期刊文献+
任意字段
题名或关键词
题名
关键词
文摘
作者
第一作者
机构
刊名
分类号
参考文献
作者简介
基金资助
栏目信息

加速康复外科对胃癌病人术后近期临床结局的影响 被引量：13

Influence of fast track surgery on recent clinical outcomes in gastric cancer patients
下载PDF
导出
摘要 目的:观察加速康复外科(FTS)对胃癌病人手术后近期临床结局的影响。方法:将106例胃癌病人随机分为对照组(n=53,采用常规围手术期处理方案)和FTS组(n=53,采用加速康复围手术期处理方案)。动态监测比较两组病人术前和术后第1、3、7天血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和C-反应蛋白(CRP)水平。同时记录空腹血糖(FBG)、空腹胰岛素定量(FINS)。根据稳态模式评估法(HOMA)计算胰岛素抵抗指数(HOMA-IR),并比较两组病人术后发热时间、肛门排气时间、住院天数、住院费用和并发症的发生等情况。结果:FTS组病人术后第1和第3天IL-6、TNF-α和lnHOMA-IR明显低于对照组;术后第1、3和第7天,CRP明显低于对照组(P<0.05);FTS组病人术后发热时间、肛门排气时间、住院天数和住院费用明显少于对照组(P<0.05),而术后并发症的发生并未增加(P>0.05)。结论:FTS措施能降低胃癌病人手术后的胰岛素抵抗,减轻应激反应,加速病人的康复。 Objective： To investigate the influence of fast tract surgery on recent clinical outcomes in gastric cancer patients.Methods： 106 patients with gastric cancer receving radical operation were randomly divided into two groups： fast track group and control group.Serum levels of TNF-α,IL-6,CRP and fasting blood glucose（FBG）and fasting insulin（FINS） in 106 patients were assayed preoperatively and on 1st,3rd,7th day postoperatively,and insulin resistance index（HOMA-IR）was calculated using Homeostasis Model Assessment（HOMA）to evaluate insulin sensitivity.The postoperative hospital stay,duration of fever,medical cost,postoperative time of flatus and postoperative complications were recorded respectively.Results： On the postoperative 1st and 3rd day,serum levels of TNF-α,IL-6 and lnHOMA-IR in patients in fast track group were significantly lower than those in patients in control group（all P〈0.05）.On the postoperative 1st,3rd and 7th day,serum levels of CRP in patients in fast track group were significantly lower than those in patients in control group（all P〈0.05）.The postoperative duration of fever,postoperative time of flatus and postoperative hospital stay and treatment expense in patients in fast track group were also significantly lower than those in control group（all P〈0.05）.Patients in fast track group had no more complications than those in non-fast track group（P〉0.05）.Conclusion： Fast tract surgery can reduce the incidence and the degree of insulin resistance and lessen stress reaction in gastric cancer patients during perioperative period.
作者 王东升 仲蓓 孔营 周岩冰
机构地区 青岛大学医学院附属医院普通外科
出处 《肠外与肠内营养》 CAS 北大核心 2010年第6期338-340,344,共4页 Parenteral & Enteral Nutrition
关键词 胃癌 加速康复外科 胰岛素抵抗 C-反应蛋白 细胞因子 Stomach Neoplasm Fast track surgery Insulin resistance CRP Cytokine
分类号 R735.2 [医药卫生—肿瘤]
  • 相关文献

