快速康复外科在肝胆外科应用术后机体应激反应的研究

Research on Postoperative Stress Response after the Application of Fast Track Surgery in Hepatobiliary Surgery

目的研究快速康复外科(FTS)在肝胆外科的应用,以及术后机体的应激反应和有效性评价。方法将2008年8月-2011年6月收治肝胆外科手术治疗的171例患者随机分成FTS组和对照组,其中FTS组82例,对照组89例。FTS组采用FTS的围手术期处理方法,对照组采用常规经典方法。分别检测术前和术后第1、3、5、7天的血清白细胞介素(IL)-6和C反应蛋白(CRP)水平,观察术后住院时间、住院费用等指标。结果 FTS组与对照组首次排气时间分别为(2.4±0.3)、(3.3±0.6)d,术后住院时间分别为(9.1±2.7)、(14.1±4.1)d,住院费用分别为(16 432±3 012)、(21 612±1 724)元,差异有统计学意义(P<0.05)。在术前和术后第1、3、5、7天,FTS组血清IL-6分别为(8.57±2.58)、(30.21±12.44)、(17.41±11.73)、(11.14±7.12)、(10.50±5.19)ng/L,对照组分别为(9.13±2.99)、(51.31±19.50)、(36.82±12.33)、(28.23±9.18)、(15.44±4.33)ng/L,两组术前差异无统计学意义(P>0.05),术后各时点FTS组低于对照组,差异有统计学意义(P<0.05)。在术前和术后第1、3、5、7天,FTS组血清CRP分别为(18.41±4.01)、(69.74±26.03)、(45.52±20.50)、(39.14±11.23)、(29.03±6.47)μg/L,对照组分别为(17.74±2.11)、(99.23±23.50)、(86.81±17.34)、(68.22±15.60)、(37.70±9.55)μg/L,两组术前差异无统计学意义(P>0.05),术后各时点FTS组均低于对照组,差异有统计学意义(P<0.05)。两组术后并发症发生率差异无统计学意义(P>0.05)。结论 FTS理念应用于肝胆外科的部分手术能够改善患者术后的应激反应,且安全有效。

Objective To investigate the application of fast track surgery（FTS） in hepatobiliary surgery, and discuss the postoperative stress response and its efficacy and safety assessment. Methods A total of 171 patients undergoing different hepatobiliary operations in our ward from August 2008 to Jule 2011 were randomly divided into control group（n=89） and FTS group（n=82）. Patients in the FTS group received the improved methods while those in the control group received traditional care. A series of indicators such as hospital stay, hospital expense, duration of intravenous infusion, postoperative complications, and the C-reaction protein（CRP） and interleukin-6（IL-6） levels in serum were observed postoperatively. Results For the FTS and control group, the first exhaust time was respectively（2.4±0.3） and（3.3±0.6） days, postoperative hospital stay was（9.1±2.7） and（14.1±4.1） days, hospitalization expense was（16 432±3 012） and（21 612±1 724） yuan, all of which had significant differences（P〈 0.05）. Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, IL-6 serum level for the FTS group was respectively（8.57±2.58）,（30.21±12.44）,（17.41±11.73）,（11.14±7.12）, and（10.50±5.19） ng/L, and for the control group was respectively（9.13±2.99）,（51.31±19.50）,（36.82±12.33）,（28.23±9.18）, and（15.44±4.33） ng/L. There was no significant difference in the preoperative IL-6 level between the two groups（P〉 0.05）, while IL-6 level was significantly lower in the FTS group than the control group after surgery（P〈 0.05）. Before surgery and on the 1st, 3rd, 5th and 7th day after surgery, CRP serum level for the FTS group was respectively（18.41±4.01）,（69.74±26.03）,（45.52±20.50）,（39.14±11.23）, and（29.03±6.47） μg/L, and for the control group was respectively（17.74±2.11）,（99.23±23.50）,（86.81±17.34）,（68.22±15.60）, and（37.70±9.55） μg/L. There was no significant difference in the preoperative CRP level between the two groups（P〉0.05）, while CRP level was significantly lower in the FTS group than the control group after surgery（P〈 0.05）. Postoperative complication rate after surgery was not significantly different between the two groups（P〉 0.05）. Conclusion The application of FTS in some hepatobiliary operations is effective and safe by decreasing the stress response.