快速康复外科理念对结直肠癌合并糖尿病患者术后应激反应及血糖水平的影响

Influence of fast track surgery on postoperative stress reaction and blood glucose level in patients with colorectal cancer and diabetes mellitus

目的观察围术期应用快速康复外科理念(FTS)对结直肠癌合并糖尿病患者应激反应及血糖水平的影响。方法选取2013年6月~2016年6月在秦皇岛市第二医院行经腹结直肠癌根治术合并糖尿病患者124例。根据围术期处理方法不同,将患者分为对照组(60例)和观察组(64例)。对照组给予常规围术期处理,观察组给予FTS理念指导下的围术期处理。观察两组患者术后首次排便时间、肛门排气时间及进半流食时间,比较手术前后两组患者的应激反应[C反应蛋白(CRP)、白介素6(IL-6)、皮质醇(Cor)]和空腹血糖(FPG)水平。结果观察组患者术后排便时间、肛门排气时间、进半流食时间均短于对照组,差异有统计学意义(P<0.05)。两组患者术前血清CRP、IL-6、Cor、FPG水平差异无统计学意义(P>0.05),术后两组血清CRP、IL-6、Cor、FPG水平差异有高度统计学意义(P<0.01);除观察组术后第3天FPG与术前比较差异无统计学意义(P>0.05)外,其他指标同组患者手术前后差异均有高度统计学意义(P<0.01)。结论采用FTS理念对结直肠癌合并糖尿病患者进行围术期处理,可以减轻患者的应激反应,降低血糖水平,从而促进患者尽快康复。

Objective To explore the influence of fast track surgery （FTS） on stress reaction and blood glucose level in the perioperative patients with colorectal cancer and diabetes mellitus. Methods A total of 124 patients with colorectal cancer and diabetes mellitus, who were admitted in the Second Hospital of Qinhuangdao from June 2013 to June 2016 were selected. All patients were divided into the control group （60 cases） and the observation group （64 cases） accord- ing to the perioperative treatment. The patients in the control group were performed with routine perioperative treatment, while the patients in the observation group were given FTS perioperative treatment. The defecation time, anal exhaust time, time of wallowing half-solid food in the two groups after operation were observed. And the stress reaction indexes （CRP, IL-6, Cor） and fasting blood glucose （FPG） level in the two groups before and after the operation were compared. Results The defecation time, anal exhaust time, time of wallowing half-solid food in the observation group were significantly shorter than those in the control group （P 〈 0.05）. There were no significant differences in the. levels of CRP, IL-6, Cor and FPG before operation in the two groups （P 〉 0.05）, but after operation there were statistically significant differences between the two groups （P 〈 0.01）; except the FPG in observation group on postoperative 3 day （P 〉 0.05）, compared with before surgery of the above indicators, there were also significant differences in each group on postoperative 1 and 3 day （P 〈 0.01）. Conclusion FTS concept used for the perioperative management of eolorectal carcinoma complicated with diabetes mellitus, can reduce the stress response and the level of blood glucose, and accelerate the patients＇ postoperative rehabilitation.