加速康复外科治疗在子宫全切围手术期的应用

Application of fast track surgery for total hysterectomy during perioperative period

目的：探讨加速康复外科（FTS）对子宫全切术安全性和有效性的影响及其机制。方法：选择2013年1月～11月在该院妇科因子宫全切术的患者98例,分别采用FTS（FTS组）和传统的围手术期处理原则（传统组）,并测量C反应蛋白（CRP）和白细胞介素-6（IL-6）。比较两组患者术后住院时间、住院费用、不良反应的发生、胃肠功能恢复、CRP、IL-6以及手术并发症的差异。结果：两组患者均治愈出院。FTS组患者与传统组相比,术后恶心、呕吐的发生、胃肠功能恢复时间、住院时间以及治疗费用明显低于传统组,差异有统计学意义（P〈0.05）。CRP及IL-6术后24 h较术前均明显升高,差异有统计学意义（P〈0.05）,FTS组明显低于传统治疗组（46.4 mg/L vs 88.9 mg/L;44.4 pg/L vs 343.5 pg/L）,差异有统计学意义（P〈0.05）。结论：FTS应用于子宫全切术,有利于患者的康复,缩短住院时间,降低住院费用,且不会增加手术并发症。其机制可能是减轻患者的应激反应。

Objective： To explore the effect of fast track surgery（ FTS） on safety and feasibility of total hysterectomy and the mechanism. Methods： A total of 98 patients undergoing total hysterectomy in the hospital from January to November in 2013 were selected and divided into FTS group and control group（ treated with conventional perioperative treatment）. The levels of C- reactive protein（ CRP）and interleukin- 6（ IL- 6） in the two groups were compared; the postoperative hospitalization times,medical costs times,adverse reactions,recovery of bowel function,CRP and IL- 6 levels and operative complications in the two groups were compared. Results： All the patients in the two groups were cured. The incidence rates of postoperative nausea and vomiting,recovery of bowel function,hospitalization time and medical cost in FTS group were statistically significantly lower than those in control group（ P〈0. 05）. The levels of CRP and IL- 6 at 24 hours after operation in the two group were statistically significantly higher than those before operation（ P〈0. 05）,and the levels in FTS group were statistically significantly lower than those in control group（ 46. 4 mg /L vs. 88. 9 mg /L; 44. 4 pg /L vs. 343. 5 pg /L）（ P〈0.05）. Conclusion： FTS used for total hysterectomy is helpful to recovery of the patients,FTs can shorten hospitalization time and reduce medical cost,and it can＇t increase operative complications,the probable mechanism is reducing stress reaction of these patients.