经开始下降〔CRP:(57.21±30.42)mg/L;SAA:(237.43±215.66)mg/L〕;FT组CRP及SAA峰值均明显低于传统组(P<0.001);术后72h时FT组CRP和SAA浓度明显低于传统组(P<0.001)。术后7d,2组患者CRP和SAA浓度进一步下降,组间比较差异无统计学意义(P>0.05);且均低于各组内术后24h及72h时的CRP和SAA值(P<0.001),但均高于各组内术前24h的CRP和SAA值(P<0.001)。结论在非微创手术条件下,快速流程围手术期临床管理可显著减轻结直肠癌手术的炎性反应,科学的临床管理也是促进患者快速康复的重要手段。

Objective To evaluate the effect of perioperative period clinical care mode through fast-track （FT） under non-minimal invasive operation on the inflammatory response of colorectal cancer resection. Methods Fifty-five patients underwent elective colorectal cancer resection were randomized divided into two groups：FT group （n=29） in which patients were performed FT perioperative care and tradition group （n=26） in which patients were received traditional perioperative care. The non-minimal invasive operations were performed in this study. The venous blood samples were respectively collected at 24 h before operation,at 24 h,72 h,and 7 d after operation,and were used to detect the concentrations of serum C-reactive protein （CRP） and serum amyloid A protein （SAA）. Results There was no complication such as infection,fistula of stoma and inflammatory ileus that was potential to influence the study results in two groups,and no patient died. The trend of changes in the concentrations of CRP and SAA of patients was accordant in each group. The peak concentrations of CRP and SAA of patients in FT group were respectively observed at 24 h after operation 〔CRP：（72.36±60.94） mg/L; SAA：（328.97±267.20） mg/L〕,while which were respectively delayed to 72 h after operation in tradition group 〔CRP：（112.71±63.92） mg/L; SAA：（524.18±331.03） mg/L〕. At the same time,the concentrations of CRP and SAA in FT group began to descend 〔CRP：（57.21±30.42） mg/L; SAA：（237.43±215.66） mg/L〕. The peak concentrations of CRP and SAA in tradition group were significantly higher than that in FT group （P0.001） and the concentrations of CRP and SAA in FT group were significantly lower than those in tradition group at 72 h after operation （P0.001）. On 7 d after operation,the concentrations of CRP and SAA further decreased,but the difference between two groups was not significant （P0.05）. Likewise,the concentrations of CRP and SAA at 7 d after operation were significant higher than those 24 h and 72 h after operation （P0.001）,lower than that 24 h before operation （P0.001）,respectively. Conclusion This study demonstrates that perioperative period clinical care mode through FT under non-minimal invasive operation can reduce the inflammatory response of colorectal carcinoma resections and scientific clinical care is an important means to promote quick rehabilitation.