参考文献9

  • 1Gouvas N,Tan E,Vvindsor A,et al. Fast track vs standard care in colorectal surgery a meta-analysis update. Int J Colorectal Dis, 2009,24(10) :1119-1131.
  • 2Yendamuri S, Fulda GJ, Tinkoff CH. Admission hyperglycemia as a prognostic indicator in trauma. J Trauma,2003,55 (1) :33-38.
  • 3Tsubo T, Kudo T, Matsuki A, et al. Decreased glueose utilization during prolonged anaesthesia and surgery. Can J Anaesth, 1990, 37 ( 6 ) : 645-649.
  • 4Thorell A, Nygren J, Ljungqvist O. Insulin resistance:a marker of surgical stress. Curr Opin Clin Nutr Metab Care,1999,2( 1 ) :69-78.
  • 5贾建国,陈宏,薛纪秀,张淑文.腹部择期手术患者胰岛素抵抗临床观察[J].中国临床营养杂志,2008,16(3):152-155. 被引量：7
  • 6尤巧英,李成江,李红,朱麒钱,斯徐伟.炎症因子与胰岛素抵抗和2型糖尿病大血管病变的相关性研究[J].中华流行病学杂志,2005,26(10):804-807. 被引量：27
  • 7Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia:resuhs from overview of randomised trials. BMJ, 2000,321 (7275) :149-160.
  • 8Ljungqvist O, Nygren J, Thorell A. Modulation of post-operative insulin resistance by pre-operative carbohydrate loading. Proc Nutr Soc ,2002,61 ( 3 ) :329-336.
  • 9Vaithiswaran V,Srinivasan K, Kadambari D. Effect of early enteral feeding after upper gastrointestinal surgery. Trop Gastroenterol, 2008,29(2) :91-94.

二级参考文献16

  • 1DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique : a method for quantifying insulin secretion and resistance [J]. Am J Physiol, 1979, 237(3) :E214-E223.
  • 2Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man [J]. Diabetologia, 1985, 28(7):412-419.
  • 3Straczkowski M, Stepien A, Kowalska I, et al. Comparison of simple indices of insulin sensitivity using the euglycemic hyperinsulinemic clamp technique [ J ]. Med Sci Monit, 2004, 10(8) :480-484.
  • 4Rabasa-Lhoret R, Bastard JP, Jan V, et al. Modified quantitative insulin sensitivity check index is better correlated to hyperinsulinemic glucose clamp than other fasting-based index of insulin sensitivity in different insulin-resistant states [ J]. J Clin Endocrinol Metab, 2003, 88 (10) :4917-4923.
  • 5Chen H, Sullivan G, Quon MJ. Assessing the predictive accuracy of QUICKI as a surrogate index for insulin sensitivity using a calibration model [ J]. Diabetes, 2005, 54 (7) : 1914-1925.
  • 6Lee S, Muniyappa R, Yan X, et al. Comparison between surrogate indexes of insulin sensitivity and resistance and hyperinsulinemic euglycemic clamp estimates in mice [ J ]. Am J Physiol Endocrinol Metab, 2008, 294 (2): E261- E270.
  • 7Malita FM, Karelis AD, St-Pierre DH, et al. Surrogate indexes vs. euglycaemic-hyperinsulinemic clamp as an indicator of insulin resistance and cardiovascular risk factors in overweight and obese postmenopausal women [ J]. Diabetes Metab, 2006, 32(3) :251-255.
  • 8Rosenzweig T, Braiman L, Bak A, et al. Differential effects of tumor necrosis factor-alpha on protein kinase C isoforms alpha and delta mediate inhibition of insulin receptor signaling [J]. Diabetes, 2002, 51(6):1921-1930.
  • 9de Alvaro C, Teruel T, Hernandez R, et al. Tumor necrosis factor alpha produces insulin resistance in skeletal muscle by activation of inhibitor kappa B kinase in a p38 MAPK-dependent manner [J]. J Biol Chem, 2004, 279(17): 17070-17078.
  • 10Andreozzi F, Laratta E, Sciacqua A, et al. Angiotensin Ⅱ impairs the insulin signaling pathway promoting production of nitric oxide by inducing phosphorylation of insulin receptor substrate-1 on Ser312 and Ser616 in human umbilical vein endothelial cells [ J] . Circ Res, 2004, 94 (9) : 1211- 1218.

共引文献32

同被引文献101

引证文献13

二级引证文献163

肠外与肠内营养
2010年 第6期

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部